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How to Sleep Better During the Third Trimester

By Chaunie Marie Brusie, B.S.N., R.N.
Reviewed by Alyssa Quimby, M.D.
July 08, 2022

Most parents-to-be expect to lose sleep when their newborn enters the world. But for pregnant people, that loss of sleep can start early—as in, the whole third trimester. It can feel demoralizing that in the weeks during which exhaustion and discomfort peak, you may also struggle with sleep.

There are a lot of reasons sleep can become more elusive near the end of pregnancy. The growing size of the baby and uterus can make it hard to get comfortable. There may be increased pressure on your bladder causing you to need more bathroom visits. Pregnancy-related heartburn can keep you up at night. Meanwhile, you may be experiencing increased anxiety about labor and delivery, or adding to your family, which can make it hard to get a good night’s rest.

But we still need sleep. In fact, pregnant people often need more sleep than they did before and are advised to get eight to 10 hours of shut-eye each night. And for good reason.

Research suggests that a lack of good sleep during pregnancy is associated with higher rates of preeclampsia. And that’s not all: “The problems associated with lack of sleep—including excessive fatigue, difficulty concentrating, increased incidence of accidents, and mood instability—are exacerbated in pregnancy,” explains Daniel Roshan, M.D., a board-certified ob-gyn at Rosh Maternal and Fetal Medicine, in New York City.

5 Ways to Get Better Sleep in Late Pregnancy

Here are some tips that may help you sleep better during your third trimester.

1. Address Any Underlying Sleep Disorders

First things first: Just because sleep can be extra challenging during pregnancy doesn’t mean you should accept a lack of sleep as normal. It’s possible an underlying sleep disorder could be affecting your sleep—especially if you’ve had sleep difficulties in the past, have a diagnosed sleep disorder, or have worsened symptoms during pregnancy.

“If there is previously existing sleep apnea, this should be addressed early on if possible,” says Jyoti Matta, M.D., a board-certified internist and the medical director of the Center for Sleep Disorders at Jersey City Medical Center, in New Jersey. Matta explains that untreated sleep apnea can lead to high blood pressure and other complications that pose a particular risk during pregnancy.

According to Matta, some of the other underlying sleep disorders that could worsen with pregnancy include narcolepsy, insomnia, and restless legs syndrome.

“Restless legs syndrome is a big concern for some women during pregnancy,” she says. It’s marked by a strong, often irresistible urge to move the legs. “It can present itself for the first time during pregnancy, or it can worsen for people who already experience restless-leg issues.”

Talk to a doctor who can help you decide whether you may benefit from further evaluation.

2. Manage Your Mental Health

Another commonly overlooked source of sleep disruption? Your mental health.

Pregnancy, mental health, and sleep can be a challenging triangle, explains Matta. Insomnia can make anxiety and depression worse, which can then make insomnia even worse—and it becomes a vicious cycle.

Matta also notes that pregnant people who have discontinued certain antidepressants may also be at added risk of increased insomnia, along with other symptoms.

If you have a mental health disorder and are experiencing problems with sleep, be sure to talk to your doctor. Other treatment options, such as cognitive behavioral therapy (CBT), may help, Matta says. CBT techniques focus on improving sleep by changing thoughts, behaviors, and emotions.

Additionally, if your doctor has advised that you discontinue your mental health medication, have a conversation with them about how it may affect your sleep and what you should do if you encounter a problem—it’s a good idea to have a plan in place, just in case.

3. Talk to Your Doctor About Melatonin

You may think melatonin is off the table during pregnancy, but Matta says that’s not necessarily the case. She warns that melatonin may not work for everyone and notes that many pregnant people choose to avoid it during the first trimester to be cautious. That said, it could be an option for some pregnant people who are having trouble nodding off.

“For some patients, taking supplemental melatonin can improve sleep,” she notes.

Matta considers melatonin to be “generally safe” to take during pregnancy In fact, findings from a recent review also suggest that the use of melatonin is likely safe in pregnancy and even when breastfeeding.

Roshan cautions that melatonin has not been well studied during pregnancy, even though it has been used by many pregnant people in the second and third trimesters when needed.

Always discuss any medications or supplements with your own healthcare provider before taking them, especially during pregnancy.

4. Consider Trying Other Medications or Supplements

Along with talking to your doctor about melatonin, Roshan notes that Benadryl may be an effective, temporary sleep aid that some pregnant people could consider trying. “Antihistamines such as Benadryl can be used in the short term to improve quality and quantity of sleep,” he says.

If you have acid reflux that keeps you up at night or have been diagnosed with gastroesophageal reflux disease (GERD), which is a condition that’s characterized by periodic episodes of stomach acid flowing up into the esophagus, often causing heartburn, ask your doctor if taking any medication could be helpful for you. “For some women, taking a GERD medication recommended by their provider can lessen the effect of acid when they lie down to sleep,” he explains.

In addition, Roshan says a magnesium supplement may help both with restless legs and also with creating a deeper sleep. Be sure to discuss with your care provider whether you’re getting enough magnesium with any prenatal vitamin you’re already taking.

5. Don’t Overlook the Basics

Roshan reminds pregnant people struggling with sleep not to overlook the basics. That means practicing good sleep habits like avoiding eating or drinking, especially anything with caffeine, for at least two hours before bedtime and avoiding phones or other screens in the bedroom.

Here are some other late-pregnancy sleep tips he recommends:

  • Raise your head for sleep. If you’re experiencing a lot of heartburn, consider propping pillows to avoid lying too flat. “[This] can help increase lung expansion for adequate oxygenation during sleep and decrease reflux of acid in the esophagus,” Roshan explains.
  • Check your mattress. Make sure you have a comfortable and supportive mattress so you aren’t waking in the night because of discomfort, Roshan says. If a new mattress is out of the budget, there are bed toppers that may cost less and are easy to add for a short amount of time.
  • Use all the pillows. Specialized pregnancy pillows, of course, are helpful, but so are positioning regular bed pillows in key areas. “Be sure to place a pillow between your knees and under your belly on the side you're sleeping on,” Roshan says. “Placing a pillow behind your back, as well, may help make you more comfortable and able to achieve adequate and deeper sleep.”

The Bottom Line

Good sleep is possible, Roshan says, even as your pregnancy moves into the latter weeks. And it’s not just a luxury.

“It is critical to a healthy pregnancy to make modifications to ensure adequate sleep,” Roshan says. His advice? Prioritize sleep, make any modifications you need, and if you need help, don’t hesitate to ask your doctor.

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