Written by
Danielle Pacheco, Staff Writer
Medically Reviewed by
Ealena Callender, OBGYN
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The third trimester of pregnancy brings a host of sleep-related changes as the weight gain and pressure of the growing fetus start to have a direct impact on muscles, joints, and blood flow.
If you can’t sleep and you’re pregnant in your third trimester, keep reading for advice on how to improve your sleep quality. We’ll take a closer look at the factors that influence third trimester sleep, including conditions like sleep apnea and restless legs syndrome, and discuss the best third trimester pregnancy sleeping positions.
For most women, the third trimester is the most difficult, bringing back pain, heartburn, and sleep apnea, among other things. Not only is it more difficult to get quality sleep, but you’ll also experience daytime fatigue as a result of your changing body.
It’s estimated that 2 in 3 women suffer from lower back pain and sore muscles during pregnancy, which in turn causes sleep disturbances. Women with higher levels of depression or anxiety typically describe their back pain as more severe.
Insomnia strikes an estimated 3 in 4 women during late pregnancy. Principal drivers of insomnia in pregnant women include anxiety, depression, disturbed dreams, nighttime awakening, fetal kicking and other movements, and pain and discomfort from the baby bump. Frequent bathroom breaks due to overactive kidneys and the weight of the uterus against the bladder can also disrupt sleep.
A significant number of women develop snoring and sleep apnea during pregnancy. Although often benign, this may also be a warning sign of a more severe condition. Research shows that snoring is correlated with high blood pressure and preeclampsia, while sleep apnea may increase the risk of maternal morbidity. Sleep apnea also appears to be correlated with gestational diabetes.
Research shows that as many as 1 in 3 women have restless legs syndrome in the third trimester, characterized by uncomfortable sensations that provoke an irresistible urge to move the legs. Restless legs syndrome appears more when the body is at rest and can make it virtually impossible to get to sleep. The third trimester also brings nighttime leg cramps for many women.
As the digestive system slows down in late pregnancy, many mothers-to-be develop heartburn. This uncomfortable condition involves acid rising back up through the esophagus, causing a burning sensation in the chest.
Poor sleep during the third trimester is associated with a host of problems, the most serious being preeclampsia and preterm birth. Pregnant women who experience insomnia or habitual snoring appear to be more likely to give birth to a baby that is too large or too small for gestational age, and research shows that women who experience sleep problems in late pregnancy have longer labors and are more likely to need a cesarean section.
In terms of risks to the mother, poor sleep also appears to be linked to a higher risk of gestational diabetes mellitus. In turn, better sleep is associated with more successful breastfeeding and a lower chance of depression during pregnancy and postpartum.
Through a combination of sleep hygiene, vitamin and mineral supplements, and safer sleeping positions, pregnant women can improve the quality and quantity of their sleep. Remember to always check with your healthcare provider before changing your routine or starting a new medication, and inform them immediately if you have symptoms that could indicate a serious condition.
Doctors agree that the best sleeping position in the third trimester is on the left side, with your legs slightly tucked up towards your chin. This position improves blood flow to the uterus, and helps deliver nutrients and oxygen to the fetus. The improved circulation and kidney function also reduces swelling, hemorrhoids, and varicose veins in your legs. Women with severe swelling may try propping the legs up higher than the belly.
By contrast, sleeping on your right side during the third trimester puts the weight of the uterus on your liver, and sleeping on your back can block the inferior vena cava and cut off blood flow. As you’ll soon find out, sleeping on your stomach is virtually impossible because of the baby’s size. Don’t worry if you briefly flip into these positions, but try not to spend too long in them.
Sleeping on your left side is easier said than done for those who are normally stomach or back sleepers. A pillow between the legs, tucked into the small of the back, or propping up your belly may ease the strain and help you feel more comfortable, and a strategic pillow wedged behind you may help you adjust to side sleeping. Some companies even make purpose-built positional therapy devices, pregnancy wedges, and body pillows that are designed with your needs in mind.
Most sleep medications are contraindicated for pregnant women, but there are still plenty of products that can aid in improving your sleep. A white noise machine, meditation app, or lavender scent may help lull you to sleep, while the best pillow and mattress are essential to make sure you’re properly supported.
Women who suffer from specific pregnancy-related sleep disorders should prioritize dealing with these first. This may mean doing some light stretching before bed or taking mineral supplements to prevent leg cramps and restless leg syndrome. Heartburn can be avoided by sleeping on your left side, eating smaller meals, not eating right before bed, and avoiding certain trigger foods such as spicy or very fatty foods.
As the uterus grows, you may experience shortness of breath, which can be alleviated by propping up the head while you sleep. Rolling over onto your side generally opens the windpipe and eases symptoms of sleep apnea. Those with more severe sleep apnea symptoms may use a sleep apnea machine.
Pregnant women who struggle from anxiety may find it helpful to join a yoga class or parenting class for a supportive group environment. Regular exercise is recommended for pregnant women and is an important part of sleep hygiene, but it’s important not to exercise too late in the day as the body needs time to wind down afterward. Yoga or relaxation exercises, a prenatal massage, and relaxing music are some ways to prepare your body for falling asleep.
General sleep hygiene tips apply to pregnant women as well. Try to set a regular bedtime and create a calm, dark atmosphere with an adequate temperature. Wind down before bedtime with a warm bath or a calming cup of herbal tea, and avoid caffeine, stimulants, and blue screens before bedtime.
While you should stay hydrated throughout the day, it’s a good idea to avoid big meals and excessive fluids in the hours leading up to bedtime. This is especially true for women who suffer from heartburn or find themselves waking up for frequent bathroom breaks. Using a nightlight in the bathroom will help you stay drowsy so you can get back to sleep more easily.
When nothing else works, many pregnant women compensate for lost sleep overnight by taking naps during the day. This is a good option for some, but it may make it more difficult to drift off at night.
Your bed should be a soothing haven that’s reserved for sleep and sex. If you’ve been lying in bed for a while and you can’t fall asleep, get up and do a calming activity such as reading a book or taking a bath. Lying in bed fretting about getting to sleep is counter-productive and may make you associate bedtime with stress.
Interestingly, one study found that women were more likely to experience postpartum depression if they worried about sleep in the third trimester, regardless of the actual quality of their sleep. So, while it’s good to have awareness of the importance of sleep, try not to let it become a major source of stress. Likewise, don’t worry if you feel like you’re sleeping a lot during your pregnancy third trimester. This is likely just a result of the extra energy the fetus requires.
Promising evidence suggests that a combination of cognitive behavioral therapy coupled with sleep hygiene practices may be an effective way to help with sleep problems in the third trimester. Research also suggests that treating depressive symptoms may help improve sleep quality and reduce daytime fatigue. It’s normal to feel anxious and excited about the impending childbirth, so don’t be afraid to discuss these fears with your partner or a trusted confidant.
Staff Writer
Danielle writes in-depth articles about sleep solutions and holds a psychology degree from the University of British Columbia.
OBGYN
MD
Dr. Callender is a board-certified obstetrician-gynecologist who has been working in women’s health for over a decade.
