A guide to sleeping while pregnant

Pregnancy is an exciting time for expectant moms and families. When considering the physical and emotional impact pregnancy can have on women, however, sleep is often affected and can oftentimes be disturbed. Many pregnant women also experience fatigue and daytime sleepiness and develop sleep problems during pregnancy.

With the majority (78 percent) of expectant women reporting sleep disturbances, it’s important for women to understand how pregnancy can impact sleep.

Healthy sleep is essential for both mom and baby, to ensure expectant mothers and babies stay healthy, and babies develop properly while in the womb. Studies show that sleep problems can be linked to complications at birth including preterm delivery; and after birth, such as postpartum depression.

In this guide, we will explore these aspects related to pregnancy and sleep:

• Why sleep is important during pregnancy
• How pregnancy affects sleep
• Sleeping positions during pregnancy
• Sleep disorders during pregnancy
• Sleeping with a partner
• Top sleep tips for pregnancy
• Resources for pregnancy sleeping

Why is sleep important during pregnancy?

During pregnancy, women need both healthy and extra sleep, because it takes a lot of energy to grow a baby. The entire body is working harder than normal, and changing hormones and sleep-related issues can make getting a good night’s rest a challenge.

The first step in making sleep a priority during pregnancy is to make sure you’re getting enough sleep. The National Institute of Child Health and Human Development recommends the following hours of sleep for expectant mothers, infants, and children:

• Pregnant women: 9 to 11 hours (regular adults need 7-9 hours)
• Newborns up to 3 months: 14 to 17 hours per day
• Infants up to 15 months: 12 to 15 hours
• Toddlers up to 2 years: 11 to 14 hours

The amount of sleep and quality of sleep is directly linked to overall health and wellbeing for pregnant women. Consider the effect that the relationships between sleep and pregnancy have on the following:

Energy: Pregnant women need more energy than the average person, due to the physical demands and changes happening to the body during pregnancy. The body uses energy to recover and repair itself, which is important for women as their bodies change during pregnancy.

Weight gain: Expectant mothers have recommendations for gaining weight, and poor sleep could affect weight gain or loss, which could ultimately put babies at risk. It’s also important for pregnant women to be active to ensure they stay strong and don’t gain too much weight. Insufficient sleep can cause a lack of motivation to be active.

Mood: Sleep deprivation can lead to depression, anxiety, and mood problems, all of which could have a negative impact on pregnant women. Although mood swings are common for pregnant women, lack of sleep and fatigue can make them and mood-related symptoms more severe.

How pregnancy affects sleep

Pregnancy puts higher demands on expectant mothers both emotionally and physically, which can impact overall mood, comfort, and sleep, most importantly. The physical symptoms associated with pregnancy are also the most common causes of poor sleep and can include headaches, nausea/vomiting, urinary frequency, heartburn, backaches, and cramps.

Changing hormone levels are responsible for many of the sleep issues and fatigue women experience during pregnancy. According to one study, a higher level of cortisol, estrogen, and progesterone can increase arousal and add to sleep disorders like insomnia.

During pregnancy, women may experience new or more intense pre-existing sleep issues as they progress through each trimester. From the time a woman becomes pregnant to the time her child is born, they experience sleep problems common and associated with each trimester, as well as during the postpartum period.

In this part of the guide, we will explore how sleep changes during the stages of pregnancy:

First trimester

During early pregnancy, hormone levels can make expectant mothers feel exhausted. An increase in metabolism and blood production and lower blood pressure are responsible for taking much of the energy. Plus, if you’re working or taking care of other children and a family, this can add to fatigue.

Pregnant women tend to sleep more during their first trimester, which spans 12 weeks. During this time, changes in hormones can cause symptoms that make sleeping more difficult, thus resulting in more fatigue.

Women may experience sleep-related issues including insomnia, frequent urination, aches and pains, cramping, and nausea, also known as morning sickness. All of these issues can disrupt a solid night of sleep, leaving pregnant women feeling unrested and fatigued.

