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Sleep is important during pregnancy, but many people find it difficult to sleep well when they are expecting. Research suggests that by late pregnancy, around 60% of pregnant people experience insomnia.
We examine the factors that can contribute to sleep problems and share advice on how to sleep better during pregnancy.
What Is Pregnancy Insomnia?
Insomnia is having trouble falling or staying asleep that carries over into daytime tiredness. When insomnia occurs due to pregnancy-related factors, it is sometimes called pregnancy insomnia.
For many people, sleep problems may appear for the first time during pregnancy. Pregnant people may experience poor-quality or not enough sleep. They may sleep less deeply and wake up often during the night. Due to poor sleep, pregnant people may then feel sleepy during the day.
People who already have a sleep disorder may find the symptoms get stronger during pregnancy, while people who have never had sleep problems may develop them for the first time.
Causes of Insomnia During Pregnancy
A number of factors contribute to insomnia during pregnancy. Pregnant people may start to have trouble sleeping as early as the first trimester when hormone levels start to change . Sleep problems become more common in the third trimester as the body changes and fetal growth continues.
- Nausea: Nausea begins early in pregnancy and can occur at night, affecting sleep.
- Hormones: Changing hormone levels can affect sleep patterns during pregnancy.
- Altered metabolism: Pregnancy increases a person’s metabolism and heart rate, which can make it hard to wind down for sleep.
- Snoring: The weight gain and stuffy nose that occur during pregnancy compress the upper airway and leave less room for air to pass through. As a result, pregnant people may experience snoring or difficulty breathing, especially when back sleeping.
- Back pain: Changes in the muscles, joints, and posture cause back pain for a majority of pregnant people, even in early pregnancy.
- Leg cramps: Leg cramps occur for around half of pregnant people, and a quarter of pregnant people may experience restless legs syndrome (RLS). RLS causes uncomfortable feelings in the legs that can make it difficult to fall asleep in later pregnancy.
- Nighttime bathroom trips: Not only does the growing fetus put pressure on the bladder, but blood volume also increases during pregnancy, meaning the kidneys produce more urine. Most pregnant people feel the need to urinate two or more times at night, which can be disruptive to sleep.
- Heartburn: Many pregnant people experience heartburn at night, especially in later pregnancy, which can make it difficult to sleep. Not only does the uterus put pressure on the digestive system, but pregnancy hormones also make it easier for stomach acid to come up the esophagus.
- Physical discomfort: As the midsection grows and fetal movements become more noticeable, it can become difficult to get comfortable for sleep. Switching to side sleeping may also be difficult for those who are accustomed to sleeping on their back or their stomach.
- Anxiety: It is natural to have concerns when expecting a baby. For some, stress about pregnancy or the life changes that await can lead to insomnia or nightmares.
Risks of Sleep Deprivation While Pregnant
Going consistently short on sleep during pregnancy is thought to have risks for the fetus, and it may increase the risk of gestational diabetes, preterm birth, longer labor , more weight gain, and preeclampsia. Preeclampsia is a pregnancy condition involving high blood pressure that requires medical attention.
Sleep problems during pregnancy may be especially problematic if they are caused by obstructive sleep apnea, a sleep disorder in which the sleeper momentarily stops breathing multiple times per night. Obstructive sleep apnea is linked to a higher risk of preeclampsia and gestational diabetes.
Pregnancy insomnia may contribute to depression and anxiety in late pregnancy and after birth. Improving sleep during late pregnancy appears to diminish the risk of postpartum depression.
Pregnancy is a demanding time for the body, and it is important to obtain sufficient high-quality sleep. According to experts, pregnant people should try to get 8 to 10 hours of sleep per night.
Tips to Cope With Pregnancy Insomnia
Common strategies for coping with pregnancy insomnia include sleep aids, therapy, and lifestyle changes. Although there is little research on how to treat pregnancy insomnia, experts usually prefer to recommend non-medicinal therapies, to minimize the risk to the fetus.
Melatonin During Pregnancy
Experts recommend that pregnant people avoid sleep medications, including melatonin supplements. However, some health care providers believe that melatonin may be safer than pharmaceutical sleep aids if pregnancy insomnia persists.
