pregnant woman sleeping in bed

How to Solve 5 Pregnancy Sleep Problems

By Carol Caffin
Reviewed by Elizabeth Eden, M.D.
November 03, 2023
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Awake again? It may not be comforting to hear this at 3 a.m., but you’re not the only pregnant person tossing and turning throughout the night. Almost everyone experiences sleep disruption during pregnancy, according to Raquel Dardik, M.D., a board-certified ob-gyn and associate professor of obstetrics and gynecology at NYU Langone Medical Associates in West Palm Beach, Florida.

Pregnancy sleep problems can not only leave you drained and cranky the next day but also sometimes lead to serious and lasting health implications. “Sleep disorders in pregnancy have been linked to complications including preeclampsia, gestational diabetes, fetal growth restriction, and low birth weight,” says Stephen Bacak, D.O., a board-certified ob-gyn and the director of maternal-fetal medicine at Cleveland Clinic Akron General.

In addition, he notes, studies have shown an increase in perinatal depression, preterm birth, prolonged labor, and cesarean birth among pregnant people who experienced sleep disturbance.

All the more reason to try to get any sleep problems during pregnancy under control. The good news, experts say, is that there are strategies you can try to improve your snooze. Here are some of the more common pregnancy-related sleep problems—and suggestions for solving them.

1. Pregnancy-Related Insomnia

Sometimes, the reason you can’t sleep is simply because you’re pregnant. “Oftentimes, alterations in sleep quality and duration are due to the many changes that take place in a woman’s body during pregnancy,” Bacak says. The significant anatomical, psychological, and hormonal changes of pregnancy can all contribute to insomnia, which is the inability to fall asleep, stay asleep, or to sleep restfully.

According to one study, approximately 13% of pregnant women experience insomnia early in their pregnancy, and up to 74% of pregnant women report insomnia by week 39.

For one thing, your body is changing, and it may get harder and harder to get comfortable at night. As your pregnancy progresses, your baby’s movements as well as your uterine contractions can make it harder for you to fall asleep or stay asleep, says Bacak.

Hormonal changes during pregnancy—including increases in estrogen, progesterone, and cortisol—can also mess with your rest. “These hormonal modifications play a key role in physiologic changes and have a direct impact on a person’s sleep cycle,” Bacak says.

If you’re not reaching the REM stage of sleep enough, you may be left feeling unrested. “REM” stands for “rapid eye movement”; it’s the phase of sleep in which people dream. REM sleep is important for mood regulation, concentration, immune system functioning, and even pain tolerance.

Preexisting conditions, such as obesity, can exacerbate sleep problems during pregnancy, and pregnancy can worsen preexisting sleep issues, too.

What You Can Do: Improve your sleep hygiene. This includes doing all the things you may have heard can help support sleep during nonpregnancy times, like going to bed at a reasonable hour, eliminating caffeine consumption in the evening, making your bedroom dark and cozily cave-like, avoiding the blue light of electronic devices before bed, abstaining from large meals late in the day, and sticking to a regular sleep schedule.

You may also want to try propping yourself up with pillows, or investing in a body pillow to help you get into a more comfortable sleep position. Also, Dardik says that in terms of temperature, cooler is better, since rising estrogen levels can cause pregnant women to sleep hot.

2. Nighttime Bathroom Breaks

Beginning early in pregnancy, the hormones progesterone and human chorionic gonadotropin (HCG) begin to increase, and this leads to an increase in urinary frequency. In addition, the blood volume increases to support the growing fetus, resulting in more fluid being processed by the kidneys. Also, as your uterus expands to accommodate your growing baby, it puts pressure on your bladder, Bacak says, leading to an increased need to urinate day and night, especially in the third trimester.

What You Can Do: Limit beverages after dinnertime, since you’re already prone to pee more at night. This may seem tricky, since it’s important to get enough hydration during the day, so be sure to drink plenty of water in the morning and early afternoon. Limiting caffeine intake at the end of the day may help, too, since caffeinated beverages like coffee and tea can make your urge to go worse.

3. Reflux and Heartburn

As your baby grows and your uterus expands, your abdomen becomes a bit crowded, causing pressure on adjacent organs. As a result, Bacak says, your diaphragm, the muscle that separates the abdominal cavity from the chest cavity, can be pushed upward. Plus, hormonal changes in pregnancy can slow your digestive system, and progesterone can cause the lower esophageal sphincter to relax, allowing stomach acid to back up in the esophagus. This is called acid reflux.

Acid reflux can develop into a more severe condition called gastroesophageal reflux disease (GERD), and both can cause heartburn—a burning pain behind the breastbone—which can keep you up at night.

What You Can Do: Eat small, frequent meals; avoid known trigger foods, such as citrus, chocolate, spicy foods, and fast food; sleep on your left side for optimal blood flow, ideally with the support of a pregnancy pillow; and keep your head elevated with pillows. Over-the-counter antacids may help—but consult with your doctor about which types are safest to take during pregnancy.

4. Restless Legs Syndrome (RLS)

Restless legs syndrome, also known as Willis-Ekbom disease, is a sleep disorder that affects roughly 10% to 34% of pregnant people and is most commonly experienced in the third trimester. RLS causes bothersome sensations, such as tingling, burning, itching, electric shock-like sensations, or crawling skin. Symptoms are worse at night and while resting, and seem to be relieved by movement. RLS during pregnancy doesn’t usually signify anything serious, but symptoms can feel unbearable.

What You Can Do: “Management of restless legs syndrome begins with nonpharmacologic therapies, such as regular exercise, massage, yoga, meditation, acupuncture, and in some cases, cognitive behavioral therapy,” Bacak says. Because RLS has been associated with anemia, Bacak says iron and folate replacement may be recommended for some people. In more severe cases, antidepressants and other medications may be prescribed by a sleep specialist or maternal-fetal medicine specialist.

5. Sleep-Disordered Breathing

Sleep-disordered breathing (SDB) is an umbrella term for a number of conditions that include snoring and obstructive sleep apnea.

Snoring is common in pregnancy, often starting in the second trimester, and is caused in part by the pressure on your organs and also by changing hormones. Increased estrogen and progesterone cause nasal mucus membranes to swell, which can result in congestion and force you to breathe through your mouth, often resulting in snoring. Although not usually dangerous, snoring can be associated with gestational diabetes, so you should mention it to your doctor.

Sleep apnea, which causes airways to collapse while a person is sleeping and pauses their breathing, is generally more serious. Sleep apnea lowers blood oxygen levels and increases a person’s risk of preeclampsia and heart disease, among other conditions, so it’s crucial to talk to a doctor if you think you might have it.

What You Can Do: To help minimize snoring, sleep on your side, not on your back, and keep your head elevated on a pillow. Using a nasal strip can open the airways, and a warm-mist humidifier may help ease congestion. For sleep apnea, the recommended therapy is something called continuous positive airway pressure, or CPAP, Bacak says—a doctor can help you find out whether you might benefit from this type of treatment

Keep in mind that healthy lifestyle changes during the day may improve your sleep quality at night. “Regular exercise, a healthy diet, and a healthy weight all increase your chances of sleeping better,” Dardik says.

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