Pregnancy Insomnia

What is pregnancy insomnia?

Pregnancy is one of the most common causes of insomnia. During pregnancy, changes in your body can cause sleep deprivation that takes a toll on how you feel and function throughout the day. You may have trouble falling (and staying) asleep. Although you’re sleeping, the quality of your sleep may be less than what you’re used to.

Losing sleep is never good for your health. But sleep deprivation is especially concerning during pregnancy when you need more sleep than usual to recharge. While doctors recommend seven to nine hours of sleep for the average adult, they recommend eight to ten hours during pregnancy.

Managing your insomnia is essential for your health and the health of your pregnancy.

How common is insomnia during pregnancy?

Insomnia affects most pregnant people at some point.

Your chances of having to deal with insomnia increase as your pregnancy progresses. About 1 in 4 people (25%) have insomnia in early pregnancy (the first trimester). Up to 80% of people report insomnia symptoms by the end of the third trimester.

What are the symptoms of pregnancy insomnia?

With insomnia, you want (desperately) to get good, quality sleep, but it’s just not happening. You may struggle to fall asleep or find yourself waking up throughout the night. You may consistently wake too early and lose those last few precious hours of sleep before sunrise.

During the day, you may feel sleepy. You may experience:

• Irritability.
• Slowed reflexes.
• “Fog brain” or trouble thinking, remembering and focusing.

It can feel like your mind and body are working against you at the very moment you’re trying your best to do things “by the book” so you have a healthy pregnancy.

What causes sleepless nights during pregnancy?

Changing hormone levels and a body that’s adapting to a growing fetus cause various pregnancy pains and discomforts, including insomnia.

Increases in estrogen and progesterone are usually to blame for insomnia in early pregnancy. These hormones influence both your breathing regularity and the phases of your sleep cycle.

The weight of a growing fetus is usually to blame for insomnia toward the end of pregnancy. The fetus places pressure on your joints, back and bladder. It can take what feels like forever to get comfortable enough to sleep. Once you do, the urge to pee may hit — and you’re up again.

Things that keep you awake during pregnancy include:

• A pregnant belly and achy body that can make it tough to get into a comfortable position.
• Nausea and vomiting. (“Morning” sickness can keep you up at night, too.)
• Having to get up to pee at all hours of the night (nocturia).
• Cramps or uncomfortable sensations in your legs.
• Back pain and round ligament pain.
• Contractions, or an active fetus.
• Shortness of breath.
• Quicker heart rate.
• Heartburn.

Anxiety about having a baby can cause an uptick in the stress hormone cortisol, making it harder to fall asleep. It’s easy to lie in bed wide awake, fixating on all the health benefits you’re not getting from sleep. The result is ramped-up anxiety that keeps your mind racing instead of resting.

Risk factors

Many people experience insomnia for the first time during pregnancy. No one’s immune. But already having a sleep disorder (including preexisting insomnia) can make it even harder to get a good night’s rest.

Conditions that may worsen during pregnancy include:

• Obstructive sleep apnea (OSA): With OSA, a blockage in your upper airway prevents air from flowing freely, making it harder to breathe. During pregnancy, changes like weight gain, more frequent stuffy nose and shortness of breath can intensify symptoms.
• Restless legs syndrome (RLS) and leg cramps: With RLS, you may feel like you must move your legs to get comfortable. Most people with RLS have worsening symptoms during pregnancy. The twitchy feeling in your legs may be a sign you’re not getting enough folate, which your body needs more of during pregnancy.

What are the complications of insomnia during pregnancy?

Pregnancy complications related to insomnia include:

• Intrauterine growth restriction.
• Gestational diabetes.
• Preeclampsia.
• Premature birth.
• Longer labor.
• C-section delivery.

Insomnia can also contribute to anxiety and depression in late pregnancy and after (postpartum depression).

How is insomnia diagnosed during pregnancy?

Your healthcare provider will review your medical history to see if you have a preexisting sleep disorder or if you’re taking medications that can interfere with sleep. They’ll also review your symptoms. They may ask:

• What’s the issue (unable to fall asleep, waking up frequently, waking up too early)?
• When did you start having trouble sleeping?
• How often do you have trouble sleeping?
• How do you feel during the day?
• How has your sleep deprivation affected your daily routine?

What helps insomnia during pregnancy?

The best treatments are lifestyle changes you can make to retake control over your sleep routine. The best strategy for you depends on what’s keeping you up at night. Your healthcare provider can help you pinpoint the problem and tailor a solution. They may recommend any of the following.