Here are some tips for getting healthy sleep during the first trimester:

• Take naps when you need rest (listen to your body when it is time to slow down)
• Train yourself to sleep on your left side and use lots of pillows
• Drink plenty of fluids during the day (to reduce nighttime trips to the bathroom)
• Consider light snacks to help with morning sickness
• Keep a consistent bedtime schedule and a healthy sleep environment
• Exercise regularly to promote better sleep at night

Second trimester

This trimester is usually welcomed by expectant moms because some of the sleep-related issues during the first trimester will typically fade away. That goes for morning sickness, too. For many women, this timeframe is considered to be the easiest trimester during pregnancy, and they start to feel like themselves again. They usually get a boost in energy and experience more normal sleep patterns.

During these three months, the baby grows rapidly, and expectant parents can usually see the progress with an ultrasound around 18 to 22 weeks. This is often when parents will find out the sex of the baby.

Despite feeling more normal, there are still many changes happening to the body. These common issues during the second trimester may impact comfort and sleep:

• Backaches: extra weight from the baby can put more pressure on the back. It is recommended that you use a supportive chair with good back support, and use the side sleeping position with a pillow in between your legs. It’s also important to wear comfortable shoes. Body aches can keep women up and uncomfortable at night and may disrupt sleep.
• Leg cramps: muscle contractions can be uncomfortable. Stretching, hot showers or baths, and staying active and hydrated are a few ways to prevent cramps. These cramps can be disruptive during rest and sleep.
• Frequent urination: although less frequent than in the first and third trimesters, women still experience frequent trips to the bathroom. This can disrupt sleep and lead to insufficient sleep.
• Heartburn: this is caused by the body producing more hormones, specifically progesterone. It relaxes muscles in the lower throat that are responsible for keeping acids and foods down, and the ones that process food in the intestines. Heartburn can keep pregnant women up at night, which affects sleep. It is recommended to eat smaller meals during the day and avoid any foods that are acidic or spicy.

Consider these tips to get better sleep during the second trimester:

• Try keeping your head elevated to help prevent heartburn
• Sleep as many hours as possible, but as close to 8 hours as you can
• Make sure you sleep on your side (left) with knees and hips bent
• Use pillows to prop yourself up and between your legs to ease tension in the back
• If you experience bad dreams or nightmares, be sure to talk to someone (therapist or counselor)
• Stretch to prevent cramping
• Take naps when you need rest (listen to your body when it is time to slow down)
• Keep a consistent bedtime schedule and a healthy sleep environment
• Exercise regularly to promote better sleep at night

Third trimester

During the third trimester, the baby makes the biggest gains in development and size. For expectant mothers, this means the body is still changing and there are many common symptoms and issues that impact both comfort and sleep. This is the most challenging trimester for expectant mothers. Not only are they dealing with their own everyday schedule, but the baby also has his or her own patterns of sleep and may wake them up with kicks or movement.

Similar to those experienced during the second trimester, the following symptoms are also common among women in the third trimester:

• Backaches (one study showed that backaches are the biggest contributor to sleep disturbances)
• Heartburn
• Frequent urination
• Leg cramps

Additional issues during the third trimester include:

• Night waking: although this occurs throughout pregnancy, it is the most severe during the third trimester. According to one study reported by the National Sleep Foundation, women were waking up at night 3.11 times every night on average. These sleep disturbances make it difficult to get quality and healthy sleep, and they interrupt the sleep cycles.
• Snoring: this can be attributed to congestion or swelling and can put the mother and baby at risk because of high blood pressure. Snoring may disrupt sleep, and could also be a sign of sleep apnea if breathing starts and stops again. It’s important for expectant mothers to be informed about sleep apnea and its symptoms and treatments.
• Restless leg syndrome (RLS): about 15 percent of pregnant women develop RLS, and for many, it goes away after birth. The disorder can cause sleep deprivation, which can have a negative impact on overall health and wellbeing. Poor sleep can also have an affect on labor and delivery.

In the third trimester expectant mothers often have anxiety about motherhood and birth, and this can sap the energy level and lead to sleep-related problems, like insomnia.

Consider these tips to get better sleep during the third trimester:

• Sit down and relax or take naps when you need rest (listen to your body when it is time to slow down)
• Sleep on your left side with knees and hips bent and a pillow between your legs (avoid laying on your back)
• Eat a healthy diet
• Keep a consistent bedtime schedule and healthy sleep environment
• Exercise regularly to promote better sleep at night
• Avoid carbonated drinks if you have leg cramps
• Try keeping your head elevated to help prevent heartburn
• Sleep as many hours as possible, but as close to 8 hours as you can
• Use pillows to prop yourself up and between your legs to ease tension in the back
• If you experience bad dreams or nightmares, be sure to talk to someone (therapist or counselor)
• Stretch to prevent cramping

Postpartum

After your child is born, you enter the postpartum phase. This is also known as the fourth trimester and is also associated with sleep-related challenges. During this trimester, both mom and baby will adjust to the new schedule.

