For most women, pregnancy is a time of great joy, excitement and anticipation. However, pregnancy and how to sleep can pose significant sleep challenges due to changes in our sleep patterns and in our changing bodies.
To prepare us for the months ahead, let’s look at possible sleep disorders and what our first, second and third trimesters can look like.
For most women, getting a full night’s sleep becomes even harder once the baby is born. So it is very important for pregnant women to prioritize sleep as soon as possible in the early stages of pregnancy, and to find effective strategies for managing sleep problems.
Good sleep helps to strengthen our immunity, which is especially important during pregnancy. Plan to get at least seven hours of sleep a night.
Researchers from the University of California at San Francisco recently found that pregnant women who slept fewer than 6 hours per night had longer labors and were 4.5 times more likely to have cesarean deliveries.
According to the National Sleep Foundation’s 1998 Women and Sleep poll, 78% of women report more disturbed sleep during pregnancy than at other times. Many women also report feeling extremely fatigued during pregnancy, especially during the first and third trimesters.
One of the reasons for fatigue and sleep problems during pregnancy are changing hormone levels. For example, rising progesterone levels may partly explain excessive daytime sleepiness, especially in the first trimester. Progesterone helps to regulate our menstrual cycle, but its main job is to get our uterus ready for pregnancy.
Hormonal changes may also have an effect on muscles, which may result in snoring, and in obese women, increase the risk of developing sleep apnea. Hormonal changes may also be partly responsible for the frequent trips to the bathroom during the night.
These interruptions as well as those caused by nausea and other pregnancy-related discomforts can result in a significant loss of sleep. Let’s take a look at some of those discomforts.
Pregnancy Sleep Disorders
Several sleep disorders can be caused or made worse due to pregnancy. These are some common sleep disorders and symptoms that can occur.
Many women experience insomnia due to emotions and anxiety about labor and delivery, or about balancing motherhood and work, or about our changing relationship with our partners. This is especially true of first-time mothers.
Symptoms. Insomnia includes difficulty falling asleep, staying asleep, or waking up too early, or feeling unrefreshed. Insomnia related to stress or anxiety may result in significant sleep loss.
The discomforts of pregnancy such as nausea, back pain and fetal movements from our babies may also disturb our sleep.
To read more about insomnia, refer to my article, “Natural Cures For Insomnia – For Adults”.
Solution. Most drugs that are used to treat insomnia carry some risk and are typically not recommended for women who are pregnant or nursing. However, by practicing good sleep hygiene and habits that are conducive to sleeping well on a regular basis, most women are able to manage pregnancy-related insomnia.
2. Restless Legs Syndrome (RLS)
In a study of over 600 pregnant women, 26% reported symptoms of restless legs syndrome, a condition characterized by an uncomfortable sensation in our legs, and an urge to move our legs while we’re trying to fall asleep.
To read more about restless legs syndrome, see my article, “List Of Sleep Disorders – What Are The Most Common?”
Most medications for RLS pose risks to a developing fetus, so be advised that we should check with our doctor before taking any medications.
Symptoms. Symptoms of RLS include unpleasant feelings in the legs, sometimes described as creepy, tingly or achy. These feelings are worse at night or in the hours before bed, and are temporarily relieved by movement or stretching.
Solution. Prenatal vitamins that include folate and iron supplements may help reduce RLS symptoms during pregnancy, but folate is better absorbed in foods such as whole grains, cereals, and breads than it is in pill supplements. Coffee decreases absorption, and vitamin C increases absorption of folate from foods.
3. GERD (heartburn)
Gastroesophageal Reflux Disease (GERD), is also known as acid reflux or heartburn. This is a long-term condition in which stomach acids flow upwards from the stomach into the esophagus, resulting in either symptoms or complications.
One recent study found that 30-50% of pregnant women experience GERD almost constantly during pregnancy.
Nocturnal gastroesophageal reflux (nighttime GERD), also known as heartburn, is considered a normal part of pregnancy. However, nighttime symptoms of GERD can damage the esophagus and disrupt sleep during pregnancy.
Symptoms. Severe GERD can cause an extremely sore and burning throat.
Solution. Heartburn can be treated with over-the-counter antacids. More details about what we can take is referenced in the 2nd Trimester section below.
4. Sleep Apnea
Pregnant women are also at risk for developing sleep apnea. Obstructive sleep apnea is when a person’s breathing stops for several seconds during the night due to blockage in the upper respiratory system. As we sleep, soft tissues in the throat relax and collapse into the airway blocking oxygen from getting to the lungs. Partial blockage often results in snoring.
Sleep apnea is also associated with more daytime sleepiness compared to women who do not have sleep apnea during pregnancy.
