Pregnant people know there’s no tired like pregnant tired. Between the physical changes, the hormonal changes, and the mental weight of planning for a baby, there’s a lot that goes into growing a baby, with plenty of ensuing sleep disturbances.
On any given night of the nine-month journey, pregnant people may experience insomnia related to:
- Waking up at 3 a.m. to pee
- Inability to get back to sleep after getting up
- Hip/back/pelvic pain
- Round ligament pain
- General body soreness
- Panic and anxiety with emotional and physical manifestations
- Restless legs and/or leg cramps
- Discomfort with usual sleep positions
- Nausea or vomiting
- Night sweats
… and the list goes on.
If you’re having trouble sleeping while pregnant, you’re not alone. Research shows that anywhere from 66-94% of pregnant people report disrupted sleep, including insomnia. Though sleep disorders can become pronounced during pregnancy, there’s a good chance that they predate your pregnancy, but have become exacerbated.
Beyond wreaking havoc on your mental and physical well-being, there can be other impacts of sleep issues on pregnancy: Research shows that insomnia, which affects 50% of pregnant people, and sleep apnea, which affects 57%, can double the risk of a preterm birth.
Luckily, some of these issues can be resolved, whether through medical treatment, patience, or helpful sleep aids and gear. To figure out how to address the issue, it’s important to nail down why you’re not sleeping, so that you can best manage, treat, or solve the issue(s). Here are the top reasons for sleep struggles during pregnancy, and what experts advise.
Managing sleep apnea, and other conditions during pregnancy
Dr. Valeria Contreras-Crowley, an OBGYN at Women’s Specialists of New Mexico and VIP StarNetwork encourages pregnant people to “explore underlying stressors that may be going on that may affect their sleep.”
Physical stressors that contribute to insomnia and sleep apnea include:
- Snoring and blocked airway, which could restrict oxygen flow to the fetus
- Gastroesophageal reflux disorder (GERD), which can trigger insomnia through all trimesters
- Restless leg syndrome (RLS), which affects a third of people in the third trimester
For snoring and nasal congestion, changing your sleep position and keeping consistent sleep hygiene may help you get better sleep during pregnancy. In fact, if you’re ready for an entire bed upgrade, consider an adjustable-base bed, which can elevate your head and legs to help with GERD and RLS. Treatments for these conditions may also include supplements and massages, but before you get too experimental, talk to your doctor for the best course.
If you suspect that you suffer from sleep apnea, it’s important to speak with your doctor. A potentially undiagnosed condition that Contreras-Crowley says people might brush off as a side effect of pregnancy, sleep apnea in pregnancy could be a sign of high blood pressure. In this case, doctors will want to make sure your high blood pressure isn’t from pre-eclampsia.
Changing sleep positions during pregnancy
Non-pregnant people: Duct tape a big bowling ball to your stomach and try to roll around your bed a few times. Oh, but don’t lay on your back either. And you obviously can’t lie on your stomach... You get the picture. Getting comfortable enough to fall and stay asleep can be a major chore.
The recommended sleeping position is on your side, recommends Contreras-Crowley. The left side especially is supposed to be the “ideal” sleeping position, allowing optimal blood flow.
Back sleepers may want to get a head start on transitioning to side sleeping, especially after 20 weeks as your belly gets larger. Not only will the weight of your uterus and baby cause backaches, but the weight can compress the inferior vena cava and decrease blood flow back to the pregnant person’s heart.
“The physiological change wakes people up... the body senses decreased blood flow,” she explains. This cycle can happen many times a night until the pregnant person adjusts to a new sleep position.
But stomach sleepers will need help with making the change. “Try different pillow positioning. Place a pillow under the abdomen to see if that helps,” says Contreras-Crowley. A wedge, body, or pregnancy pillow may be your belly’s best friend over these months.
Fixing the “pregnancy drip”
Feel like you have allergies on overdrive during your pregnancy? It may be Pregnancy Rhinitis, which is nasal congestion that lasts for over six weeks during pregnancy. You might have also heard it referred to as the annoying “pregnancy drip.”