Newborns wake up frequently, and it is important for parents to understand their sleep patterns and the importance of creating a schedule. This will help ensure babies get the sleep they need because it is vital to their development. Learn more about sleep for newborns in our Children’s Sleep Guide.

Frequent waking up, feeding, and caring for your baby can be overwhelming and lead to fatigue and sleep deprivation. During this time, mothers are at risk for postpartum depression (PPD), which is depression and anxiety experienced by women who recently gave birth. Stress, life-changing events, and hormonal changes that occur after giving birth may lead to PPD. Ultimately, PPD can result in sleep-related problems, like insomnia.

Consider these tips to get better sleep during the postpartum period:

• Eat a healthy diet
• Keep a consistent bedtime schedule and a healthy sleep environment
• Exercise regularly to promote better sleep at night
• Talk about your sleep
• Don’t ignore how you feel: if you experience symptoms of depression, anxiety, insomnia, or any sleep-related problems, talk to your doctor or a counselor
• Don’t take on more responsibility than you already have
• Sleep when your baby sleeps
• Let others help you and divide up household responsibilities with your partner
• Be aware of how symptoms affect your sleep, and seek help if you notice symptoms of sleep apnea

Sleeping positions during pregnancy

The changes that happen to the body during pregnancy may require you to make a change to your sleeping position. The new (larger) shape of your body, back/neck pain, insomnia, shortness of breath, and even heartburn can also affect the way you feel in your normal or favorite sleeping position.

Unfortunately, your normal sleeping position may no longer be an option for you during pregnancy. It may take time to adjust to the new and most recommended sleeping positions.

The best sleeping position during pregnancy is SOS (sleep on side), according to the American Pregnancy Association. Taking that one step further, the American Pregnancy Association recommends sleeping on the left side, with legs and knees bent with a pillow between the legs. This position helps increase the amount of blood that reaches the baby (through the placenta).

Side sleeping

Side sleeping is the highest recommended position for pregnancy, and sleeping on the left side specifically.

Pros:

• Good blood and nutrient flow
• Positions the uterus off of the liver
• Reduces swelling (hands, legs, ankles, and feet)
• Reduces back pain

Cons:

• May not be comfortable at first
• Pressure on one side of the body
• May cause heartburn and shortness of breath (using pillows to change your position may help with both)

Read our Best Mattresses for Side Sleepers to learn more about recommendations for this sleeping position.

Back sleeping

Back sleeping should be avoided during pregnancy, according to the American Pregnancy Association.

Pros:

• Most comfortable if you’re a back sleeper
• Maybe OK sometimes, especially if you wake up on your back.

Cons:

• Backaches
• Low blood pressure and circulation (to mom’s heart and to the baby)
• Digestion issues
• Hemorrhoids

Read our Best Mattresses for Back Sleepers to learn more about mattress recommendations for this sleeping position.

Stomach sleeping

Stomach sleeping can be OK during early pregnancy, but as the body changes, it becomes more uncomfortable.

Pros:

• Easy for the beginning of pregnancy before abdomen changes
• Safe (although not always comfortable in later stages of pregnancy)

Cons:

• Neck and backaches
• The strain on the spine and back

Read our Best Mattresses for Stomach Sleepers to learn more about recommendations for this sleeping position.

Combination sleeping

It is OK to shift positions through the night during pregnancy, but expectant mothers should follow recommendations for side sleeping.

Pros:

• Changing positions is OK and can prevent pressure on parts of the body to prevent aches and pain

Cons:

• You may have more sleep disturbances in shifting positions to try to get comfortable again

Read our Best Mattresses for Combination Sleepers to learn more about recommendations for this sleeping position.

Sleep disorders and pregnancy

Changing hormones during pregnancy is the major reason behind many sleep problems. That said, pregnant women may also experience sleep issues during pregnancy because of pre-existing sleep disorders. Either way, these disorders can exacerbate anxiety, mood, daytime sleepiness, and fatigue.