Symptoms. A noticeable feature of sleep apnea is heavy snoring accompanied by long pauses, and then gasping or choking during sleep. If we suspect we have sleep apnea, it is highly recommended that we talk to our doctor.
Solution. Overweight or obese women who become pregnant, or women who gain excessive weight, and women who report snoring should be evaluated for sleep apnea. Our doctors may recommend a sleeping device called a CPAP machine, which maintains continual positive airway pressure during sleep. It is the best treatment for sleep apnea, and is safe to use during pregnancy.
5. Frequent Nighttime Urination
There is no over-the-counter remedy for pregnant women who experience frequent nighttime urination. See more information under the First and Third Trimester sections below for details about frequent nighttime urination.
Symptoms. The frequent need to urinate at night is a common feature of pregnancy and can result in loss of sleep.
Solution. Cut Down on fluids after 6 p.m. See more detail in the First Trimester section below.
Based on the above findings. Researchers recommend that doctors discuss both sleep quantity and sleep quality with their pregnant patients as part of basic prenatal care and stress the importance of “sleeping for two”.
The good news about most of the sleep problems experienced by pregnant women is that they tend to go away once the baby is born, but we should still pay close attention to our sleep after we give birth, as new sleep problems may arise.
What To Expect During Trimesters 1, 2, 3
We knew sleepless nights would be part of the new-mom deal, but we didn’t expect them to begin before our baby was born. Everything from morning sickness, to scary dreams, to restless legs can take a toll on our sleep.
Fortunately, we don’t have to drag through our final months of pregnancy in exhaustion. Become familiar with the symptoms during each trimester and notice the solutions that will teach us how to get more quality sleep during our pregnancy.
These are the sleep difficulties we are likely to face in the first trimester and their remedies:
Disturbed Sleep Patterns
The cause. Lethargy and overwhelming fatigue are common due to the dramatic rise in progesterone, the hormone necessary for maintaining pregnancy.
Another culprit is the metabolic changes our bodies go through. A lot of calories are going into the gestation process. The growing fetus is taking every bit of our energy.
Solution. Update our sleep schedules, plan our snooze times just like we do our meals, or our day at the office, and nap as often as possible.
It’s best to nap between 1 p.m. and 3 p.m., otherwise we may have trouble falling asleep at night. It’s advisable to take one or even two 30-minute short naps rather than one long, two-hour nap. Nap on the floor of our office, or in our car if we need to.
Another tip is to exercise early. Planning physical activity in the morning, afternoon and early evening will promote sounder sleep. Late-evening workouts, however, tend to encourage insomnia, making it harder to get to sleep or stay asleep.
Increased Bathroom Visits
The cause. Our high progesterone level, our pregnancy hormone, along with a growing uterus that’s pushing against the bladder means more frequent urination.
Solution. Cut down on fluids after 6 p.m. This will help reduce night-time bathroom runs. If we drink caffeinated beverages, do so only in the morning. The good news is that our need to urinate constantly will temporarily subside in our second trimester.
The cause. Morning sickness can and often does strike during the evening and wee hours of the night.
Solution. For nighttime, stock Saltines on our nightstand. Crackers will suppress midnight queasiness, and we won’t have to trudge to the kitchen to get them.
The cause. Breasts become painful early on because of high estrogen levels, a hormone produced by our ovaries, and levels of hCG, human chorionic gonadotropin, the hormone produced by the placenta during pregnancy.
While these hormones prepare our breasts for milk production, they also make them much more sensitive.
As our breasts grow, women who were tummy sleepers may find that this is now impossible because any pressure on the breasts may be painful. We may have to learn how to sleep in other positions, which may also lead to getting less sleep.
Solution. A hot shower just before bed can ease us into dreamland, and acetaminophen (e.g., Tylenol), is safe during pregnancy, and can alleviate soreness, says Kellie Flood-Shaffer, M.D., associate professor of obstetrics and gynecology at Texas Tech Health Sciences Center.
If it’s difficult to sleep on our stomachs, and we can’t get comfortable on our backs, we can reposition our pillows: Sleeping on our side and using a body pillow might just do the trick.
The cause. Once again, blame our fluctuating pregnancy hormones, namely our progesterone in the first and second trimesters. Our blood vessels dilate leading to headaches, which can lead to sleep loss.
Solution. Acetaminophen, for example, Tylenol, is safe to take, as we read earlier. We can also apply a cool towel to our forehead. This will help the blood vessels contract while relaxing muscles and relieving the headache.
Get rest when we can, by taking a short nap during the day if needed. This will give our bodies a much-needed break from any fatigue-induced headaches.
“Women in their second trimester tend to sleep better,” says sleep researcher Meena Khan, M.D., a professor at the Ohio State University Medical School. “Our bodies undergo their most dramatic metabolic changes in the first trimester.”