Melatonin is one of the key hormones that controls the sleep-wake cycle. This hormone is naturally produced by the body. Melatonin also exists in the form of supplements designed to help with short-term sleep problems. Taking melatonin supplements a few hours before bedtime can help complement the rise in the body’s levels of natural melatonin.
People produce higher levels of melatonin during pregnancy, especially toward the end. The melatonin that exists naturally in a pregnant person’s body crosses the placenta, reaching the fetus and helping establish the baby’s sleep-wake cycle. Some experts worry that taking melatonin supplements may deliver too much melatonin to the fetus and potentially interfere with the development of the sleep-wake cycle.
More studies are needed to confirm the safety of melatonin supplements for sleep during pregnancy. For this reason, pregnant people struggling with sleep problems should talk with a doctor before using a melatonin supplement.
Cognitive Behavioral Therapy for Insomnia During Pregnancy
In cognitive behavioral therapy for insomnia (CBT-I), a person works with a therapist to change any unproductive thoughts and behaviors that affect sleep.
During CBT-I sessions, a therapist may recommend a bedtime routine that includes regular bedtimes and wake-up times, avoiding activities other than sleep and sex in the bedroom, and minimizing the time spent in bed when unable to sleep. They may also reinforce sleep hygiene tips, such as cutting down on naps, forming a comfortable sleep environment, and avoiding caffeine and tobacco.
To address worries about not getting enough sleep, the therapist may address the person’s anxious thoughts, discuss realistic goals for sleeping a certain number of hours, and suggest relaxation techniques such as meditation and progressive muscle relaxation.
Studies have found that CBT-I helps ease insomnia symptoms and improve sleep for pregnant people. CBT-I may also help improve feelings of fatigue, anxiety, and depression. Those who do not have easy access to in-person appointments can receive CBT-I treatment over the phone or internet.
How to Sleep Better While Pregnant
There are many lifestyle changes that can help improve sleep during pregnancy.
- Keep a regular sleep schedule: Go to bed and wake up at similar times every day. Naps can help make up for lost sleep, but avoid napping in the afternoon and evening.
- Create a comfortable sleep environment: Create a cool, dark, and quiet sleep environment and keep electronic devices out of the bedroom. Use a nightlight instead of the overhead light to avoid waking up too much during bathroom trips.
- Use pillows: Use pillows to support the midsection, the lower back, and between the knees to reduce back pain. Some pregnant people may prefer a pregnancy pillow that is specifically designed to accommodate the needs of their changing body.
- Avoid stimulants: Cut out nicotine and alcohol during pregnancy, and try not to consume caffeine after noon.
- Exercise in the morning: Regular exercise is important during most healthy pregnancies, but it may be best to find time to exercise earlier in the day. Prior to starting an exercise routine, it is important to consult a doctor for specific guidance.
- Try relaxation techniques: Relaxation techniques or soothing activities such as a warm bath or a massage may help prepare for sleep. Talk with a health care provider about how to safely participate in relaxation activities throughout pregnancy.
- Sleep on the left side: Sleeping on the left side facilitates blood flow to major organs and the fetus. Left side sleeping can also help reduce swelling in the legs and ankles, and is easier on the lungs and heart. Most experts recommend against back sleeping in late pregnancy, as it may carry some risks for the fetus.
- Manage heartburn: Eating smaller meals, avoiding greasy or spicy foods, and leaving time after a meal before lying down may ease heartburn symptoms. If nighttime heartburn occurs, try raising the head of the bed for sleep.
- Treat a stuffy nose: Manage congestion with nasal strips, nasal sprays, or nasal irrigation.
- Manage leg cramps: To reduce the chances of experiencing leg cramps, perform gentle stretches and ask a doctor about calcium supplements. Calf stretches, walking, standing on the leg, pushing it against a wall, or wiggling the leg and then raising it can help manage leg cramps in the moment.
Some pregnant people have difficulty sleeping because of the worries around pregnancy and becoming a parent. For some, it is helpful to make time for things they enjoy . Others find reaching out to trusted friends or family for emotional support during pregnancy helpful in reducing stress that may be keeping them awake. Attending childbirth classes or sharing any concerns with a health care provider can also reduce worry and may help an expectant parent sleep better.
Talk to a doctor if pregnancy insomnia does not resolve with lifestyle changes. Medical conditions such as gastroesophageal reflux disease, restless legs syndrome, and obstructive sleep apnea may need specific treatment.
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