Pregnancy Insomnia: Causes & Treatment

Sleep is important during pregnancy, but many people find it difficult to sleep well when they are expecting. Research suggests that by late pregnancy, around 60% of pregnant people experience insomnia. We examine the factors that can contribute to sleep problems and share advice on how to sleep better during pregnancy.

What Is Pregnancy Insomnia?

Insomnia is having trouble falling or staying asleep that carries over into daytime tiredness. When insomnia occurs due to pregnancy-related factors, it is sometimes called pregnancy insomnia. 

For many people, sleep problems may appear for the first time during pregnancy. Pregnant people may experience poor-quality or not enough sleep. They may sleep less deeply Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source and wake up often during the night. 

People who already have a sleep disorder may find the symptoms get stronger during pregnancy, while people who have never had sleep problems may develop them for the first time.

Causes of Insomnia During Pregnancy

A number of factors contribute to insomnia during pregnancy. Pregnant people may start to have trouble sleeping as early as the first trimester when hormone levels start to change. Sleep problems become more common in the third trimester as the body changes and fetal growth continues. 

Common causes of insomnia during pregnancy include: 

• Nausea
• Hormones
• Increased metabolism and heart rate
• Snoring
• Physical discomfort, such as back pain or leg cramps
• Nighttime bathroom trips
• Heartburn
• Anxiety

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Risks of Sleep Deprivation While Pregnant

Pregnancy is a demanding time for the body, and it is important to obtain sufficient high-quality sleep. According to experts, pregnant people should try to get 8 to 10 hours of sleep per night.

Going consistently short on sleep during pregnancy is thought to have risks for the fetus, and it may increase the risk Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source of gestational diabetes, preterm birth, longer labor Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source , and preeclampsia. 

Sleep problems during pregnancy may be especially problematic Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source if they are caused by obstructive sleep apnea, a sleep disorder in which the sleeper momentarily stops breathing multiple times per night. 

Pregnancy insomnia may contribute to depression and anxiety in late pregnancy and after birth. Improving sleep during late pregnancy appears to diminish the risk of postpartum depression. 

Tips to Cope With Pregnancy Insomnia

Common strategies for coping with pregnancy insomnia include sleep aids, therapy, and lifestyle changes. Although there is little research on how to treat pregnancy insomnia, experts usually prefer to recommend non-medicinal therapies, to minimize the risk to the fetus.

Sleep Aids and Melatonin During Pregnancy

People naturally produce higher levels of melatonin during pregnancy, especially during the third trimester. The melatonin in a pregnant person’s body crosses the placenta, reaching the fetus and helping establish the baby’s sleep-wake cycle.

Taking melatonin supplements may deliver too much melatonin to the baby and potentially interfere with the development of the sleep-wake cycle. Experts generally recommend that pregnant people avoid sleep medications and talk with a doctor before starting any sleep supplements. 

Cognitive Behavioral Therapy for Insomnia During Pregnancy

In cognitive behavioral therapy for insomnia (CBT-I), a person works with a therapist to change any unproductive thoughts and behaviors that affect sleep. To address worries about not getting enough sleep, the therapist may address the person’s anxious thoughts, discuss realistic goals for sleeping a certain number of hours, and suggest relaxation techniques such as meditation and progressive muscle relaxation.

Studies have found that CBT-I helps ease insomnia symptoms and improve sleep for pregnant people. CBT-I may also help improve feelings of fatigue, anxiety, and depression. Those who do not have easy access to in-person appointments can receive CBT-I treatment over the phone or internet.

Managing Heartburn and Acid Reflux

Gastroesophageal reflux disease (GERD) is common in pregnancy, and may worsen by the third trimester. Eating smaller meals, avoiding greasy or spicy foods, and leaving time after a meal before lying down may ease GERD symptoms like heartburn. If nighttime heartburn occurs, try raising the head of the bed for sleep, using a wedge pillow, or getting a new mattress. 

Addressing Leg Discomfort

During pregnancy, people may experience leg discomfort, including restless legs syndrome and leg cramps. To reduce the chances of experiencing leg cramps, perform gentle stretches and ask a doctor about calcium supplements. Calf stretches, walking, standing on the leg, pushing it against a wall, or wiggling the leg and then raising it can help manage leg cramps in the moment.

How to Sleep Better While Pregnant

There are many lifestyle changes that can help improve sleep during pregnancy. 

• Keep a regular sleep schedule: Go to bed and wake up at similar times every day. Naps can help make up for lost sleep, but avoid napping in the afternoon and evening.
• Create a comfortable sleep environment: Create a cool, dark, and quiet sleep environment and keep electronic devices out of the bedroom. Use a nightlight instead of the overhead light to avoid waking up too much during bathroom trips.
• Use pillows: Use pillows to support the midsection, the lower back, and between the knees to reduce back pain. Some pregnant people may prefer a pregnancy pillow that is specifically designed to accommodate the needs of their changing body.
• Avoid stimulants: Cut out nicotine and alcohol during pregnancy, and try not to consume caffeine after noon. 
• Exercise in the morning: Regular exercise is important during most healthy pregnancies, but it may be best to find time to exercise earlier in the day. Prior to starting an exercise routine, it is important to consult a doctor for specific guidance.
• Try relaxation techniques: Relaxation techniques or soothing activities such as a warm bath or a massage may help prepare for sleep. Talk with a health care provider about how to safely participate in relaxation activities throughout pregnancy. 
• Sleep on the left side: Sleeping on the left side facilitates blood flow to major organs and the fetus. Left side sleeping can also help reduce swelling in the legs and ankles, and is easier on the lungs and heart. Most experts recommend against back sleeping in late pregnancy, as it may carry some risks for the fetus.
• Treat a stuffy nose: Manage congestion with nasal strips, nasal sprays, or nasal irrigation.

Some pregnant people have difficulty sleeping because of the worries around pregnancy and becoming a parent. For some, it is helpful to make time for things they enjoy. Others find reaching out to trusted friends or family for emotional support during pregnancy helpful in reducing stress that may be keeping them awake. Attending childbirth classes or sharing any concerns with a health care provider can also reduce worry and may help an expectant parent sleep better. 

Talk to a doctor if pregnancy insomnia does not resolve with lifestyle changes. Medical conditions such as gastroesophageal reflux disease, restless legs syndrome, and obstructive sleep apnea may need specific treatment. 

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