Pregnancy often has a significant impact on a woman’s quality of sleep, particularly during the first and third trimesters. Most often, this involves inadequate levels or quality of sleep (insomnia). However, some pregnant women may also develop other sleep disorders, such as sleep apnea or restless leg syndrome (sensations felt in the legs when at rest).

Changing hormone levels are among the top sources of sleeping disorders in pregnant women. In addition, many women lose sleep as a result of anxiety about impending parenthood, the health of the fetus or a changing relationship with their partner. Pregnant women often have to urinate more frequently, which contributes to increased awakenings throughout the night that may also disrupt sleep (nocturia).

Sleep concerns often initially appear during the first trimester. In many cases, women who experience sleep disruption during the first trimester have better sleep during the second trimester. During the third trimester, pregnant women commonly experience sleep difficulties, and in many cases these problems are even more intensified than in the first trimester.

Treating sleep problems during pregnancy is complicated by the fact that many medications have the potential to harm the fetus if taken by a pregnant woman. Women who experience sleep problems during pregnancy are encouraged to adhere to a consistent sleep schedule and to ensure that they are sleeping in an environment conducive to sleep. They also are encouraged to sleep on their left side to improve circulation during sleep.

Other tips for improving sleep during pregnancy include:

• Nap regularly during the daytime
  
  
• Avoid fluids before bed
  
  
• Avoid caffeinated beverages
  
  
• Use a pregnancy pillow
  
  
• Exercise regularly

Pregnancy can have a significant impact on how a woman sleeps. In most cases, sleep disturbances are limited to insomnia (inadequate amount or quality of sleep). However, some pregnant women may also develop other sleep disorders such as sleep apnea or restless leg syndrome (sensations felt in the legs when at rest).

A recent poll by the National Sleep Foundation found that the majority of pregnant respondents reported some level of sleep disturbance. Women who are pregnant often report unusual levels of fatigue, especially during the first and third trimesters, due to these sleep disturbances.

Changing hormone levels are among the top causes of sleeping disorders in pregnant women. In addition, many women lose sleep as a result of anxiety about impending parenthood, the health of the fetus or a changing relationship with their partner.

Sleep concerns often initially appear during the first trimester. As progesterone levels rise in a pregnant woman’s body, drowsiness during daytime hours may occur. While total sleep time often increases in the first trimester, the quality of sleep declines. Body changes make it more difficult for many women to become comfortable while sleeping. This may cause delayed sleep and frequent awakenings during the night.

In addition, pregnant women experience a need to urinate more frequently that leads to waking at night to use the bathroom (nocturia). Rising progesterone levels inhibit the action of the body’s smooth muscles, which contract without a person’s conscious control. Inhibition of the smooth muscles is the main source of an increased need to urinate during the first trimester. Expansion of the uterus also shrinks the storage capacity of the bladder. Finally, the kidneys are increasingly taxed by the need to filter increased blood volume that occurs during pregnancy. All of these factors contribute to a more frequent need to urinate, increased awakenings and rougher sleep.

Because women are less rested during the first trimester of pregnancy, they may become fatigued, irritable and depressed. In addition, many women experience persistent bouts of nausea and vomiting during the first trimester. This condition is traditionally known as morning sickness (hyperemesis). Despite the name, nausea and vomiting can occur at any time of day during the first trimester and may also disrupt sleep.

In many cases, women who experience sleep disruption during the first trimester often have less trouble during the second trimester. Nausea may begin to dissipate during the second trimester of pregnancy, hormonal changes start to stabilize and women often find less need to use the bathroom as the uterus moves higher into the abdomen. The second trimester is often a time when women begin to sleep more normally.

However, during the second trimester, many women report an increased frequency of nightmares, which may disrupt sleep. Heartburn may also disrupt sleep at this time, often caused by the expanding uterus and the slowed movements of gastrointestinal muscles (due to increased progesterone levels).  

During the third trimester, women generally experience a return to the sleep difficulties of the first trimester. In many cases, these sleep problems are intensified during the third trimester. As a woman’s body increases in size, she is likely to grow increasingly tired. She may find it even more difficult to become comfortable during sleep and will once again experience an increased need to urinate.

The vast majority of pregnant women frequently awaken throughout the night during the third trimester. They also begin to snore and to experience back pain and other discomforts that may interfere with sleep. A recent poll by the National Sleep Foundation found that up to 15 percent of women develop restless leg syndrome during the third trimester. This condition is characterized by uncomfortable feelings in the legs that prevent sleep, and it is often caused by iron deficiency. For most women, the condition resolves after pregnancy.

Lack of proper sleep during late pregnancy can significantly impact a woman’s delivery. Studies show that women who receive inadequate sleep during the last month of pregnancy may be at increased risk of a longer period of labor or require delivery by Caesarean section (C-section). Women are encouraged to discuss their sleeping patterns with their physician during regular prenatal care visits.

