There are many changes to a person’s body during the nine months of pregnancy, and each trimester brings its own unique challenges that can impact sleep. While a lot of focus is given to “eating for two” during this time, more and more research is focusing on the underlooked importance of sleeping for two as well.
In the following article, we’ll go over some of the ways sleep is impacted during pregnancy because of the changes in body, hormones, energy, and more. We’ll also give you some tips on how to get more rest during this important time.
Body Changes During Pregnancy
There are many physical and psychological reasons why as many as 94 percent of people1 face challenges with sleep during pregnancy, according to research published in Obstetric Medicine.
While most of these changes are a natural part of the process, understanding how they impact rest can help you to better prepare and cope.
The American Academy of Sleep Medicine has outlined some of the prenatal side effects2 that may impact sleep, including:
Your Hormones Increase
People experience a roller-coaster ride of hormone changes during pregnancy. Dramatic rises in reproductive hormone levels may be behind some of the disruptions to sleep patterns parents-to-be face. During the first trimester, estrogen and progesterone steadily increase3, peaking at term and rapidly falling after delivery.
Progesterone has been shown to have a sedative effect4, explaining why most pregnant people experience heightened fatigue during the first trimester when levels of this hormone surge. Both progesterone and estrogen have also been found to decrease rapid eye movement (REM) sleep5, the important stage when the brain is consolidating information into long-term memories.
Your Body Shape Changes
As the first trimester ends, the womb begins to expand to accommodate your tiny baby’s rapid growth, and many people find that sleeping becomes more of a challenge. Getting into a comfortable position can be difficult, especially for those who are used to sleeping on their stomach or back.
Your Appetite Increases
During pregnancy, caloric needs increase6 by 300-500 calories a day, which explains why you may be so ravenous day and night. While not every expecting parent craves pickles and ice cream, most do notice an increase in appetite very early on (or about the time when morning sickness finally goes away).
Nighttime hours are typically when growth and repair take place in the body, and this could explain why many cravings happen after the sun has set. For some people, hunger pangs are one of the many causes of interrupted sleep. In an online survey7 of 2,427 expecting mothers, 100 percent reported frequent nighttime awakenings. While craving a midnight snack isn’t the sole cause of these wakings, it may be a big contributor.
You Have Lower Energy and More Fatigue
An increase in progesterone may be why many expecting pregnant people suddenly find themselves sleeping a lot of the time. This reproductive hormone can leave you feeling very tired and may explain why napping is suddenly your favorite hobby. Energy levels are also decreasing, making it hard to function day-to-day.
Napping can help some folks to temporarily increase their energy and make it through until bedtime, but for others, napping later in the day can make it more difficult to fall asleep that night. Oftentimes, the physical demands of growing a human being are so great that fatigue and lack of energy persist despite extra time in bed.
You Experience Increased Urination
Frequent trips to the bathroom are yet another commonly reported symptom mothers-to-be experience. In one study8 of 270 pregnant women, as many as 77 percent experienced increased frequency of urination throughout all three trimesters. Nocturia (waking in the night to pee) was also reported by over 75 percent of women, further contributing to the interruptions in sleep that nearly all pregnant women face.8
There are many causes for increased urination including rising hormone levels, increased fluid intake, expanding blood vessels, and pressure on the bladder from the growing baby.
You Might Get Anxiety
- Will my baby be healthy?
- What will labor be like?
- Will life ever be normal again?
- What will my life be like with a baby?
These are just some of the many questions that may keep expectant people up at night. While some worrying is to be expected during this life-changing season, anxiety that impacts your daily life is not.
Anxiety9 is an overwhelming response to a perceived threat that is experienced in the body, mind or through behaviors. Some of the signs of anxiety during pregnancy include loss of appetite, irritability, forgetfulness, difficulty sleeping, muscle tension, and trouble concentrating. If you recognize any of these signs in yourself or a loved one, be sure to speak to your health-care provider about treatment options.
Learn More: Anxiety and Sleep
You Might Experience GERD
Gastroesophageal Reflux Disease (GERD) occurs more commonly in people who are expecting with 30-50 percent10 percent reporting frequent heartburn. Pre-existing reflux, increased maternal age, and the amount of weight gained are all risk factors for developing GERD, and the more weight somebody gains, the higher their chances become.