Before bed:

• Choose daily activities that make it easier to fall asleep. For example, light exercise early in the day can keep you healthy and help you fall asleep at night. Short naps (no more than 30 minutes) can help you play “catch up” if you’re sleep-deprived. Just don’t nap for too long or in the late afternoons or evenings. Late and long naps can keep you up at night.
• Reduce your risk of nighttime heartburn. Switch from eating three large meals a day to a few smaller meals throughout the day. Avoid foods that trigger heartburn, like spicy or greasy foods. Get treated for acid reflux (GERD) if you have it. Don’t go to bed within two hours after eating.
• Eat the right foods. Some foods can help with symptoms. For example, for leg cramps, increase calcium and magnesium in your diet by eating foods such as whole grains, beans, dried fruit, nuts and seeds.
• Avoid or reduce fluids right before bedtime. To cut back on nighttime bathroom visits, try to avoid drinking water before bedtime. If your mouth is dry or you’re thirsty, aim to drink no more than a glass of water two hours before bed. Take small sips.
• Cut out stimulants before bedtime. Avoid caffeine eight hours before bedtime. Steer clear of screens with blue light. They tell your brain to wake up. This means no scrolling on social media before bed — especially not while you’re in bed.
• Be aware of worries that may keep you up. Talk to your partner, friend or a therapist about these worries. Keep a journal where you can write down concerns, so you can discuss them with your provider later.

Once it’s time for bed:

• Practice good sleep hygiene: Sleep hygiene involves training your body to go to bed and wake up at consistent times. Follow a strict sleep schedule, even on the weekends. Also, prioritize making your bedroom a haven for sleep. Keep your bedroom cool, dark and quiet. Invest in a more comfortable mattress or a pregnancy pillow. Consider using a sound machine with natural sounds.
• Position yourself for comfort: Try sleeping on your left side with one pillow in between your legs and one supporting your belly. This position helps promote blood flow while keeping your body aligned. If this isn’t comfortable, experiment with different positions.
• Try relaxation techniques: Options include breathing exercises, stretches, meditation, yoga, taking a warm bath or having your partner give you a massage. Try a calming app that plays soothing music or sounds. Just don’t stare at your phone screen, which can keep you up.
• Don’t ruminate: Lying awake in bed, staring at the ceiling, can train your brain that your bed is a worry space instead of a sleep space. If you’re awake and can’t fall back asleep, try getting up and doing a relaxing activity, like meditating or reading (under a soft light).

Specific treatments used

If lifestyle changes aren’t helping, your healthcare provider can recommend other treatments, including:

• Medications: Finding a medication for insomnia during pregnancy can be tricky because many haven’t been tested for safety on pregnant people. Still, if you’re getting so little sleep that you’re at risk of pregnancy complications, the benefits of medications may outweigh the risks. Your healthcare provider can advise you on whether you need medications.
• Cognitive behavioral therapy (CBT): If you’re not getting relief on your own, it may be time to speak to a therapist. Studies show that cognitive behavioral therapy (CBT) can help people with insomnia during pregnancy sleep better.
• CPAP: You may need a CPAP machine to help open your airways if you have OSA.
• Folate: You may need to increase your folate if you have restless leg syndrome.

Can insomnia during pregnancy be prevented?

Insomnia during pregnancy isn’t always preventable, but you can take steps to take better control over your sleep routine. Many of the lifestyle changes that treat insomnia can keep you from losing sleep in the first place.

How long does pregnancy insomnia last?

The changes in your body that keep you up at night return to normal shortly after you have your baby.

Still, sleep quality may not improve overnight. The demands of caring for a newborn (who doesn’t yet recognize that nighttime is “sleep” time) often keep new parents up.

Eventually, your sleep schedule will become more consistent. In the meantime, it’s essential to keep tabs on your health with your provider to ensure you’re scheduling time for rest.

When should I see my healthcare provider?

Tell your healthcare provider if sleep deprivation is taking a toll on your ability to function during the day. Managing insomnia is not only good for your health but can also prevent pregnancy complications.

What questions should I ask my healthcare provider?

Questions to ask include:

• At what point should I become concerned about my insomnia posing health risks?
• Are there things I’m doing that are keeping me from high-quality sleep?
• Is OSA or RLS contributing to my inability to fall asleep?
• What treatments would you recommend?
• At what point should I see a sleep expert for help?

A note from Cleveland Clinic

Insomnia is a frequent (albeit) unwelcome guest during pregnancy. But this doesn’t mean you have to accept that your days of rest are behind you. In fact, choosing to just accept insomnia as your new normal can be harmful to your health and the health of your pregnancy.

Talk about your sleep habits with your healthcare provider. While you can’t change things like increased hormones or weight gain, you can control your sleep habits. You can be proactive in putting routines into place that allow you to get enough quality sleep.