Other factors that may negatively impact a pregnant woman’s ability to sleep include:

• Faster heart rate. A woman’s heart rate increases during pregnancy to pump the increased volume of blood.
  
  
• Shortness of breath. The expanding uterus can place increased pressure on the diaphragm (muscle between the chest and abdomen), which can make it more difficult to breathe. In addition, pregnant women must breathe faster and more deeply due to an increased need for oxygen.
  
  
• Aches and pains. The dramatic bodily changes that occur during pregnancy can lead to backaches, leg cramps and other pains that may hinder a pregnant woman’s ability to sleep. For example, hormonal changes cause the ligaments between bones and joints to loosen and cause pain that can disrupt sleep.
  
  
• Fetal movements. The movements of a fetus may be active enough to disrupt a woman’s sleep.

Treatment of sleep problems during pregnancy is complicated by the fact that many medications have the potential to harm the fetus if taken by a pregnant woman. As a result, most treatments related to sleep during pregnancy involve lifestyle changes and coping techniques.

Women who experience sleep problems during pregnancy are encouraged to adhere to a consistent sleep schedule and to sleep in an environment conducive to sleep. Usually, this is a cool, dark, quiet room. Women are urged to get as much extra sleep as possible. This helps keep them rested and prepared for times when it is more difficult to sleep.

Beginning in the first trimester, women are encouraged to sleep on their left side. This position aids the flow of blood and nutrients to both the woman and fetus and helps prevent extra body weight from pressing on the liver and the inferior vena cava (a large vein that moves blood from the legs back to the heart). Lying on the left side may also help the kidneys to filter wastes and fluids during sleep. Generally, women are urged to sleep with their knees and hips bent. Back pain may be reduced by sleeping with a pillow between the knees, under the abdomen or behind the back.

Pregnant women are urged to avoid sleeping on their back. Lying in this position for extended periods of time can contribute to backaches, breathing problems, digestive problems, hemorrhoids, low blood pressure, and decreased circulation of blood and oxygen for both the woman and fetus. By the third trimester, most women find it difficult if not impossible to sleep on their backs. Sleeping on the stomach also should be avoided during pregnancy.

Other tips for improving sleep during pregnancy include:

• Keep a night-light in the bathroom. Keeping the main overhead lights off during nighttime trips to the bathroom may prevent fully awakening during the night.
  
  
• Nap regularly during the daytime when possible.
  
  
• Avoid fluids before bed. Drinking too much prior to sleep can result in awakenings.
  
  
• Avoid all caffeinated drinks during pregnancy.
  
  
• Monitor the foods and beverages consumed. Snacking on bland foods such as crackers may help prevent nausea, which can interfere with sleep. Avoiding spicy, acidic or fried foods – especially at dinner – may also reduce the incidence of heartburn during the night. Avoiding carbonated drinks can help prevent leg cramps, which may also disrupt sleep.
  
  
• Speak with a therapist or counselor about worries or concerns. Mental health experts can help pregnant women learn to deal with any anxiety they may have. The use of relaxation techniques or participating in relaxing activities such as yoga also may be recommended.
  
  
• Use a pregnancy pillow. These special pillows are made to help facilitate sleep during pregnancy.
  
  
• Exercise regularly. Regular activity can help pregnant women sleep better at night. However, it is crucial to consult a physician before exercising during pregnancy.

Women who are overweight or obese are at increased risk for developing sleep apnea during pregnancy. In some cases, these patients may benefit from using continuous positive airway pressure (CPAP), a treatment method that uses a special mask to provide oxygen that helps keep the patient’s airway open during sleep. Women who report snoring accompanied by breathing pauses during pregnancy typically are urged to seek evaluation for the possibility of sleep apnea.

Preparing questions in advance can help patients have more meaningful discussions with healthcare professionals regarding their conditions. Patients may wish to ask their doctor the following questions related to sleep and pregnancy:

1. What type of sleep disruptions should I expect during my pregnancy?
   
   
2. When during my pregnancy are these likely to occur? How long will they last?
   
   
3. How can I sleep better during pregnancy?
   
   
4. Will exercise help me sleep better? How frequently may I safely exercise while pregnant?
   
   
5. What foods or beverages should I avoid during pregnancy? Will avoiding them help me sleep better?
   
   
6. What relaxation techniques might help me?
   
   
7. Can you recommend a counselor or therapist to help me deal with anxiety while I’m pregnant?
   
   
8. What are the chances that I may have sleep apnea? Do you recommend I get tested for it?
   
   
9. Should I look for anything in particular when choosing a pregnancy pillow?
   
   
10. Are there any other devices you’d recommend to help me sleep better?