Credit...Ana Galvañ

Can’t Sleep While Pregnant?

Certain hormonal changes, along with other pregnancy-related discomforts can sink a good night’s sleep. Here’s how to snooze more soundly.

This guide was originally published on May 22, 2019.

Like the perfect maternity outfit, sleep is something many pregnant women covet. My second and third pregnancies, for instance, were plagued with such bad morning sickness that I was left vomiting throughout the night. When that eased, my son’s kicking became so intense that one particularly sharp jab in the middle of the night caused me to awake to soaked sheets — I’d peed all over my bed.

According to one study published in the journal Sleep Medicine in 2015, most women experience some type of sleep problem during pregnancy. Of the 2,427 women surveyed, for example, all reported frequent nighttime wakings while they were pregnant; nearly 60 percent reported insomnia; and about 80 percent found it difficult to find a comfortable sleeping position.

“My patients always come to me in a panic because they’re worried about not sleeping,” said Dr. Laura Riley, M.D., an ob-gyn at New York-Presbyterian/Weill Cornell Medical Center in New York City. But this sleep deprivation isn’t harmful in any way to you or your baby. “Your body will naturally protect itself and make sure you fall asleep eventually,” Dr. Riley added. “You’ll get the rest you need.”

Still, after reviewing the latest scientific studies and recommendations and consulting with three ob-gyns, one sleep expert and a professor of nursing who’s well-versed in the topic, I found several research-backed strategies to help you get a sounder snooze.

[Pregnancy pains got you down? Read this.]

Each trimester can bring a litany of different bodily changes that can affect sleep, noted Dr. Riley. Progesterone levels rise during the first three months of pregnancy, for instance, which can increase sleepiness; but at the same time you may be struggling with nausea, which can make it harder for you to doze off. During your second trimester, your growing uterus puts pressure on your bladder, which can lead to the need for multiple bathroom breaks at night. The third trimester, however, is when “pure, sheer discomfort hits,” said Dr. Riley. Your rapidly expanding uterus can push acid from your stomach up your esophagus, triggering heartburn; while the weight of carrying your baby may lead to back pain and leg cramps. Combine these with your ever-increasing bathroom trips, and you’ve got the recipe for nights of fitful, uncomfortable sleep.

As your pregnancy progresses, your burgeoning belly may make it harder and harder to find and settle on a pleasant sleeping position. While it’s generally O.K. to sleep any way that’s comfortable during your first and the beginning of your second trimesters, experts recommend trying to sleep on your side after about 20 weeks. “As your uterus gets bigger, it lies on top of your inferior vena cava, which is the large blood vessel that provides blood to your heart,” explained Dr. Salena Zanotti, M.D., an ob-gyn at the Cleveland Clinic in Ohio. If your uterus rests on this vessel — which runs behind your abdominal cavity from your legs to your heart — for too long, it could cause a sharp dip in blood pressure that could theoretically impede blood flow to both you and your baby.

A 2017 study published in the journal B.J.O.G., for example, found that of more than 1,000 women who answered questionnaires about their sleeping positions, those who reported sleeping on their backs during their third trimesters had more than double the risk of stillbirth than those who slept on their sides. Other, older studies have found similar results.

But if you do end up on your back accidentally, reassured Dr. Zanotti, “we find that women will automatically either wake up on their own or instinctively shift over to their side in their sleep because they feel uncomfortable and light headed.” If you’re concerned about rolling over from your side, Dr. Zanotti recommended putting a pillow between your back and the mattress, so even if you do end up on your back, you’ll be on a tilt, which puts less pressure on the inferior vena cava.

Many pregnant women experience heartburn, back pain, nasal congestion and even trouble breathing due to both the pressure of their expanding uterus and hormonal changes. While these conditions may be present during the day, you may notice them more at night because you’re lying down (which can make symptoms like heartburn worse) and there are fewer things to distract you when you’re resting.

You can often relieve these uncomfortable symptoms by simply propping yourself up with pillows so that you’re sleeping at a 45-degree angle, said Dr. Sally Ibrahim, M.D., a sleep specialist at the Cleveland Clinic. You can also place a pillow between your bent knees while lying on your side to help relieve back pain, along with one under your stomach to support its weight and one behind your back to deter you from rolling over. There’s no need to spend money on a pricey pregnancy pillow, but if you can’t find relief with the ones you have at home, you might consider a body pillow, advised Dr. Ibrahim. The Wirecutter, a New York Times company that does rigorous product reviews, recommends the Bluestone Full Body Contour U Pillow or the Snuggle-Pedic Memory Foam Body Pillow.

Many of the same strategies that can help you sleep when you’re not pregnant can help you sleep when you are, said Dr. Ibrahim. These include sticking to a regular sleep schedule (waking up and going to bed at the same time each day), cutting off caffeine after lunch (health experts recommend no more than 200 milligrams of caffeine, or the amount in a 12-ounce cup of coffee, per day if you’re pregnant), and avoiding the use of electronic devices such as smart phones, tablets and laptops since many emit a type of light called blue light, which can make it harder to fall asleep.

