Pregnancy Insomnia

Key Takeaways

• Pregnancy insomnia is common, especially in the third trimester, and can involve difficulty falling asleep, staying asleep, or waking up too early.
• Hormonal changes, physical discomfort, frequent urination, heartburn, anxiety, and pregnancy-related sleep disorders can all contribute to sleep problems during pregnancy.
• Cognitive behavioral therapy for insomnia (CBT-I) is considered the first-line treatment for chronic insomnia during pregnancy, and lifestyle changes may also help improve sleep.

What Is Pregnancy Insomnia?

It’s normal to experience sleep changes during pregnancy, but when these are significant, you might have pregnancy insomnia. Insomnia occurs when a person frequently has trouble falling asleep, wakes up frequently during the night, or wakes up in the morning before their scheduled wakeup time and cannot get back to sleep. 

Although insomnia is commonly used to refer to trouble sleeping, doctors don’t officially diagnose the condition unless it occurs on three nights or more per week. Insomnia symptoms that last fewer than three months are called short-term insomnia. Symptoms that stretch over more than three months are considered chronic insomnia. Depending on the cause of your pregnancy insomnia, you may find your sleep improves after giving birth. 

What Are the Symptoms of Pregnancy Insomnia?

To be diagnosed with insomnia, a person must experience ongoing difficulty sleeping that interferes with daytime function. Potential symptoms include:

• Trouble falling asleep
• Waking frequently
• Early morning awakenings
• Daytime fatigue
• Mood changes
• Difficulty concentrating

What Causes Insomnia During Pregnancy?

During pregnancy, the body undergoes multiple changes to accommodate the growing fetus. Pregnancy insomnia often arises due to a combination of physical discomfort, changing hormones, and sleep disorders that are more common during pregnancy. 

Although insomnia isn’t necessarily a pregnancy symptom in the first trimester, you may find yourself feeling very tired during the day. Trouble sleeping is especially common in the third trimester, when there are many factors making it difficult to sleep. 

Hormonal Changes

Estrogen and progesterone increase during pregnancy and affect sleep patterns, including the way you pass through different stages of sleep.

Physical Discomfort

During pregnancy, the body undergoes multiple changes to accommodate the growing fetus. Your heart rate and metabolism increase, which can make it hard to wind down for sleep, and you may experience shortness of breath, especially when lying on your back. 

As the fetus grows, you may experience discomfort from the baby bump and difficulty switching positions. In the second and third trimesters, many pregnant people develop sore legs or an aching back from the extra weight and stretching ligaments. 

Frequent Urination

Most pregnant people will attest to needing frequent bathroom trips. Your body is producing extra blood to nourish the fetus, which means your kidneys are working overtime and producing more urine as a result. The uterus is also right next to the bladder, so as it grows bigger, the extra pressure makes you need to visit the bathroom more often.

Heartburn and Indigestion

Pregnancy hormones slow digestion and loosen the valve that keeps food from coming back up the esophagus. Together with the growing uterus, these changes cause many pregnant people to experience bloating and acid reflux, especially when lying down.

Anxiety and Stress

There’s a lot to think about during pregnancy. Worries about childbirth, your baby’s health, and the idea of welcoming a new child to your family may keep you awake or trigger stress-related dreams and nightmares.

Other Pregnancy Symptoms That Affect Sleep

Certain sleep disorders and physical symptoms are more common during pregnancy.

• Leg cramps: About 40% of pregnant people experience sleep-related leg cramps. They’re thought to result from problems processing calcium during pregnancy, so adding calcium or calcium supplements to your diet may help. When you get a leg cramp, try flexing your foot forward, pressing your foot against the wall, or adding pressure by standing on the affected leg.
• Restless legs syndrome: Restless legs syndrome is a nervous system disorder marked by an irresistible urge to move the legs when lying at rest. RLS is two to three times more common during pregnancy. The symptoms usually dissipate if you move, stretch, or rub the leg, but they’re bothersome and can disrupt sleep. Ask your doctor about iron supplements.
• Nasal congestion: Hormonal changes and increased blood flow during pregnancy can cause nasal stuffiness and even nosebleeds. To avoid irritating the nasal cavities, blow your nose gently, drink plenty of fluids earlier in the day, and consider using a cool mist humidifier or ask your doctor about nasal sprays.
• Obstructive sleep apnea: People with obstructive sleep apnea (OSA) stop breathing multiple times per night, leading to sleep disruption as they wake up to catch their breath. OSA and snoring in general become more common in pregnancy due to weight gain and nasal congestion. You may be able to treat OSA with CPAP therapy.
• Fetal movement: Though it’s exciting to feel your baby moving around inside you, increased fetal movements and potentially contractions at night can be distracting and make it hard to sleep.

How Is Insomnia During Pregnancy Treated?

Although most sleep aids aren’t approved for use during pregnancy, there are lifestyle changes and treatment methods that may help improve sleep. Strategies like maintaining a consistent sleep schedule, limiting caffeine, staying physically active, and creating a comfortable sleep environment may help reduce insomnia symptoms.