It’s important for pregnant women to be aware of potential sleep disorders during pregnancy, and of the affects pregnancy can have on existing sleep disorders. Being knowledgeable helps ensure you are using proper treatment and seeking help if needed.

In this guide, we will break sleep disorders during pregnancy into two different categories, and discuss each disorder and treatments, including possible sleep aids:

• How pregnancy affects pre-existing sleep disorders
• Sleep disorders that might develop during pregnancy

How pregnancy affects pre-existing sleep disorders

Sleep Apnea: 

Sleep apnea is a sleep disorder that causes breathing to stop and start again during sleep, which can occur hundreds of times during the night. This happens when the airway in the back of the throat is blocked and reduces oxygen flow to the brain.

Symptoms include: snoring, tossing/turning, gasping for air, sore or dry throat in the morning, morning headaches, difficulty concentrating, and daytime sleepiness. This disorder can disrupt sleep, resulting in sleep deprivation.

Treatments include: a continuous positive airway pressure (CPAP) machine that uses air pressure to keep your airway open; custom-made mouth appliances to keep your throat and airway open; and surgery, which can be performed before or after pregnancy.

Pregnant women should watch for symptoms and speak with their doctor about sleep apnea. Sleep apnea can cause poor sleep, which can have an impact on labor and delivery, according to the National Sleep Foundation.

Narcolepsy: 

This a disorder that causes people to fall asleep at any time, very suddenly without any notice. This could occur during normal activities like eating, working, or driving. The disorder can cause people to be sleepy during the day even if they’ve gotten enough sleep and can distract from a regular life and sleep routine.

Treatments include: natural home remedies like: keeping a regular sleep schedule; naps during the day at certain times; exercise; avoiding certain activities (like driving) when you feel sleepy. Other treatments are narcolepsy medications, which all have some risks to child development. These drugs are all focused on reducing daytime sleepiness, and other symptoms caused by this disorder like fatigue or headaches. Many women opt to stop taking these drugs during pregnancy.

Pregnant women should consider the risks of taking medications during pregnancy, and talk to their doctor about the disorder, to ensure they are getting healthy sleep. 

Insomnia: 

This disorder can be experienced before pregnancy and is when people have a difficult time falling asleep, staying asleep, or waking up too early, and feeling unrefreshed.

Symptoms of insomnia include: trouble falling asleep at night, waking up at night, low energy during the day, irritability, depression, anxiety, difficulty concentrating, poor work performance, headaches, and stomach issues.

Treatments include: non-medical treatments include: sleep restriction and stimulus control training, cognitive behavioral therapy, relaxation training, breathing exercises, meditation, guided imagery, and alternative medicine like acupuncture. Medications for insomnia are both over-the-counter and prescription drugs and the majority of these are benzodiazepines, sleeping pills, antihistamines, and antidepressants.

Pregnant women should know that as the pregnancy progresses, so does the incidence of Insomnia. It’s also important for them to understand that prescription insomnia medications should not be taken during pregnancy, and they should talk to their doctor about a treatment plan. There may be some over-the-counter pills, supplements, and herbs that can be taken as sleep aids, but these should still be discussed with their doctor.

Sleep disorders that might develop during pregnancy

Insomnia (see above for pre-existing condition): this disorder can be brought on by stress and anxiety related to all-things pregnancy, birth, and motherhood. The overwhelming feelings can cause insomnia, resulting in sleep deprivation. Poor sleep is linked to birth complications and can negatively impact overall health and wellbeing, including mood.

Restless leg syndrome: also known as RLS, this disorder causes unpleasant sensations or an uncontrollable urge to move your legs when resting. The symptoms of RLS are even more severe at night, which can cause sleepers to stay awake and disrupts sleep. This can lead to sleep deprivation.

Possible treatments for RLS include making lifestyle changes such as implementing a good sleep routine, taking a hot bath, exercise, iron supplements, healthy diet, massage, relaxation, and reducing caffeine intake. There are a handful of medications for RLS, that haven’t been studied among pregnant women long enough for data to prove the drugs won’t affect the baby. Women should consult with their doctor before taking any supplements or medications while pregnant.

Pregnant women should watch for symptoms of RLS and make sure they consult the doctor before taking any supplements or discussing medications. Sleep deprivation caused by RLS can have a negative impact on overall health and wellbeing, and potentially labor and delivery.

Sleep Apnea (see above under pre-existing condition): This disorder may develop during pregnancy, and overweight women may be more at risk.

