Sophie Bostock, PhD
Sleeping in Pregnancy
Why I am so tired?
Many women experience fatigue long before they have a visible bump. Most adults need 7 to 9 hours sleep, but surveys suggest that pregnant women report needing at least an extra hour. It’s normal to feel tired, even when you’re getting more sleep than usual. High levels of the hormone progesterone in the first trimester can increase sleepiness and sleep need.
By the third trimester, the unborn infant is growing fast, and is also heavy - requiring lots of energy to carry around! Almost all women report broken sleep due to pain and discomfort, movement, cramps or needing the toilet during the night. Sleep disorders also become more common, such as restless legs syndrome, breathing-related problems such as snoring and sleep apnoea, and insomnia.
Studies suggest that 38% of women experience insomnia during pregnancy, which has been linked to increased risk of preterm birth.
What can I do to improve my sleep?
The general advice below is relevant to all mothers-to-be. If you’re worried about lack of sleep, or you think that you might be developing a sleep disorder, don’t hesitate to speak to your healthcare team for advice.
1. Protect time for sleep. Your biological sleep need has increased, so you will need to change your routine to make more time for sleep. This might mean asking friends or family to help out so that you can catch up on sleep safely. If you’re looking after young children, try and nap when they nap. A brief 20 minute power nap can help to lift your mood and energy levels, and is unlikely to leave you feeling groggy afterwards.
2. Heartburn, or reflux, is more common during pregnancy. Progesterone can relax the muscle which usually keeps food in the stomach, so that acidic foods rise back up towards the throat. If heartburn is interfering with your sleep:
- avoid citrus fruits and juices, rich or fatty foods and spicy dishes
- eat small, regular meals, to reduce the content of the stomach at any one time
- it may help to sleep propped up on an extra pillow
3. Be active. Staying physically active is good for sleep, and can also help to reduce leg cramps. Doctors recommend keeping up a normal exercise routine for as long as you feel comfortable.
- If you didn’t exercise a lot before pregnancy, take it gently.
- Aim to be able to hold a conversation while you're exercising without becoming breathless.
- If you suffer from leg cramps, regularly stretching out your calves during the day and before bed may help to prevent problems occurring at night.
4. Nocturia. Most women need to pee more often during pregnancy, and may wake up multiple times at night.
- Drink plenty of water to stay hydrated during the day, but cut back two hours before bedtime to reduce overnight bathroom trips.
- Avoid diuretics like tea and coffee which make you lose more water
- When you do go, lean forwards on the toilet to help empty your bladder each time.
5. Vivid dreams. Pregnancy can be associated with unusually vivid or bizarre dreams. This might simply be because more frequent waking makes it more likely that you will remember your dreams, but it may also be that you have more things to worry about than usual.
- Try to reserve the last hour before you get into bed to do something relaxing – listen to music, have a bath or shower, read a book or do some crafts to take your mind away from worries.
6. Restless Legs Syndrome is defined by a strong urge to move the legs at night, accompanied by an itchy, creepy, crawly, jittery or burning sensation. Up to 30% of pregnant women experience symptoms of RLS, especially in the third trimester. Women with low iron or folate levels can be at greater risk. RLS makes getting to sleep more difficult and has been linked to depression. Fortunately, symptoms in pregnancy typically disappear after delivery.
7. Snoring. Weight gain, fluid retention and a change in the position of the diaphragm increase the risk of snoring during pregnancy. For most women this is a temporary issue with no serious consequences (though your partner may decide to sleep next door!). If you notice that you pause or struggle for breath during the night, this may suggest obstructive sleep apnoea (OSA) and it’s worth asking your doctor for advice.
8. Insomnia. A recent study found that treating insomnia in pregnancy using digital Cognitive Behavioural Therapy for Insomnia (digital CBT-I) was linked to reduced rates of depression and anxiety postpartum (Felder et al 2021). In the trial, 208 women were randomised to either use the Sleepio programme or usual care alone. At 3 months postpartum, 4% of the Sleepio group had probable major depression, vs 18% of the control group.