Regular exercise is also key. The United States Department of Health and Human Services recommends that pregnant women get at least 150 minutes of moderate exercise such as brisk walking or swimming each week. But try to exercise earlier in the day — at least four hours before bedtime — since evening workouts can raise your body temperature and heart rate and make it more difficult to fall asleep, said Dr. Kathryn Lee, Ph.D., R.N., a professor of nursing at the University of California, San Francisco.

Another good option to consider is yoga. Though there haven’t been many formal studies on the topic, one small Japanese study published in The Journal of Obstetrics and Gynaecology Research in 2018 found that among 38 pregnant women who had at least one 1-hour yoga session each week, those who were in their third trimesters reported getting more sleep and had fewer nighttime wakings than the 53 pregnant women who didn’t practice yoga. Avoid napping as much as possible, said Dr. Ibrahim. It’s tempting, especially with the fatigue of the first trimester, but anything more than a brief 30- to 60-minute cat nap can lead to trouble falling asleep at night.

Increased progesterone levels, along with a rapidly expanding uterus pushing against your bladder, mean more trips to the bathroom. While it can merely be an annoyance during the day, it can be downright frustrating at night when you’re awoken for the umpteenth time. “The temptation many pregnant women have is to cut down on what they drink,” said Dr. Riley. “But that’s a bad idea.” Your body needs fluid, not just for you, but for the baby too. Dehydration during pregnancy can also make you more susceptible to leg cramps or Braxton Hicks, aka “false” contractions. The Office on Women’s Health recommends that pregnant women drink at least 10 cups of fluid, preferably water, each day. (Coffee and tea are fine too, just remember to avoid going over the 200-milligram limit of caffeine per day.) If you find that you’re waking up more than once or twice a night to urinate, plan on getting the bulk of your liquids during the morning and afternoon. Cut off all liquids about two hours before bed.

[Why are pregnant women so sweaty? We found out.]

According to a study published in the journal Obstetric Medicine in 2015, about 4.5 percent of pregnant women in the United States say they’ve taken over-the-counter or prescription sleep aids during their pregnancies. But, said Dr. Riley, “I tell my patients not to use them.” While diphenhydramine (Benadryl), the most commonly recommended over-the-counter sleep medicine by doctors, can help and is safe to take occasionally while pregnant, it loses its effectiveness if you take it more than once or twice a week, Dr. Riley said. Some doctors prescribe zolpidem (Ambien), but that may carry risks: One Taiwanese study of nearly 12,500 pregnant women published in the journal Clinical Pharmacology and Therapeutics in 2010 found that the nearly 2,500 pregnant women who used zolpidem for more than 30 days during their pregnancies had a 39 percent increased risk of low birthweight, 49 percent increased risk of preterm delivery and a 74 percent increased rate of C-section compared to the women who didn’t take the drug. Dr. Riley also advised against using the dietary supplement melatonin. “We just don’t have enough information about its safety,” she said.

If you or your sleeping partner notice that you’re snoring, see your doctor. While snoring becomes common as pregnancy progresses (some research suggests that nearly half of all pregnant women snore), it could be a sign of sleep apnea — a serious sleep condition which causes a temporary cessation of breathing while sleeping. Pregnant women with sleep apnea are not only more likely to be diagnosed with pre-eclampsia and gestational diabetes, but they also tend to have longer hospital stays after giving birth and serious pregnancy complications such as congestive heart failure and cardiomyopathy (enlarged heart muscles).

It’s important to talk to your doctor if you snore, said Dr. Ibrahim, especially if you have other risk factors for sleep apnea such as being overweight or if you have been diagnosed with hypertension (high blood pressure), Type 2 diabetes or pre-eclampsia during your pregnancy. Weight gain during pregnancy can also worsen sleep apnea, as it can lead to the accumulation of more fat around the neck area.

If you have symptoms, your doctor can refer you to a sleep specialist who can conduct a sleep study and prescribe treatment, which usually involves wearing a continuous positive airway pressure device while sleeping. C.P.A.P. devices deliver a constant flow of pressurized air to help keep your airway open. Symptoms usually improve after delivery.

Also talk to your doctor if you have an uncontrollable twitchy feeling in your lower legs. According to the National Sleep Foundation, about 15 percent of pregnant women develop restless leg syndrome — an almost uncontrollable urge to move the legs, particularly in the evenings — in the last trimester of their pregnancies. Symptoms, which tend to worsen at night and improve after any kind of movement, typically resolve after giving birth. But developing it in one pregnancy ups your chances of doing so in later ones, said Dr. Ibrahim. In some cases, an iron or folic acid deficiency can be to blame for R.L.S. during pregnancy, so it’s important for your doctor to check your blood levels of both. If your levels are low, your doctor may recommend a supplement. Most doctors also recommend cutting out caffeine; getting 30 minutes of exercise most days of the week; and avoiding sedating antihistamines, such as Benadryl, which can worsen the problem. While there are medications for R.L.S., such as ropinirole (Requip), it’s still not clear how safe these are to use during pregnancy, so doctors recommend avoiding them.

Hallie Levine is a health and science journalist and a mother of three.