Heartburn, acid reflux, and GERD can all be blamed on hormone changes that relax the muscles in the esophagus, allowing stomach acids to rise and creating a burning sensation in the throat. As your uterus expands to accommodate your growing baby, more pressure is placed on the stomach, making heartburn and reflux even worse.
See More: First Trimester Sleep
Tips For Better Sleep During Pregnancy
Insomnia and fatigue can be challenging to cope with, coupled with all of the other prenatal symptoms that can make sleep disturbances worse. Although it may be tempting to reach for an over-the-counter sleep aid or herbal supplement, these are not recommended during pregnancy.
Instead, try these tips which may help to naturally improve the quality of your sleep:
Prioritize Rest
The demands of life will only continue to rise as the day of your baby’s arrival draws closer. Schedule and plan times for rest into your day, even if it just means sitting with your feet up for five minutes every hour.
Related: Best Mattress for Pregnancy
Maintain a Consistent Bedtime/Wake-Up Time
Get into the routine of going to bed and waking up at the same time every day. This helps to regulate the circadian rhythm and may make it easier to fall asleep quickly at night.
Practice Self-care
Very soon, your life will be very different. Now is a good time to get into the habit of making self-care a priority in your life. Take a bath, journal, meditate, and soak up the quiet and peaceful time that you have.
Get Some Exercise
Exercising for at least 30 minutes a day is a great way to improve rest at night. Yoga, walking, and swimming are all great choices, but be sure to check with your health care provider before starting any new exercise routine.
Strategize Naps
Naps can be very rejuvenating when you are battling ongoing fatigue. Try to nap earlier in the day and keep naps to 30 minutes or less to avoid disturbing nighttime rest.
De-stress
Anxiety about your impending delivery and motherhood can keep you up, worrying all night long. Use relaxation techniques to clear your mind like talking to a trusted friend, journaling, or spending time in nature.
Start Side Sleeping Early
Obstetricians recommend that people sleep on their left side during pregnancy to maximize the flow of blood and nutrients to the baby. Re-conditioning the body to sleep in a new position takes time, so start training yourself to sleep on your side early, before it becomes necessary.
Avoid Big Meals Before Bed
While it may be tempting to give in to late-night cravings, eating large amounts before bed can increase reflux and heartburn. Instead, focus on eating healthy foods earlier on in the day, eating a lighter dinner and a small snack in the evening.
Sleep Positions During Pregnancy
As your body changes throughout your pregnancy, certain sleep positions will be more comfortable – and safer for you and the baby – than others.
Sleeping on Your Back While Pregnant
Research11 shows that sleeping on the back through the first trimester of pregnancy doesn’t seem to have harmful effects on the baby or the parent. So, if this is your preferred sleep position, feel free to continue with this to rest as well as you can during this time.
Once you get to the second trimester, though, the American Pregnancy Association12 recommends you avoid sleeping on your back. This is because your growing abdomen would be resting on your intestines and major blood vessels in this position and could result in sleep apnea, backaches, breathing problems, digestive issues, hemorrhoids, or a drop in blood pressure.
Find Out More: Sleeping on Your Back During Pregnancy
Sleeping on Your Side While Pregnant
According to the American Pregnancy Association (APA), side sleeping is the safest sleep position for all trimesters of pregnancy. They specifically recommend sleeping on your left side in order to increase the amount of blood and nutrients that will reach the placenta and your baby12.
Side sleeping will place the least amount of pressure on your veins and internal organs. If you’re having trouble sleeping on your side, investing in a pregnancy pillow could help make you more comfortable.
Sleeping on Your Stomach While Pregnant
Stomach sleeping is not the best sleep position in general, but if you feel the most comfortable in this position normally, you’re safe to continue sleeping this way through your first trimester.
As your pregnancy progresses and your abdomen continues to grow, though, this will likely also make stomach sleeping uncomfortable and could put undue pressure on your baby. Instead, the American Pregnancy Association recommends side sleeping starting in the second trimester, with a supportive pillow in between the knees to keep the back properly aligned12.
What Has Been Your Experience with Sleep and Pregnancy?
Why is Sleep During Pregnancy So Important?
