Pregnancy Insomnia

You may be wondering why your habit of sleeping soundly and peacefully through the night disappeared since you got pregnant. There is nothing to worry about as insomnia or trouble sleeping is a common phenomenon in pregnancy, affecting about 78% of all expectant mothers without causing harm to the unborn child [1].

Pregnancy Insomnia

Symptoms of insomnia in pregnancy

  • Struggling to fall asleep [1]
  • Waking up often at night
  • Problem in getting back to sleep
  • Having an incomplete or improper sleep

Is insomnia an early pregnancy symptom

Insomnia itself is not regarded as a sign of early pregnancy, though the presence of other signs like nausea and fatigue may come in the way of an undisturbed night’s sleep [9, 10].

When does insomnia occur during pregnancy

Insomnia is believed to be most common in the third trimester, with several findings mentioning that women get the least sleep during this time, waking up at increased intervals at night than before [21].

Poor or disturbed sleep in the third trimester may also be one of the several factors responsible for triggering postpartum depression, as shown in a study [21].

Does it occur in the second trimester

Most women are said to have a better sleep than before in the second trimester (13th to 27th week) since a lot of the bodily discomfort mellows down by then [30]. However, some might still experience sleepless nights because of various physical or emotional stress.

What causes sleeplessness during pregnancy

Common physical reasons why you can’t sleep

  • Back pain [1]
  • Other cramps and pains
  • Morning sickness
  • Shortness of breath
  • Frequent urination
  • Heartburn
  • Increasing abdomen size
  • Restless leg syndrome

Common psychological reasons why you can’t sleep

  • Stress [2]
  • Anxiety
  • Vivid dreams

Causes of insomnia in early pregnancy (first trimester)

Hormonal changes – The progesterone hormone, high at this time, acts as a sedative, making it extremely difficult for you to keep your eyes open during the day. And when you need to take a few naps to get through the day, falling asleep at night may be a challenge [8, 12].

Increased anxiety – You may be anxious about a lot of things, like your baby’s well-being or some financial concerns, which might take a toll on your night’s sleep [8].

Breast tenderness – The swelling and pain caused by sore breasts that occur in 3rd or 4th week of pregnancy, because of the increased estrogen and progesterone production as well as high blood flow, may often give you sleepless nights [3, 13, 14].

Morning sickness – Beginning around the 4th week, it is predominant in the first trimester, sometimes even continuing up to the second or third [15, 16, 17]. Your sleep would undoubtedly be disrupted when you have bouts of nausea and vomiting throughout the day and night  [16].

Heartburn – The release of the hormone progesterone, which is high in early pregnancy, helps in relaxing the uterus muscles. Though at the same time it enhances gastric acid secretion, resulting in acidity and heartburn, causing sleep disturbances [3, 18].

Frequent urination – The urge to urinate at short intervals as early as the sixth week of your pregnancy because of the increased blood flow and changing hormone levels reduces your sleep [1, 20].

Causes of insomnia in late pregnancy (third trimester)

Increasing tummy size – As you are nearing delivery, your tummy gets bigger, not allowing you a comfortable night’s sleep in a desired posture [21].

Restless leg syndrome – Occurring in about 10 to 25% of expectant mothers, RLS induced due to pregnancy mostly happens in the third trimester. Since the symptoms show up when you are at rest for long, you might experience jerking leg movements at night when you are trying to sleep [22, 23].

Frequent urination – Just like the first trimester, the urge to urinate often will also occur at this time, as the growing size of the baby exerts a lot of pressure on your bladder [20, 24].

Heartburn – In the third trimester heartburn mostly occurs as your baby’s size increases and the surrounding organs get squeezed under its pressure, causing the food to pass slowly from the stomach to the intestine [18, 21].

Shortness of breath – Similarly, the uterus pushing against the lungs makes it hard to breathe, especially when lying down. The problem is higher in those carrying their baby high, pregnant with more than one baby, or have high amounts of amniotic fluid (polyhydramnios) [25, 26].

Snoring – Studies show that about 25% of women have experienced frequent snoring in the third trimester, because of swollen nasal passages or increased weight, alongside other reasons [21, 27].

Excessive kicking by the baby  Though this varies from one mother to the other, babies mostly sleep when you are moving about as the rocking motion gives them comfort, while they get fidgety when you are at rest [21, 28].

Tips to deal with troubled sleeping during pregnancy at home

  • Avoid tea, coffee, and carbonated beverages, especially within 2 hours of bedtime, since they can increase the urine production (because of their diuretic properties) as well as heighten the symptoms of RLS [20, 23].
  • Avoid reading or watching television in bed, and lie down only when you want to sleep as remaining in a stationary position for long aggravates RLS [23].
  • Go for a foot bath and leg massage before bedtime [23].
  • While urinating, lean forward to empty your bladder. This also helps in preventing UTIs [20].
  • Opt for a comfortable bra, preferably the ones that are unpadded and come without hooks [13].
  • Support the upper part of your body with extra pillows as this would reduce breathing discomfort by minimizing the uterus’ pressure on the lungs [26].
  • Go for meditation or yoga or even enroll yourself in a prenatal class to learn relaxation techniques [1, 2].
  • Dimming the lights, changing the thermostat to a suitable temperature, and playing soothing music can help you sleep by creating a relaxing ambiance [1].
  • Have your dinner 3 hours before bedtime for a better digestion to avoid heartburn or bouts of vomiting.
  • Keep light snacks like crackers near your bed to fight nausea in the middle of the night [16, 18].
  • Go for high protein snacks before bedtime like boiled eggs, peanut butter treats, or nuts as these can help maintain your sugar levels, preventing vivid dreams, excessive sweating, and headaches when you try to sleep [31].

Sleeping aids for insomnia while pregnant

Natural aids to try at home

Milk – The protein lactium in it, helps to lower the cortisol levels released during stress [32] while its L-tryptophan content induces sleep by raising the brain’s serotonin levels [31].

Pregnancy safe essential oils (Lavender, frankincense, ylang-ylang, and eucalyptus) – It is never advisable to use essential oils without consulting a doctor or midwife. If using, take no more than three drops at a time and dilute them with a career oil for a foot massage or warm bath before bedtime to get a relaxing effect [33].

Medicinal aids

Though it is best to stay away from sleeping pills or tablets, your doctor might recommend them in specific cases [37]. Anti-histamines like doxymaline (Unisom Sleep Tabs, Sleep Aid), and diphenhydramine (Benadryl, Sominex) are possibly safe when taken in prescribed doses [35, 36].

On the other hand, benzodiazepines (Restoril, ProSom) and nonbenzodiazepines (Imovane, Sonata) were reported to be harmful to the baby in a 2015 research [37].

When to call a doctor

If you experience severe insomnia alongside a feeling of anxiety, continued bouts of sadness, reduced appetite, and little or no interest in things you used to enjoy do not delay in consulting your doctor as the sleeplessness might be a sign of depression [2].



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