Maternal Health

Insomnia and Sleep Difficulties in Pregnancy

Medically reviewed by Dr. Lisa Okafor, MD, FACOG · Board-Certified OB-GYN

Content reviewed against published ACOG, NIH, March of Dimes guidelines

Last reviewed: July 2026

Your health matters just as much as your baby's. If you are dealing with insomnia and sleep difficulties in pregnancy, here is what you need to know.

The short answer

Key takeaways

Insomnia affects up to 78% of pregnant people at some point during pregnancy. It can be caused by physical discomfort, frequent urination, hormonal changes, anxiety, and difficulty finding a comfortable sleeping position. While frustrating, it is very common and there are many strategies that can help improve sleep quality.
Usually normal when: Difficulty falling or staying asleep that worsens as pregnancy progresses
Call your doctor if: You are so exhausted that you are unable to function safely (for example, falling asleep while driving)
Varies by age — see the age-by-age breakdown below

“About 1 in 8 women experience symptoms of postpartum depression. If you have symptoms of depression that last longer than 2 weeks, tell your health care provider.”

— Depression During and After Pregnancy, Centers for Disease Control and Prevention (CDC)

Parents everywhere have the same worry. You are doing the right thing by looking into it.

What Parents Should Know

According to ACOG, NIH, March of Dimes guidelines, insomnia affects up to 78% of pregnant people at some point during pregnancy. It can be caused by physical discomfort, frequent urination, hormonal changes, anxiety, and difficulty finding a comfortable sleeping position. While frustrating, it is very common and there are many strategies that can help improve sleep quality. At First trimester, despite extreme fatigue, many people have difficulty sleeping in the first trimester due to nausea, frequent urination, and hormonal changes. Establishing a regular sleep schedule, keeping the bedroom cool and dark, and addressing nausea before bed can help. It is still safe to sleep in any position during the first trimester. It is generally considered normal when difficulty falling or staying asleep that worsens as pregnancy progresses. However, you should contact your pediatrician promptly if you are so exhausted that you are unable to function safely (for example, falling asleep while driving).

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal

Worth Discussing

Difficulty falling or staying asleep that worsens as pregnancy progresses

You are so exhausted that you are unable to function safely (for example, falling asleep while driving)

Waking frequently to urinate or due to physical discomfort

Insomnia is accompanied by severe anxiety, panic attacks, or thoughts of self-harm

Feeling tired despite getting some sleep

Insomnia is severe and persistent, significantly affecting your daily function

Sleep improves with position changes, pregnancy pillows, or relaxation techniques

You are experiencing loud snoring or gasping during sleep, which could indicate sleep apnea

By Age

What to expect by age

First trimester

Despite extreme fatigue, many people have difficulty sleeping in the first trimester due to nausea, frequent urination, and hormonal changes. Establishing a regular sleep schedule, keeping the bedroom cool and dark, and addressing nausea before bed can help. It is still safe to sleep in any position during the first trimester.

Second trimester

Sleep often improves somewhat in the second trimester as nausea decreases and energy returns. Begin practicing side sleeping, ideally on your left side, which optimizes blood flow to the baby. A pregnancy pillow between your knees and behind your back can improve comfort. Vivid dreams may also disrupt sleep during this time.

Third trimester

Insomnia is most common and severe in the third trimester. Physical discomfort, frequent bathroom trips, heartburn, leg cramps, and baby movements all contribute. Limit fluids before bed, elevate your head for heartburn, and try relaxation techniques like deep breathing or guided meditation. If you wake at night and cannot fall back asleep within 20 minutes, get up and do a quiet, non-stimulating activity until you feel sleepy.

What to Tell Your Pediatrician

Describe when you first noticed insomnia and sleep difficulties in pregnancy and how it has changed over time.
Note your baby's current age and which age-specific patterns you are seeing.
Mention if insomnia is severe and persistent, significantly affecting your daily function.
Mention if you are experiencing loud snoring or gasping during sleep, which could indicate sleep apnea.
Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...

Difficulty falling or staying asleep that worsens as pregnancy progresses
Waking frequently to urinate or due to physical discomfort
Feeling tired despite getting some sleep
Sleep improves with position changes, pregnancy pillows, or relaxation techniques

Mention at your next visit when...

Insomnia is severe and persistent, significantly affecting your daily function
You are experiencing loud snoring or gasping during sleep, which could indicate sleep apnea
Lack of sleep is contributing to anxiety or depression

Act now when...

