Pregnancy and Sleep: A Contradiction in Terms?

Pregnancy is an exciting and physically demanding time. There are so many changes happening in your body all at once. But while many mothers-to-be anticipate the sleepless nights that will come once the baby is born, many are unprepared for the sleeplessness they experience during the pregnancy itself. One reason for this is that changing levels of hormones (primarily estrogen and progesterone) can affect your sleep patterns.

Hormonal swings during pregnancy aren’t the only culprits. Physical symptoms, such as body aches, nausea, need to urinate at night, leg cramps, fetal movements, and heartburn, as well as emotional changes, like depression, anxiety, and worry can interfere with sleep. And unfortunately, these sleep–related problems may become more prevalent as your pregnancy progresses. Some may even develop sleep apnea.

First Trimester (Months 1-3)

During the first trimester, your body is working hard to protect and nurture your developing baby. The placenta (the organ that nourishes the fetus until birth) is forming, your body is making more blood, and your heart is beating faster. High levels of progesterone are also produced, increasing feelings of sleepiness. Indeed, many women sleep more than usual during their first trimester of pregnancy. Unfortunately, more doesn’t necessarily mean well. There are 3 common sleep stealers during your first trimester:

• Frequent urination—This is because your body produces 30%-50% more blood while you are pregnant, and your kidneys need to work harder to filter the additional volume. Also, as your baby grows, there is increased pressure on your bladder, causing you to need to go more frequently.
• Progesterone—While progesterone makes you sleepy, it can also disrupt your sleep, leaving you feeling more fatigued during the day. So, indulge your busy body and take catnaps whenever you feel the need.
• Getting comfortable—Always been a stomach sleeper? Tender breasts during your first trimester may make you reconsider. If possible, try learning to sleep on your left side. Many doctors recommend you begin learning to sleep on your left side early in your pregnancy, so that by the time you are in your third trimester, the position feels more normal for you. This allows maximum blood flow to the fetus, improves kidney flow, helps reduce swelling, and reduces the amount of pressure on your liver. Another reason to avoid sleeping on your stomach is to avoid putting pressure on the fetus.

Second Trimester (Months 4-6)

During your second trimester, progesterone levels continue to rise, but more slowly. This allows for better sleep than during your first trimester. Your growing baby moves above the bladder and decreases the pressure on it, thereby decreasing your need for frequent visits to the bathroom. You still may not be sleeping as well as you did before you became pregnant, but you’re less exhausted and many women report having a general sense of well being during their second trimester.

Progressing heartburn will be more of an issue as the stomach and esophagus becomes displaced. It may be more of a problem if you are sleeping on your back.

Third Trimester (Months 7-9)

The third trimester is when you may experience the most sleep disturbances. As your pregnancy progresses, you’ll likely find that lying on your left side with your knees bent will be the most comfortable sleeping position. Common causes of sleep disturbance in the third trimester include:

• Frequent urination—It’s back. Your baby is growing, as is the pressure on your bladder, requiring you to run for the bathroom once again.
• Leg cramps and backache—Aches and cramps in your back and legs are often the result of the extra weight you are carrying.
• Shortness of breath—Your growing baby may also increase pressure against your diaphragm. This may cause you to feel slightly short of breath and uncomfortable when you are trying to sleep.
• Heartburn—Heartburn may continue to progress during the third trimester as the growing baby presses on the stomach.
• Dreams—Some women experience very vivid dreams, even nightmares during their pregnancy.
• Stress—Stress can interfere with sleep as well. If you are feeling worried about your baby’s health, or the changes having a baby will bring to your life, remember that these feelings are completely normal.
• Snoring/sinus congestion—Many women who have never snored before may begin doing so at some time during their pregnancy. This is the result of increased congestion/swelling in the nasal passages. If you develop symptoms of sleep apnea (loud snoring and periods of stopped breathing during sleep), you should talk with your healthcare provider.
• Restless leg syndrome (RLS) —Some women may develop restless leg syndrome (RLS) during their third trimester of pregnancy. Symptoms of RLS include crawling or moving feelings in the foot, calf, or upper leg.

If you have any concerns about symptoms you are having, make sure you talk to your healthcare provider to see if they are normal or a sign of a problem.

Sleeping Tips

Because you’re pregnant, over-the-counter sleep aids, including herbal remedies are not recommended. However, there are some things you can do to improve your chances of getting a good night’s sleep:

• Reduce your intake of caffeinated beverages.
• Drink lots of fluids during the day, then taper off before bed.
• Try to avoid eating a large meal just before bed.
• Avoid foods that cause heartburn. These depend on the individual, but may include fried foods, dairy products, and spicy foods.
• If heartburn is a problem, elevate the head of your bed.
• Use your bed only for sleeping or sex.
• Try going to bed and getting up at the same time every day.
• Exercise regularly if allowed by your healthcare provider, but avoid rigorous exercise just before bed.
• If you’re having trouble with nausea, try eating frequent bland snacks (like crackers) throughout the day.
• Learn relaxation techniques.
• Nap as needed, but keep them short. Long naps during the day may ruin your night’s sleep.
• Try putting pillows either between your legs, at the small of your back, or both.

If you still can’t sleep, try reading or catching up on correspondence. Eventually, you should feel drowsy enough to fall back to sleep.

Revision Information

• Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
• Review Date: 10/2017
• Update Date: 12/04/2015