Insomnia during pregnancy—it’s cruel, but pretty common. Let’s talk about why it happens, when it’s the most prevalent, and how to deal with it. 

 

By OBGYN and fertility expert Dr. Kenosha Gleaton

So, you’re pregnant— you’re tired, nauseated, and walking around with a little human on your bladder. You probably feel like you need a good night’s sleep more than ever before, yet you can’t seem to fall asleep or stay asleep. Here’s the 411 on pregnancy and insomnia. 

How pregnancy affects sleep patterns

Many women report having difficulty sleeping during pregnancy. One study found the incidence of insomnia in pregnant women ranges from 12% during the beginning of pregnancy to 73% towards the end of the third trimester. 

There’s a multitude of reasons for disrupted sleep in pregnancy, including:

  • Early pregnancy symptoms: including nausea/vomiting and frequent urination
  • Mid-late pregnancy symptoms: fetal movement, heartburn, shortness of breath, cramping
  • Hormones: oxytocin, estrogen, and progesterone are all being secreted in higher amounts and can influence wakefulness and the cortisol-melatonin ratio.

When is insomnia typically the worst during pregnancy?

During the first trimester:

One study found that about 13% of pregnant women experienced sleep disturbance in their first trimester, and around 12.6% experienced insomnia.

Insomnia in the early weeks of pregnancy is usually associated with rapid changes in hormone levels. For example, estrogen administration has been found to reduce REM sleep.  There are also the common pregnancy symptoms that can be culprits of sleep disruption, including nausea, cramping, and frequent urination. 

During the second trimester:

Insomnia and sleep disturbances start to increase throughout the second trimester. Sleep disturbances are up to 19%, and there’s a decrease in total sleep-time. These interruptions in the sleep-cycle are likely due to a combination of hormonal changes and physical changes, as the body begins to change and make room for a growing baby. 

During the third trimester:

It’s most common for women to experience insomnia and sleep disturbances in the third trimester. Around 66% of women surveyed reported having sleep disturbances in their third trimester, and over 98% reported nocturnal awakenings. 

In the last few weeks of pregnancy, sleep disturbances are mostly due to general discomfort caused by fetal movement, backaches, heartburn, leg discomfort, and frequent urination. 

Tips to sleep better during pregnancy

While hormones and a growing baby are difficult to control, there are a few tricks you can use to get a better night’s sleep:

  1. Exercise: some moderate exercise during the day can help tire your muscles, causing you to fall asleep a little bit easier. 
  2. Managing nausea: “morning” sickness can make it difficult to get a good night’s rest. Trying out the BRATT diet- bland, low fat, and easy to digest foods like bananas, rice, applesauce, toast, and herbal tea, can help manage nausea and vomiting. Learn more about managing morning sickness.
  3. Pregnancy pillows: some extra cushion to support your bump and legs can be a game changer. Taking the extra weight off can help with back pain as well as overall comfort.
  4. Diet: Changing up your diet could be the solution to sleepless nights. Cutting out caffeine a couple of hours before bed (this includes small amounts found in things like chocolate), avoiding any liquids for an hour or so before bed, and avoiding heavy meals can help your body prepare for a good night's rest. 
  5. A relaxing bedtime routine: It can be hard to go from a busy day to immediately falling asleep. Get in the habit of doing something that will relax you before you get into bed. This could include journaling, yoga, reading a book, or just lighting a candle and listening to some music. Try to avoid screens if you can- research shows that screens may negatively impact sleep. 

Pregnancy-safe medications or supplements to help sleep

You may want to grab the first sleep-aid you see if you’re struggling with insomnia, but not all medicines and supplements are intended for use while pregnant. For example, benzodiazepines (flurazepam, estazolam, quazepam, and others) are not recommended for pregnancy. 

There are some pregnancy-safe options to explore, such as:

  • Magnesium - known for its stress- reducing properties and can provide sleep support
  • Melatonin: in small amounts is likely safe for short periods of time. Melatonin is useful for regulating circadian rhythms, but has been shown to have other endocrine and antioxidant benefits as well. 
  • Doxylamine: aka Unisom is considered completely safe and often effective for nausea and insomnia
  • Diphenhydramine: aka Benadryl can help with pregnancy associated congestion and insomnia

Before taking any sleep-aids, consult with your doctor to determine what is right for you. 

When to talk to your OBGYN

If you find yourself getting little to no sleep for 2 or more consecutive days, or you feel that your sleep disturbances are negatively affecting your health, talk to your OBGYN. You should also consult your doctor if a symptom such as heartburn or pain is the primary cause of your insomnia. While it’s common to lose some sleep during pregnancy, it’s also important you’re able to get an adequate amount of rest to support your overall health. 

Take-aways

  • The incidence of insomnia in pregnant women ranges from 12% during the beginning of pregnancy to 73% towards the end of the third trimester. 
  • Some common causes of insomnia during pregnancy include: nausea, frequent urination, fetal movement, heartburn, back pain, and hormonal changes.
  • Some tips to handle insomnia include exercise, relaxation, changing up your diet, and avoiding caffeine and liquids before bed.