Common sleep pregnancy issues

It’s 3 AM and you’re wide awake wondering how you’ll ever fall back to sleep when your back is aching, your heartburn is burning, and you’ve already been to the bathroom to pee four times. You expected not to sleep once the baby arrives, but no one told you it would be difficult to sleep while you were pregnant too! 

IN THIS ARTICLE

Why does sleep change during pregnancy?

During pregnancy, fluctuating hormone levels and your growing baby lead to a lot of changes that can make sleep feel hard to come by, no matter what trimester you’re currently in. You can experience things like restless leg syndrome (RLS) [] and leg cramps, nasal congestion and even obstructive sleep apnea (OSA), gastroesophageal reflux disease [] (otherwise known as GERD, heartburn, or just reflux), back pain [], and a frequent need to urinate. As if that isn’t enough, you may even be lying in bed at night anxious about your new role as a parent. Don’t worry, there are ways to help yourself get more sleep!

Why is sleep so important during pregnancy?

The American Pregnancy Association [] reports that 78% of women experience insomnia during pregnancy. A 2017 study [] of 782 pregnant women found that 28% of women sleep for less than 7 hours in the second trimester. 

Sleep is crucial for our day-to-day functioning whether we’re pregnant or not. When we experience daytime drowsiness from lack of nighttime sleep it can impact our memory, mood, and decision-making.

A lack of sleep during pregnancy can place moms at risk of developing gestational diabetes mellitus [] and impact our immune system [], too. Some studies have found that disordered sleep can lead to preeclampsia [], preterm delivery, and depression []. 

Sleep disorders in pregnancy

While many factors can keep a pregnant mom awake during the night, some of the most common sleep disorders during pregnancy [] are congestion and OSA, GERD, and RLS. It’s always a good idea to mention your sleep troubles to your trusted healthcare provider. But if you suspect you have one of these conditions, make sure to bring up your concerns in light of your symptoms and sooner rather than later.

Obstructive sleep apnea

OSA is described as snoring, gasping, and lapses in breathing leading to a reduction in airflow through the respiratory tract, reduced oxygenation, and poor quality sleep. As hormones change and your baby grows during pregnancy, nasal congestion can develop and contribute to disordered breathing. This combined with the other normal physiologic changes in pregnancy, including weight gain, can result in OSA. 

OSA can also cause risk factors. A 2017 study [] shared that there are higher rates of C-sections in pregnant women at high risk for OSA than in pregnant women without OSA. Risk factors [] of OSA may include older age, obesity, African-American race, craniofacial abnormalities, and smoking - as well as co-morbid conditions including type II diabetes, hypertension, cardiac arrhythmias, and cardiovascular disease. For those that are diagnosed with gestational OSA, there is some evidence [] that it may resolve after pregnancy. 

You may not know right away if you develop OSA during your pregnancy. If you notice that you’re falling asleep during the day while working or watching TV, getting sleepy at odd hours during the day, waking with a headache, dry mouth, or sore throat, feeling irritable or forgetful, and/or your partner tells you they’re worried about long pauses in your breathing or loud snoring during the night, talk to your doctor. 

Your doctor will review your history and symptoms, evaluate your nose, throat, and mouth, and may recommend seeing a sleep medicine specialist for a test called a sleep study or polysomnography. This will confirm the diagnosis of OSA and help your physician determine the most appropriate treatment options.

Gastroesophageal reflux disease

As many as 17 - 45% of pregnant women experience GERD [] at some point during their pregnancy. GERD is characterized by a burning sensation in the chest or stomach and can also include burping, bloating, and general discomfort. Symptoms are worse after meals and lying down, so it can definitely affect your sleep. Complications are rare but in some instances, GERD can lead to nausea and vomiting. Again, the good news is that symptoms usually resolve soon after your baby is delivered.

First-line treatments for GERD also involve lifestyle and dietary changes as well as positioning recommendations and even relaxation techniques. In some cases, your doctor may recommend medication to help.

For some pregnant people, GERD can be a sign of preeclampsia. If your symptoms are combined with headache, pain below the ribs, nausea, vomiting, feeling very sick, or sudden swelling of the face, hands, or feet, it’s recommended that you contact your doctor right away.

Restless leg syndrome

Research studies have confirmed that 26 - 30% of pregnant people [] experience RLS at some point during their pregnancy though it’s most prevalent in the third trimester. One small study [] found that 34.8% of women still had symptoms of RLS at 3 months post-delivery. More research is needed to determine when symptoms of RLS in pregnant women will truly dissipate and whether symptoms during pregnancy predict symptoms later on in life.