Following are the second trimester difficulties we may face, and the solutions for them:
Heartburn / GERD
The cause. Queasiness usually subsides, but acid reflux rises. The growing uterus places pressure on the stomach, forcing acid upward into the esophagus. Meanwhile, our hormones are skyrocketing, which can loosen the muscles between our stomach and esophagus, allowing acid to leak upwards. Lying down in bed aggravates the burn, as the leak is more prone in this position.
Solution. Stay upright for four hours before nighttime sleeping. The digestive process takes a lot longer during pregnancy, and sitting up will help keep stomach acids where they belong.
Lying down and watching TV after dinner is not a good idea. We may want to start eating bigger breakfasts and lighter dinners if heartburn is keeping us awake. Also consider breaking up our usual three meals into six smaller ones throughout the day.
We should also avoid spicy, fried, and acidic foods, including tomatoes, citrus fruits, juices, and coffee. If we take all these precautions and still experience heartburn when sleeping during pregnancy, we might want to seek some relief from an over-the-counter product.
It’s my understanding that we can use Tagamet, Prilosec, antacids, or Mylanta to ease discomfort, but to be on the safe side, contact our Ob-Gyn to get prior approval.
The cause. Though worse in our third trimester, leg cramps, which are usually in the calf, can startle us awake and keep us up in the wee hours. These usually begin during the second trimester.
Solution. Limit or avoid carbonated drinks. A calcium imbalance can lead to leg cramps. The phosphorus in bubbly beverages, including soda water, decrease the amount of calcium we’re able to metabolize.
In addition, make sure we’re getting enough calcium from good food sources like dairy products, dark-green leafy vegetables, and canned salmon with bones.
If we get a painful leg cramp, flex the foot, extend the heel, and point the toes toward our head to lessen the cramp.
Can’t Get Comfortable
The cause. We’re too big to sleep on our stomachs, but we’re told to avoid sleeping on our backs.
When we lie on our backs, the weight of the uterus can compress the inferior vena cava, which is the vein that transports blood from our lower body to our heart. To compensate, our body works harder to pump blood to our heart, and as a result, our blood pressure increases, and the blood flow to the uterus slows down. This is why doctors recommend sleeping on our left sides.
Solution. Sleep on our left sides. When we sleep on our left sides, our uterus pushes forward, and thus alleviates pressure on our heart, ensuring that our baby will get plenty of blood and oxygen through the night.
We don’t have to sleep entirely on our sides. With the help of a pillow, we can almost assume our favorite position. While on our backs, place a pillow underneath our right hip, so our uterus is tilted, but our upper chest and back are flat. This ensures proper blood flow and will help us to doze off.
To view many comfortable sleep positions with the use of various pillow arrangements, refer to my article, “Lower Back Pain And Sleeping – To The Rescue”.
Scary Or Disturbing Dreams
The cause. As our pregnancy progresses, we may get more anxious or perhaps more stressed about, for example, our baby’s growth, our parenting abilities, or our finances, which can all interfere with a good night’s sleep.
Solution. Make relaxation a priority. Easier said than done, but a quieter mind will ensure a better night’s sleep. Here are some relaxation tips:
- Experts suggest meditation, such as prenatal yoga
- Other relaxation techniques, like soaking in a warm bath
- Eating tryptophan-rich foods such as turkey, milk and bananas. This amino acid turns into mood-soothing serotonin in the brain. Serotonin in the brain is thought to regulate anxiety, happiness, and mood.
- Enrolling in a parenting class now so that we feel better able to care for a newborn
- Seeking help if we’re losing sleep due to anxiety-related dreams
To view 11 healthy sleep practices that prepare us for bedtime, refer to my article, “Natural Cures For Insomnia – For Adults”.
Research says that by the end of pregnancy, a large percentage of expectant women report waking up at least three times a night, while two-thirds are awakened five or more times. It’s vital to have made sleep a priority by this time.
Let’s take a look at some of the issues and solutions we may experience during the third trimester:
The cause. A Yale University study found that nearly 60 percent of pregnant women say that lower-back pain causes sleep disruptions.
The reasons for our back pain can be due to weight gain, slouching or poor posture, hormonal changes, emotional stress, and muscle separation as our uterus expands.
Solution. If we’re prone to laying on our right sides, we may want to change our routines, as sleeping on our left side will take stress off our lower back, help prevent snoring, and increase circulation to our babies, as we read earlier. As a reminder, this will also improve the flow of blood and nutrients to our fetus.
Put pillows between our knees, behind our backs, and under our bellies, or use a pregnancy pillow.
Also stretch and do abdominal exercises frequently.