Good sleep is one of the most important things an expectant mother can do for her baby. Adequate rest is essential for a healthy pregnancy and full-term delivery.
According to the American Academy of Sleep Medicine, “Not sleeping well can lead to a number of problems. Expectant mothers who have poor nighttime sleep are more likely to have a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls, and use more over-the-counter or prescription sleep aids, all of which may adversely affect the healthy development of her baby. In addition, recent studies associate lack of sleep with serious health problems such as an increased risk of obesity, cardiovascular disease and diabetes.”2
Progesterone Production:
Progesterone is an essential hormone in the reproductive process, playing an important role in fertility and the maintenance of a healthy, full-term pregnancy. Early on, progesterone is produced by the corpus luteum, a temporary endocrine structure in the ovaries. Eventually, the placenta takes over production at around 8-10 weeks.13This hormone14 is necessary for nurturing a healthy environment for the developing fetus and to prevent rejection by the mother’s body.
Research has discovered that progesterone activates receptors in the brain that shorten the time it takes for the body to enter REM cycles and also decrease the amount of time spent in this phase4. With elevated levels throughout all three trimesters, this hormone may be to blame for your zombie-like state day and night.
Gestational Diabetes:
Gestational Diabetes Mellitus15 (GDM) is a form of diabetes that develops during pregnancy and causes elevated blood sugar levels that the body has a hard time controlling. This is also what doctors are testing for when you have to take that dreaded glucose tolerance test and drink that nasty orange beverage.
Pregnant people with GDM have an increased risk of developing preeclampsia, are more likely16 to require a C-section, and are at a greater risk for developing type 2 diabetes after giving birth. Babies born to mothers with GDM have an increased risk of macrosomia, hypoglycemia, jaundice, and birth-related injuries. After birth, these infants are also more likely to develop metabolic syndrome, type 2 diabetes, and obesity later on in life.
In this same study of 686 pregnant women in Asia, shorter durations (< 6 hours per night) and poor quality sleep were independently associated with an increased risk of gestational diabetes16.
Preeclampsia:
Preeclampsia17 is defined as having high blood pressure levels (> 140/90 mmHg) coupled with excess levels of protein in the urine after the 20th week of pregnancy, and it can pose serious threats to both parent and baby, increasing their risks of serious complications and even death.
In a cross-sectional study18 of 311 women, those with preeclampsia experienced more insomnia, snoring, fragmented sleep, and sleep apnea than non-pregnant women. The women with preeclampsia also had higher rates of anxiety and depression than the control groups.
Life After Baby:
Many seasoned parents will warn expecting friends to “sleep now while you can.” While fatigue and restless nights can make parents-to-be long for the days after delivery when they can finally rest in their favorite positions again, sleep after baby can be even more challenging.
Newborns have fragmented sleep patterns in the early days, waking frequently for feedings during the night. Babies who were used to being rocked to sleep by the daily movements of busy mothers may be born with their days and nights reversed. It can take weeks or months for the circadian rhythm to regulate in infants, and nighttime waking can continue into early childhood for some.
Sleep Disorders Caused or Made Worse During Pregnancy
Unfortunately, many sleep disorders can develop or be made worse during pregnancy, increasing the risk of developing hypertension, gestational diabetes, intrauterine growth restriction, and postpartum depression.
Estrogen levels19 are elevated up to 100 times and progesterone more than 200 times during pregnancy compared to pre-conception levels. These hormone fluctuations coupled with other physical and psychological factors contribute to the higher prevalence of sleep disorders during pregnancy.
Insomnia
Insomnia appears to be a very common struggle that many pregnant people face with as many as 57 percent of people reporting this challenge, according to the Sleep Center in Philadelphia7. Additional research has found that insomnia may affect women differently depending on which trimester they are in.
Read More: How To Deal With Insomnia After Pregnancy
One study found that “At the beginning of pregnancy, the incidence of insomnia is lower at 12.6 percent and then increases as pregnancy progresses. Up to 73.5 percent of women display some degree of insomnia at a median of 39 weeks, further classified as mild in 50.5 percent, moderate 15.7 percent, and severe in 3.8 percent. In the last trimester of pregnancy, up to 69.9 percent reported difficulty in maintaining sleep, 34.8 percent described early morning awakenings, and 23.7 percent reported difficulty falling asleep.” [1]
Restless Leg Syndrome
Restless Leg Syndrome (RLS) is a sleep-related disorder that causes irresistible impulses to move your limbs (typically legs). Symptoms tend to be worse in the evening or at night and during prolonged periods of rest.