Symptoms of RLS include an urge to move your legs that is most often accompanied by a feeling of discomfort and usually worse at rest and in the evenings. The symptoms are usually relieved while moving or stretching but can return once the activity ceases. Some factors that may contribute to whether a pregnant person develops RLS include changing hormones, environmental/dietary variables, genetics, older maternal age, lack of sleep, depression, multiple pregnancies, and stress/anxiety. For dietary variables specifically, women who have lower serum ferritin (a protein that stores iron), low folate, and inadequate vitamin D levels without necessary supplementation are at greater risk to develop RLS []. 

If your restless legs are keeping you awake at night it’s advisable to speak with your healthcare provider. Your doctor can determine if adding iron-rich food or an iron supplement would be beneficial in relieving your symptoms. Sometimes, acupuncture and other relaxation techniques may be prescribed. Knowing can help, too.

7 tips and tricks for improving sleep during pregnancy

1. Prepare yourself for sleep

It’s difficult for anyone, let alone a pregnant person, to go from the hustle and bustle of the day straight to sleep. Create a bedtime routine that prepares your body for sleep. Take a warm, but not hot, bath to help with symptoms of RLS before bedtime. Dim the lights and turn off the screens. 

If your body is aching, do some gentle back and leg stretches. This will not only help with back pain but can relieve RLS symptoms too. Aim to go to bed around the same time each night so that your body knows what it’s supposed to be doing and when. For more information on bedtime routines for adults check out .

2. Check your environment

Ensure that your bedroom is conducive to sleep by installing black-out curtains. Play some white noise if your partner snores or you’re worried about noise outside your window waking you up. Use your bedroom, and especially your bed, for sleep and sleep-related activities only. If you frequently lay on your bed during the day to watch TV or work you’ll be less likely to associate your sleep space with sleep. 

3. Get comfortable

Pregnant people often experience back pain starting as early as the first trimester so it’s important to find a comfortable position to sleep in. Sleeping on your side can relieve pain/pressure on your back and is recommended later in pregnancy to take pressure off of your inferior vena cava as well.

Older research has found that sleeping on your left side is most beneficial for blood flow to your developing fetus. Newer research [] including women up to 30 weeks of pregnancy shows, however, that sleeping either on the left or right side is not correlated with any increase in pregnancy-related complications. Knowing the can help!

Body pillows, otherwise known as pregnancy pillows, can help to keep your spine aligned and provide back pain relief. If you’re experiencing signs of GERD while on your side, elevating the head of your bed with a wedge pillow by six to eight inches can help calm your symptoms while still allowing you the freedom to roll onto your side.

4. Keep a journal by your bed

There are so many things on a pregnant person’s ever-growing to-do list. Do yourself a favor and keep a journal next to your bed. If you think of something that needs to be done before your baby arrives, jot it down in your journal so you can quickly get back to sleep. This will help you avoid worrying all night that you’ll forget! If you’re awake worrying about getting your baby’s safe sleep space set up just right, you can read more about that .

5. Consider your diet

It’s usually a good idea to eat a diet containing iron-rich foods but this is especially true during pregnancy. Doing so can help deter the pesky symptoms of RLS and give you more energy too. Certain acidic foods have been known to trigger GERD. If you’re experiencing GERD symptoms avoid these foods [] including alcohol, coffee, chocolate, rich fatty food, tomato-based foods, fruit drinks, and fizzy drinks. Eating smaller but more frequent meals helps with GERD symptoms too.

You may also be wondering if you can take . The short answer is that it's not known if melatonin may harm fetal development so it's not recommended. Always consult your doctor before taking any supplements or medications.

6. Watch your timing of fluids

It’s important to stay hydrated all day while pregnant, but drinking too much too close to bedtime can cause you to wake frequently in the night to urinate. Aim to drink the bulk of your fluids in the earlier part of your day. In the hour or so leading up to bedtime, take a break from hydration to help cut down on your nightly trips to the bathroom.

7. Move your body

Moving your body during the day can help with backaches, body swelling, boost your mood, prevent excess weight gain, and improve muscle tone, strength, and endurance. All of these factors are so important to a good night’s sleep! Just make sure you consult your doctor before embarking on any new exercise programs while you’re pregnant.