Sleep In Pregnancy- The Ultimate Guide

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.

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 are 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, back aches, 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 health 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 health 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, the baby 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 effect 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 a 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 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 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