Sleeping with a pregnant partner

Pregnancy is definitely a life-changing event, and its impact on sleep can affect both expectant mothers and their sleeping partners.

When sleeping with a partner who is pregnant, expectant parents should be prepared for the following changes:

• Sleep disturbances become more frequent
• Rotating positions may become more common
• Snoring may occur and become more severe
• Trips to the bathroom become more frequent during the night
• Insomnia may cause your partner to be up during the night
• Your partner may experience restless leg syndrome
• Heartburn is very common
• Pregnant women may develop sleep apnea
• Frequent back, neck, and body aches

To be up to the task of being the best partner possible, it’s important that you get healthy sleep, too, so you can offer support while feeling emotionally and physically rested.

Consider these top tips to make sure you are getting good quality sleep:

• Pick the right mattress and pillows for you and your partner, and consider what is recommended for your sleeping position.
• Make your bedroom a sleep-only zone, and avoid screens, like TVs and phones.
• Exercise during the day.
• Stick to one consistent bed and wake-up time.
• Drink less fluid during the night to avoid getting up in the night.
• Limit big meals, alcohol, caffeine, and nicotine before bed.
• If you can’t fall asleep, get out of bed and try doing something that will make you sleepy, and then try going to bed again.
• Make your pre-bed ritual relaxing for both you and your sleep partner.

There are many things you can do for your partner to help promote healthy sleep during pregnancy. Consider the following:

• Offer your partner a massage before bed
• Make your partner a hot bath or warm tea
• Ensure your room is dark and quiet
• Make sure the sleeping temperature is cool (it’s easy for pregnant women to get hot during sleep)
• Avoid distractions like TV, phones, and tablets
• Consider a relaxing sound machine or white noise maker
• Encourage your partner to take breaks and nap if needed
• Sleep in another room if you snore loudly and keep your partner awake, or if you are sick
• If you have a different sleep schedule, make sure your routine is quiet and relaxing in the evening and morning
• Help arrange the pillows for your partner
• Choose an activity to do together to wind down before bed

The top 10 sleep tips for pregnancy

The National Sleep Foundation recommends that pregnant women make sleep a priority and manage any sleep issues as early as possible, to ensure healthy sleep for them and their babies. This can be achieved by implementing schedules and habits that promote healthy sleep.

Consider these top sleep tips for pregnancy:

Pick the right mattress

Each person has different preferences and sleeping positions, and those can vary during pregnancy. That said, support and comfort are extremely important for expectant moms during pregnancy. Read more about the best mattresses for couples and sleeping as a couple during pregnancy.

Plan, schedule, and make sleep a priority

You need healthy sleep to function your best, and to ensure you stay healthy during pregnancy.

Limit screen time before bed

While a majority of smartphone owners use their phones before bed, this common practice makes it harder to fall asleep because blue light stimulates the mind. Lack of sleep can impact overall health and wellbeing. The National Sleep Foundation recommends powering down devices at least 30 minutes before going to sleep.

Sleep on your left side

Give your body and your baby the best chance to get blood flow and nutrients. Keep your knees and hips bent and use a pillow between the knees and behind your back to avoid lower back pain.

Regulate what you drink before bed and avoid certain foods

Make sure you drink plenty of water during the day (not at night) to avoid trips to the bathroom all night. Limit foods that can cause heartburn, and stick to small meals throughout the day.

Take daytime naps when you need to rest

If you have trouble falling asleep at night, try to take fewer naps.

When you can’t sleep, get up and do something else

Laying awake forcing yourself to sleep doesn’t help. Try getting out of bed to do a relaxing activity to help you feel sleepy. Reading, knitting, taking a warm bath, or reading are some examples.

Exercise daily

Make sure it’s OK with your physician first. Exercise for at least 30 minutes a day to stay strong and active. This will help you expend energy and promote sleep at night.

Keep snoring and your vitals in check

Snoring can be common for pregnant women. If you’re having frequent pauses during breathing, talk to your doctor about sleep apnea. Also, if you experience swollen ankles or headaches, make sure your doctor checks your blood pressure and urine.

Make your bedtime routine relaxing

Keep your bedroom sleep-friendly and relax before bed with a calm routine. Warm baths or showers, meditation, and breathing techniques can help. Make sure your sleep environment is cool, dark, and quiet.