If these measures aren’t effective, your doctor may recommend cognitive behavioral therapy for insomnia (CBT-I). CBT-I is considered the first-line treatment for chronic insomnia and focuses on identifying and changing thoughts and behaviors that interfere with sleep. It may include techniques such as sleep restriction, stimulus control, relaxation training, and cognitive restructuring.

In some cases, a healthcare provider may discuss medication options if insomnia is severe and significantly affecting daily life, but treatment decisions during pregnancy should always be made in consultation with a medical professional.

How to Sleep Better During Pregnancy

Following good sleep hygiene practices and making some special pregnancy-specific adaptations can help you sleep better during pregnancy.

Improve Sleep Position

As pregnancy progresses, back sleeping becomes uncomfortable and potentially dangerous, as the uterus puts weight on one of your important veins. Experts recommend sleeping on your side, preferably your left side, for optimal blood flow to your organs and the fetus.

If you typically sleep on your back, you may find it difficult to adjust to side sleeping. A pressure-relieving mattress can help you sleep more comfortably. You can also make yourself more comfortable by adding extra pillows between your legs, under your lower back, or supporting the baby bump. Some pregnant people find a full-body pillow or a pillow specifically designed for pregnancy works best.

Maintain a Consistent Sleep Schedule

Going to bed and waking up at the same time every day helps teach your body when it’s time to sleep. Some experts recommend avoiding naps, while others suggest short naps early in the day to compensate for disrupted nighttime sleep.

Create a Comfortable Sleep Environment

Ideally, your bedroom should be pleasantly cool, dark, and quiet. To help your brain associate this space with sleep, make the bedroom a screen-free zone that’s reserved for sleep and intimacy only.

Implementing a calming bedtime routine can also help you wind down for sleep. This may include taking a warm bath, preparing a soothing cup of milk, or other gentle activities that signal to your brain that it’s time for sleep.

Reduce Evening Discomfort

To reduce heartburn and nighttime bathroom trips, try to eat smaller meals and limit fluids close to bedtime. Avoid trigger foods such as spicy, greasy, or acidic foods, and ask your doctor about antacids. If you’re hungry before bed, a good option is to eat a few crackers.

Experts recommend limiting caffeine during pregnancy, but if you do drink coffee or tea, be sure to have your last cup early in the day. You should also eliminate nicotine and alcohol, which can pose risks for the baby.

Manage Stress and Anxiety

During pregnancy, it’s natural to worry about childbirth and the prospect of welcoming a new child to your family. Consider signing up for childbirth classes to help you feel more prepared, or ask your healthcare provider for stress coping techniques such as meditation.

Get Daytime Activity

Regular exercise during pregnancy helps pave the way for sound sleep, and mild exercise may even reduce leg cramps. Try to exercise earlier in the day so you’re not too amped up at bedtime.

Consult a Sleep Coach

If pregnancy-related sleep problems are affecting your daily life, additional support may help. Sleep Doctor's sleep consult connects you with a licensed healthcare provider who can evaluate your symptoms, identify potential sleep disorders, and recommend appropriate treatment options.

For ongoing guidance, Sleep Doctor's sleep coaching program offers personalized support, practical strategies, and accountability to help you build healthier sleep habits and improve your sleep throughout pregnancy and beyond.

When to Talk to a Doctor

Though it’s common to have trouble sleeping during pregnancy, it’s still a good idea to bring up this issue with your healthcare team. They can recommend methods to sleep better and prescribe supplements if needed. They may refer you for a sleep study or home sleep apnea test to check for sleep disorders such as sleep apnea.

Contact your doctor immediately if you have more severe symptoms, such as:

• Very itchy skin
• Jaundice (yellow skin)
• Severe nausea, loss of appetite, vomiting, or fatigue
• Sudden or extreme swelling or weight gain
• Nosebleeds that last for longer than a few minutes

Frequently Asked Questions

Is insomnia a sign of pregnancy?

Insomnia can occur for many reasons, so it’s not necessarily a sign of pregnancy. In fact, during the first trimester, many people find they sleep well. That being said, many people do find it difficult to sleep during pregnancy.

When does pregnancy insomnia start?

Pregnancy insomnia can start at any time, but it’s most common for sleep problems to increase as pregnancy progresses, with most people experiencing the worst sleep in the third trimester.

Can you take sleep aids while pregnant?

Experts currently recommend that you avoid taking sleep aids during pregnancy, including over-the-counter and herbal or natural products. This recommendation is based on the fact that there’s hardly any research on whether these medications are safe for the fetus.

In certain cases, your healthcare provider may prescribe sleep aids if they consider that the risk from not sleeping outweighs the potential risk of the medication itself.

Is melatonin safe during pregnancy?

As with other sleep aids, there’s little research on the safety risks of taking melatonin while pregnant. Some studies even indicate melatonin may have benefits for the fetus, but more research is needed. If lifestyle remedies and CBT-I haven’t helped you sleep better, your doctor can decide if it’s appropriate and safe for you to take melatonin.