RLS is twice as likely to occur in females20, possibly explaining why it is more common during pregnancy as well.
Gestational RLS21 prevalence is between 10% and 38% depending on factors like which trimester women are in. Risk factors for gestational RLS include a personal or family history of RLS, a history of growing pains, obesity, smoking, and snoring in the first trimester.
Although it may be tempting to just chalk this up as yet another annoying symptom, RLS can be serious in some cases. A study22 of 231 women found that there was a two-fold increase in the risk of preterm birth among those with RLS. Preeclampsia is also reported to occur more in women with RLS.
Read More: Restless Leg Syndrome
Sleep Apnea
While some snoring is normal during pregnancy and could be due to more congestion, pauses in your breathing may be worth a trip to the doctor.
Sleep apnea occurs when the upper airways are partially or fully obstructed, decreasing oxygen saturation in the blood and resulting in brief arousals during the night. Although these episodes typically last for only 10-30 seconds, the compound effect they can have on the overall quality of rest is significant.
Several studies have estimated that sleep-disordered breathing during pregnancy occurs in as many as 3-27 percent of people23, with rates increasing with gestational age. Nasal congestion, gestational weight gain, decreased lung volume, swelling or shortening in the esophagus and throat, and large abdominal mass are all contributing factors to the increased prevalence of sleep apnea during pregnancy.
See More: Sleep Apnea – Types and Treatments
When Should I Speak to My Doctor?
The body is undergoing tremendous changes during pregnancy, and many symptoms like morning sickness and frequent urination are to be expected. However, if you notice that your legs are shaking excessively, you have changes in snoring, your legs and feet are abnormally swollen, or you are experiencing severe headaches, you should speak to your doctor as these could be signs of high blood pressure or other serious complications.
Good Questions for Your OB
What sleeping aids are safe for me?
While most sleeping aids are not approved for use during pregnancy, your doctor may know of over-the-counter or prescription options that have been deemed safe for you.
Is it ok to exercise when pregnant?
Exercise can be a great way to stay healthy and strengthen your body for delivery. In some cases, exercise may not be safe for all expecting parents. Speak to your doctor about what types of exercise may be best for you.
What vitamins can help my symptoms?
Growing a baby is hard work for your body, and nutrient needs are at an all-time high. Aside from your daily prenatal, some vitamins can cause harm if taken in large quantities, so always check with your doctor before taking any additional supplements.
Am I sleeping too much?
Getting adequate rest is important for the health of you and your baby. Excessive sleep can be normal in many cases, but if you are worried, speak with your doctor about the number of hours you are sleeping in a day.
What snacks might help me sleep?
Certain foods are high in naturally occurring melatonin, a hormone that helps you sleep. Foods that contain protein and fat are also satiating and may prevent frequent wakings caused by hunger. Your doctor may be able to recommend some good bedtime snack choices as well.
Last Word of Advice
Pregnancy can bring a myriad of feelings: exciting, nerve-wracking, sleep-deprived, exhausted, nauseous, complicated, joyful. Your body will go through tremendous changes over these nine months, from your hormones to your shape. It is no wonder sleep can be impacted at any point throughout this journey.
However, sleep is also incredibly important during pregnancy in order to keep you and your baby healthy. Maintaining a consistent sleep routine, getting adequate exercise, sleeping in the proper position, and eating the right foods at the right time are just a handful of ways you can improve your sleep during pregnancy. Remember: Don’t take sleep aids and always talk to your doctor before introducing new supplements or exercises.
For more of what to expect during every trimester, download this sleep map for pregnancy we created.
Raina Cordell
RN, RHN, Certified Health Coach
About Author
Raina Cordell is a Registered Nurse, Registered Holistic Nutritionist, and Certified Health Coach, but her true passion in life is helping others live well through her website, www.holfamily.com. Her holistic approach focuses on the whole person, honing the physical body and spiritual and emotional well-being.
Combination Sleeper
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