This can keep you awake or even cause you to snore during your sleep. The cause is that pesky increased blood flow, which allows your baby to grow but also increases blood flow to mucous membranes, including in your nose.
Saline spray is a safe treatment for the pregnancy drips, but nasal decongestants might not be. Check with your doctor before you try to treat that runny nose keeping you up at night.
Addressing anxiety and labor fear
Pregnancy means a lot of changes, physically, emotionally, life-wise, not to mention labor. It can all add up to a lot of anxiety, which can rear its ugly head at the most optimal times, right? Like 3 a.m.
“[It helps to] develop good coping mechanisms and address underlying anxiety and stress,” Contreras-Crowley says, affirming that the fear of the unknown can contribute to insomnia and impact good sleep. “There’s an anxiety about the change of life that women share. They get overwhelmed.”
The first step to overcoming not sleeping due to pregnancy fears and anxieties is to realize just how normal it is to worry. One study revealed that nearly 80% of women have worries and fears related to the pregnancy or birth. It’s normal to worry about trying to conceive, then miscarrying, then if our babies are developing well, and then labor, with a million other concerns along the way.
The second step to addressing these anxieties is chatting with a partner about those fears and having a birth plan, says Contreras-Crowley. You don’t have to stick with it when the time comes, but knowing you are prepared can alleviate the “what ifs.”
She also recommends talking with a counselor or medical professional to get answers to your fears. Giving birth during stressful times, like during the COVID-19 pandemic or an economic slowdown, can add an additional layer of worry, but keeping quiet about those stressors won’t result in answers. Although it can feel like one at times, pregnancy doesn’t have to be a solo journey.
Keeping up with good sleep hygiene during pregnancy
Are you falling asleep binge-watching “Call the Midwife”? Are you scrolling Etsy late into the evening trying to pick the best outfit to take your baby home in? That's normal, but it isn’t very good sleep hygiene, which Contreras-Crowley emphasizes is just as important for pregnant people.
And as mentioned above, addressing poor sleep quality and insomnia sometimes starts with lifestyle changes first.
You’ve heard the typical advice to avoid blue light, including screentime, before bed — but there’s more to sleep hygiene than avoiding social media from your bed. You should also try:
- Sticking to the same bedtime and wake time, even for nights and weekends
- Creating a cool, dark, sleep space that you find relaxing
- Removing devices and TVs from the bedroom to avoid the temptation to check them
- Avoiding caffeine six hours before bed and other fluids two to three hours before bed
- Avoiding snacking right before bed, as this could contribute to GERD at night
- Exercising during the day, preferably not before bed
- Practicing self-care, like journaling, reading, or taking a bath.
Contreras-Crowley also has additional advice for pregnant people who are tired from their terrible night(s) of sleep:
- Take a nap! “[Pregnant people] should listen to their bodies because they are having rapid cell growth. They may need that for production. It doesn’t typically affect nighttime sleep [negatively] the way it would if you weren’t pregnant... you should still be able to fall asleep at night.”
- Use a non-addictive sleep aid. Specifically, she lists Tylenol PM, Benadryl, and Unisom as options to try, though you should consult with your doctor before taking any meds while pregnant.
- Bring it up with your doctor. To truly address underlying conditions related to sleep that you may think are pregnancy related, but might not be, express your concerns at your next prenatal appointment.
Don’t sleep on sleep
Avoiding chronic sleep deprivation is a holistic process that includes prioritizing yourself and working with your doctor. Sleep plays an important role in our immune system, so it’s no wonder that research continues to show how important it is to get sleep early in the pregnancy stages. Lack of sleep has shown to impact the health of you and the baby by contributing to the risk of:
- Gestational diabetes mellitus
- High blood pressure
- Painful labor
- Complications such as preterm birth and low birth weight
Talk about setting examples. Early research also shows that sleep quality before and after pregnancy could potentially shape how your infant sleeps. OK, we didn’t mean to increase the pressure and keep you up! To destress, we recommend trying some gentle, mindful yoga during the day. A small study shows that women who started yoga in their second trimester slept better than those who started yoga in their third trimester.
Or think of it this way: In nine or so months, you'll have a new tiny middle-of-the-night sleep disruptor, so sleep now while you can, friends.