Sleep and Pregnancy

Sleep issues are common during pregnancy. Studies suggest that up to 92% of pregnant people experience poor sleep quality at some point during their pregnancy. More than half report insomnia symptoms during pregnancy, and a significant percentage experience symptoms of sleep-disordered breathing and restless legs syndrome. Additionally, pregnant people are susceptible to nausea, heartburn, leg cramps, and other types of discomfort while they sleep.

There are measures people can take to sleep better and feel less tired during pregnancy. Understanding how pregnancy affects sleep during each trimester and how to work around these issues is key to getting enough rest while pregnant, though postpartum sleep issues are also somewhat common. We’ll explore the many ways in which pregnancy impacts sleep, and share tips for sleeping better while pregnant.

How Does Pregnancy Change Sleep?

Pregnancy brings a host of physical and psychological changes that can affect sleep. Body weight increases by around 20% during pregnancy. The growing uterus displaces the diaphragm and affects breathing, while pain and pressure in the lower back can make it tough to find a comfortable sleep position.

Shifting hormone levels contribute to nausea, daytime sleepiness, and snoring at night. Increased nighttime urination and heartburn can also disrupt sleep. On the psychological side, pregnant people are more likely to experience distressing dreams and nightmares that interrupt sleep. Worries about the baby’s health can also keep expecting parents up at night.

Each trimester is marked by general trends in sleep issues, but overall sleep quality tends to be worse at the end of the third trimester. People may also notice certain sleep issues during the postpartum period after their baby arrives.

Sleep is Vital to Pregnancy

Quality sleep supports healthy development of the fetus and helps the expecting parent prepare for the birth.

Poor sleep during pregnancy can lead to complications for both the parent and child. Research suggests that those who receive less than six hours of sleep per night near the end of their pregnancy are more likely to require a cesarean delivery (C-section) or experience longer labor times. Sleep deprivation also causes a stress response in the body that may cause an increased risk of postpartum depression and premature birth.

Snoring and obstructive sleep apnea during pregnancy have both been linked to an increased risk of preeclampsia, gestational diabetes, and unplanned C-section. Obstructive sleep apnea may also increase the risk of preterm birth and low birth weight.

Common Sleep Disorders & Issues During Pregnancy

Sleep problems can take many different forms during pregnancy. Common issues include:

  • Insomnia: One study found that over 90% of pregnant people woke up frequently during the night, and nearly 70% reported taking longer than 30 minutes to fall asleep. For some, increased anxiety during pregnancy contributes to insomnia.
  • Heartburn: Heartburn is common during pregnancy, affecting between 17% and 45% of pregnant people. Symptoms typically worsen at night, which may make it difficult to fall asleep. Fortunately, pregnancy-related heartburn typically goes away on its own soon after childbirth.
  • Snoring and Obstructive Sleep Apnea: By the third trimester, up to 45% of pregnant people experience loud snoring as a result of fluctuating hormone levels and added pressure on the diaphragm. Obstructive sleep apnea may also develop during pregnancy. This sleep-related breathing disorder is associated with multiple partial or complete pauses in breathing during sleep, and it can cause sleepiness and fatigue during the day.
  • Restless Legs Syndrome: Up to 30% of people experience restless legs syndrome (RLS) during pregnancy. People with RLS feel uncomfortable sensations in their legs, usually when lying down, that can only be relieved by moving the legs. The symptoms of RLS can be distressing and frustrating, impairing the person’s ability to rest or sleep. Several studies have shown that symptoms usually go away after the baby is born, although some people may still experience RLS afterwards.
  • Pregnancy Dreams: Pregnant people report having more nightmares and bad dreams, particularly later in their pregnancy. These nightmares may disrupt sleep and cause nighttime awakenings. Dream content during pregnancy may center around pregnancy, childbirth, or parenthood. The dreams of pregnant people are also more likely to contain morbid content, which may reflect the stress and worries that come up during pregnancy.

First Trimester Sleep

Hormonal fluctuations often cause people to sleep more during the first trimester. The circadian clock guiding a person’s sleep cycle may also fall back, leading them to fall asleep earlier in the evening. Daytime fatigue and poor quality sleep are common complaints during the first trimester as the body adapts to pregnancy.

