Although sleep disturbance is commonly reported in pregnancy, there have been few studies on sleep characteristics in pregnancy. In this study, all women attending the antenatal clinic at Sapporo Medical College Hospital for 1 month during autumn and 3 months during winter were surveyed with a questionnaire and sleep log. Of the 192 patients, 169 (88.0%) stated that sleep was altered from their usual experience. A principal components analysis identified three sleep factors from the ten items in the measure of sleep used (Sleep Log). The three factors were: Sleep Duration and Quality, Insomnia and Daytime Alertness. Although no significant differences across trimesters were found on the three sleep factors, Sleep Duration and Quality, and Insomnia were worst during the first trimester. Sleep normalized in the second trimester, but the third trimester was characterized by increased Insomnia and decreased Daytime Alertness. The most frequent reasons cited by women for sleep alterations were urinary frequency, backache or ache in the hips and fetal movement. Contingency X2 analyses were used to investigate a relationship between the frequency of reporting the reasons and the trimester of pregnancy. Significant increases were found in reporting as the reasons for sleep difficulties, fetal movement in the third trimester, and heartburn, nausea and vomiting in the first trimester. The description of sleep patterns during pregnancy has clinical relevance as sleep alterations in pregnancy are common.

Orally administered progesterone may have advantages over other routes of administration in the treatment of premenstrual syndrome (PMS) because of substantially higher levels of the anxiolytic metabolites 5 alpha and 5 beta pregnanolone. The only previous placebo-controlled trial which used oral progesterone reported beneficial effects in the treatment of PMS. The present study, a double-blind crossover trial, compared the administration of 300 mg daily oral progesterone with 200 mg daily vaginal progesterone and matched placebos for 10 days premenstrually. Although there was a significant treatment effect on symptoms, no difference between active treatments and placebo was found. The trial was terminated with 25 women completing treatment as it was evident that no clinically significant effect of either form of progesterone was likely to be detected even with twice the sample size. Serum levels of progesterone and metabolites showed that oral administration resulted in supraphysiological levels of 5 alpha and 5 beta metabolites and there was a negative correlation between 5 alpha pregnanolone levels and anxiety. However, this did not translate to overall reduction in premenstrual distress or anxiety beyond that achieved by placebo, as measured by validated questionnaires.

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