Frequent Urination Again
The cause. Just like in the first trimester, the urge to urinate at night increases as our uterus grow larger and the baby drops lower in our pelvis.
Solution. Cut back on liquids in the evening, and don’t drink liquids for two hours before going to bed. Whenever we urinate, lift our bellies to allow our bladders to empty completely.
Snoring and Disordered Breathing
The cause. Nasal congestion and abdominal weight gain can partially close our airways, and lead to snoring.
Studies show that In six percent of women, snoring can progress to obstructive sleep apnea, a condition in which breathing stops for at least 10 seconds. As we read in one of the previous sections, this is more common in women who are overweight or obese pre-pregnancy.
We may need to have our airflow monitored or tested to ensure that we and our baby are getting enough oxygen.
Solution. See a certified sleep specialist if snoring and apnea become extreme, as this can be of concern. I understand that a good place to find a specialist is from the American Board of Sleep Medicine.
Restless Legs Syndrome (RLS)
The cause. About 20 percent of pregnant women experience the truly weird sensation of what feels like ants crawling up and down our legs. Studies have shown that women who have lower levels of iron and folate are at higher risk for sleepless nights due to RLS.
Solution. Have a pre-bedtime light leg massage and warm bath. Evening walks also help prevent RLS.
During the day, we can eat more fortified grains and leafy greens. “Eating foods rich in iron and folate can reduce the severity of restless legs syndrome,” says sleep researcher Meena Khan. “Avoid caffeine, too, because it inhibits absorption of iron and folate.”
The cause. Our brains may be absorbed in all the many things we need to do before the birth of our babies.
Solution. The more we take care of before our babies are born, the more in control and calm we’ll feel later. Keep track of all we need to get done, delegate what we can, chip away at the rest by tackling a little bit each day, and don’t be afraid to ask for help.
As we know, sleeping well throughout pregnancy can be challenging. Now, let’s take a look at a visual summary of how to cope with the sleep concerns that we’ve just read about in order to minimize our sleep loss and maximize our quality of sleep:
_√_ Plan, schedule and prioritize our sleep
_√_ Try to exercise for at least 30 minutes a day unless our health care provider has advised against it
_√_ Sleep on our left sides to improve the flow of blood and nutrients to our fetus, our uterus and kidneys. Lie on our left sides with our knees and hips bent.
_√_ Place pillows between our knees, under our abdomens and behind our backs. This may take pressure off our lower backs.
_√_ Avoid lying on our backs for extended periods of time
_√_ Drink lots of fluids during the day, especially water, but cut down on the amount we drink in the hours before bedtime
_√_ Do not eat large amounts of spicy, acidic or fried foods in order to avoid heartburn. Also, eat frequent small meals throughout the day.
_√_ Snoring is very common during pregnancy, so be screened for sleep apnea if we have pauses in our breathing associated with our snoring
_√_ Have our blood pressure and urine protein checked, especially if we have swollen ankles or headaches
_√_ Be evaluated for iron or folate deficiency if we develop restless legs syndrome
_√_ Don’t lie in bed forcing ourselves to sleep. If we can’t sleep, get up and read a book, knit or crochet something for our babies, write in a journal, or take a warm bath.
_√_ Put a nightlight in the bathroom instead of turning on the light to use the bathroom. This will be less disruptive and help us return to sleep more quickly.
_√_ Add daytime naps as necessary, but reduce them, or nap earlier in the day if we have difficulty falling asleep at night
Other Related Articles
To help us develop good sleep habits early in our pregnancy, please refer to these two related articles I’ve written:
- The importance of sleep to our overall health, which will also affect our care for our babies, “Sleep Deprivation And New Parents – Awareness And Help”.
- How to deal with anxiety and sleep, “Sleep And Coronavirus Anxiety – How To Increase Our Quality of Sleep”.
Medical Disclaimer: All information contained in this website, including information related to medical matters, health issues, treatments, and products, serves for informational purposes only. Read more.
As we’ve read, there are many sleep disorders that can become more exaggerated during our pregnancy, and can deplete our quality of sleep. By doing as much now, to improve our sleeping habits before childbirth, we will feel more energetic and able to care for our babies.
My desire for new moms and dads is to prepare us by becoming familiar with what we may observe or experience during the three trimesters, and how to remedy those difficulties, while developing our coping skills.
What I learned writing this post: After writing many articles regarding quality sleep, I find that similar sleep concerns occur whether we’re pregnant or not pregnant.
Developing and teaching ourselves good sleep routines makes us better able to cope with life’s occurrences, like having a newborn.
May you have a wonderful journey being new moms and dads.
Before you go, please share a helpful sleeping tip for our new moms and dads in the comment area below. Thank you for reading, and come back and visit again.
‘Happy Deep Sleep’ in your new journey.