Another issue that may impact sleep is morning sickness, or persistent nausea and vomiting which – despite the name – can afflict people at any time of the day or night. Morning sickness is most predominant during the first trimester. Other sleep issues that often occur during this trimester include headaches or migraines, constipation, pain from tenderness in the breasts, and back pain.

Tips for Sleeping During the First Trimester

While sleep issues are less common during the first trimester, morning sickness and physical discomfort may make it difficult to fall asleep. Possible strategies include:

  • Modify Your Sleep Position: Identifying and settling on a comfortable sleep position may be an effective strategy during this time. Those who have a hard time finding the right position in bed can try lying on their side with both knees bent. The left side is often most comfortable because it takes pressure off of the liver and promotes healthy blood flow throughout the body.
  • Exercise Regularly: Research shows that those who exercise while pregnant tend to enjoy more uninterrupted sleep than those who do not exercise at all. Experts recommend pregnant people engage in 30 minutes of moderate exercise on a daily or near-daily basis. Plan to end your exercise session well before bedtime so it does not interfere with sleep.

Second Trimester

For many people, the second trimester brings fewer sleep issues than the first or third. Morning sickness typically tapers off by week 16, so persistent nausea and vomiting are less common. People also tend to experience less pain from tender breasts after the first trimester.

However, some may experience new discomforts during the second trimester as their body continues to change. Many pregnant people report lower back and pelvic girdle pain during this time, typically around week 22. These pains can often be attributed to loosening joints, and may persist throughout the pregnancy and well into the postpartum period. Leg cramps are also somewhat common during the second trimester.

Tips for Sleeping During the Second Trimester

Although sleep problems are less common during the second trimester, pregnant people can still take measures to alleviate discomfort and get the sleep they need. These include:

  • Modify the Side Sleeping Position as Needed: As their stomach continues to expand, most pregnant people continue to feel most comfortable sleeping on their left side. Tucking a pillow under the stomach, beneath the lower back, or between the knees may alleviate pressure from back and pelvic pain.
  • Talk to Your Doctor About Leg Cramps: Certain medications that are safe for pregnant people can reduce cramp-related pain. For example, oral magnesium has been explored as a treatment option for pregnancy-induced leg cramps. People should always consult their doctor before going this route.
  • Take Time to Nap When Tired: Napping has been shown to help pregnant people recoup some of the sleep they miss at night. However, keep in mind that long naps can negatively affect sleep quality and your ability to sleep through the night, so try to keep naps short and several hours prior to bedtime.

Third Trimester

For many people, sleep quality significantly decreases between the second and third trimesters. Lower back and pelvic pain and leg cramps may continue to worsen, and common pain relief medications such as ibuprofen should not be taken during the third trimester due to fetal health risks. Heartburn and other symptoms of gastro-esophageal reflux disease may also be more severe during the third trimester compared to the first or second.

Pregnant people are also considered more vulnerable for certain sleep disorders. The weight gain of pregnancy can lead to obstructive sleep apnea, a sleep disorder believed to affect 11% to 20% of pregnant women. Roughly 64% of pregnant people in their third trimester also experience insomnia symptoms, compared to 44% to 47% during the first two trimesters. Depression and anxiety frequent vivid or disturbing dreams, and the need to urinate at night can also produce insomnia symptoms in the latter stages of pregnancy.

Tips for Sleeping During the Third Trimester

Sleeping on the left side is very much encouraged during the third trimester. In addition to putting weight on the liver, sleeping on the right side also adds pressure to the fetus. Other third trimester strategies include:

  • Modify Diet to Reduce Heartburn: Avoiding fatty foods and eating smaller meals may help ward off heartburn. Try to wrap up your last meal and reduce fluid intake several hours before bedtime to minimize nighttime awakenings.
  • Find Time to Relax in the Evening: Pregnant people in their third trimester can benefit from improving their sleep hygiene. They should avoid activities that are overly stimulating. Winding down with a warm bath or shower, light massage, meditation, or other relaxing activity can help establish a sleep-inducing evening routine.
  • Talk to a Doctor if Sleep Disorder Symptoms Appear: Pregnant people who experience symptoms of a sleep disorder should talk to their doctor about safe treatment options. Continuous positive air pressure (CPAP) therapy has proven effective for pregnant people with obstructive sleep apnea, but a prescription is required for CPAP machines.

Sleep disorders and other secondary conditions that arise during pregnancy may need to be treated directly. If you are having trouble sleeping or coping with stress, talk to your doctor. They can provide additional recommendations and treatment options to support you and your baby’s health.

Postpartum Sleep

The sleep problems that occur during pregnancy and intensify during the third trimester may continue after the baby is born. The average person sleeps six hours per night after giving birth. Postpartum depression – a condition that affects 1 in 8 people after giving birth – can cause difficulty falling asleep. Other reasons for postpartum sleep issues may include anxiety and nocturnal awakenings to check on the new infant.

Sleep & Pregnancy FAQs

What Is the Best Sleep Position During Pregnancy?

Pregnant people typically feel most comfortable sleeping on their left side. Lying on the right side can place undue pressure on the liver and hinder steady blood flow. That said, there is no danger in switching to your right side if your left hip feels sore.

For maximum comfort, sleep experts recommend lying with both knees bent. Placing a bellow below the stomach, lower back, or legs can create extra cushioning. Some pregnant people also feel comfortable on toppers made of convoluted – or “egg crate” – foam. This material can alleviate pressure and stiffness in areas like the lumbar region and hips.

Pregnant people may find sleeping on their stomach more comfortable during the first trimester, but over time their stomach will probably grow too much to continue using this position. Back sleeping is not recommended while pregnant, especially during the second or third trimesters. The growing uterus can put excessive pressure on the spine and back, hindering blood flow to the fetus.

How Many Hours of Sleep Do You Need While Pregnant?

According to current recommendations from sleep experts, adults between the ages of 19 and 64 should sleep seven to nine hours per night. Of course, getting enough sleep while pregnant can be a challenge. Roughly 27% of pregnant people sleep less than seven hours a night, and more than 90% report some sort of sleep issue during their pregnancy.

Since sleep plays an important role in a person’s overall physical and mental health, everyone should strive to get at least seven hours of sleep each night. However, some sleep loss is to be expected during pregnancy. Try napping to supplement your nightly sleep, and consult your doctor if you are concerned about major sleep loss or feeling excessively tired during the day.

How Can You Sleep Better When Pregnant?

Pregnant people are susceptible to a host of sleep-related issues. Following healthy sleep hygiene guidelines may not address every issue during pregnancy, but these measures have proven effective for many pregnant people.

  • Sleep on your side with both knees bent and a pillow beneath your back, stomach, or legs
  • Reduce consumption of caffeinated beverages like coffee or tea before bed
  • Establish a consistent sleep schedule by going to bed and waking up at the same times each day
  • Limit daytime sleeping to short naps
  • Enjoy relaxing pre-bedtime activities like taking a bath, reading, or drinking warm milk
  • Don’t exercise too close to bedtime – this can raise your heart rate and body temperature, making it harder to fall asleep

What Causes Excessive Sleepiness During Pregnancy?

There are many reasons pregnant people lose sleep and feel excessively tired during the day. Common causes of sleep loss during pregnancy include lower back or pelvic pain, leg cramps, the frequent need to urinate at night, heartburn, and stressful dreams. Pregnant people are also at risk for sleep disorders like insomnia and obstructive sleep apnea.

What Can You Take to Help You Sleep While Pregnant?

Taking any prescription or over-the-counter medication or supplement while pregnant can pose fetal health risks. This also applies to pain medications like ibuprofen during the latter stages of pregnancy. Do not take any medication for sleeping or pain relief at any stage of pregnancy without consulting your doctor.

Certain foods and drinks can induce sleepiness without posing risks to an unborn baby. These alternatives to sleep medication include warm milk, tart cherry juice, kiwis, and fatty fish.

Sleep & Pregnancy Resources

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Michael Breus, Ph.D - The Sleep Doctor is a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine and one of only 168 psychologists to pass the Sleep Medical Specialty Board without going to medical school. Dr. Breus is a sought after lecturer and his knowledge is shared daily in major national media worldwide including Today, Dr. Oz, Oprah, and for fourteen years as the sleep expert on WebMD. Dr. Breus is the bestselling author of The Power of When, The Sleep Doctor’s Diet Plan and Good Night!