You are so exhausted that you are unable to function safely (for example, falling asleep while driving)
Insomnia is accompanied by severe anxiety, panic attacks, or thoughts of self-harm

What You Can Do at Home

Keep track of when you notice insomnia and sleep difficulties in pregnancy — noting the time of day, duration, and any triggers can help your pediatrician.
Remember that difficulty falling or staying asleep that worsens as pregnancy progresses — this is generally within the range of normal.
At First trimester, focus on observation rather than intervention unless your pediatrician advises otherwise.
Prioritize your own rest and nutrition. Accept help when offered, and do not hesitate to reach out to your healthcare provider.
While monitoring at home, seek immediate care if you are so exhausted that you are unable to function safely (for example, falling asleep while driving).

Vivid or Disturbing Dreams During Pregnancy

Vivid, intense, or disturbing dreams are extremely common during pregnancy. They are caused by hormonal changes, increased REM sleep disruptions from waking frequently at night, and the natural anxieties and excitement of becoming a parent. These dreams do not predict the future and are not a sign that something is wrong.

Restless Leg Syndrome in Pregnancy

Restless leg syndrome (RLS) affects up to 26% of pregnant people, making it about 2-3 times more common during pregnancy. It causes an irresistible urge to move the legs, often accompanied by uncomfortable sensations, and typically worsens at night. It may be related to iron or folate deficiency and usually resolves after delivery.

Anxiety During Pregnancy

Some worry during pregnancy is completely normal, but anxiety that is persistent, intense, or interfering with your daily life affects approximately 15-20% of pregnant people. Prenatal anxiety is treatable, and getting support early benefits both you and your baby. You deserve to feel better.

Guide

Postpartum Recovery Guide

Week-by-week postpartum recovery timeline and warning signs.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is insomnia and sleep difficulties in pregnancy normal?

When should I call the doctor about insomnia and sleep difficulties in pregnancy?

You are so exhausted that you are unable to function safely (for example, falling asleep while driving) Insomnia is accompanied by severe anxiety, panic attacks, or thoughts of self-harm

When is insomnia and sleep difficulties in pregnancy normal?

Difficulty falling or staying asleep that worsens as pregnancy progresses Waking frequently to urinate or due to physical discomfort Feeling tired despite getting some sleep

What causes insomnia and sleep difficulties in pregnancy?

Insomnia affects up to 78% of pregnant people at some point during pregnancy. It can be caused by physical discomfort, frequent urination, hormonal changes, anxiety, and difficulty finding a comfortable sleeping position. While frustrating, it is very common and there are many strategies that can help improve sleep quality. Common explanations include: Difficulty falling or staying asleep that worsens as pregnancy progresses. Waking frequently to urinate or due to physical discomfort.

What should I mention to my pediatrician about insomnia and sleep difficulties in pregnancy?

You should mention insomnia and sleep difficulties in pregnancy at your next visit if: Insomnia is severe and persistent, significantly affecting your daily function. You are experiencing loud snoring or gasping during sleep, which could indicate sleep apnea. Lack of sleep is contributing to anxiety or depression.

Is insomnia and sleep difficulties in pregnancy normal at First trimester?

Is insomnia and sleep difficulties in pregnancy normal at Second trimester?

Should I go to the ER for insomnia and sleep difficulties in pregnancy?

Seek emergency care if you are so exhausted that you are unable to function safely (for example, falling asleep while driving), or if insomnia is accompanied by severe anxiety, panic attacks, or thoughts of self-harm. When in doubt, call your pediatrician's after-hours line for guidance.

Does insomnia and sleep difficulties in pregnancy go away on its own?

In many cases, insomnia and sleep difficulties in pregnancy resolves on its own, especially when difficulty falling or staying asleep that worsens as pregnancy progresses. By Third trimester, insomnia is most common and severe in the third trimester. Physical discomfort, frequent bathroom trips, heartburn, leg cramps, and baby movements all contribute. Limit fluids before bed, elevate your head for heartburn, and try relaxation techniques like deep breathing or guided meditation. If you wake at night and cannot fall back asleep within 20 minutes, get up and do a quiet, non-stimulating activity until you feel sleepy.

ACOG NIH MARCH OF DIMES

References

[1]American College of Obstetricians and Gynecologists. Sleep During Pregnancy. ACOG, 2022. ACOG
[2]National Library of Medicine. Sleep Disorders in Pregnancy. StatPearls, 2023. NIH
[3]March of Dimes. Sleep During Pregnancy. March of Dimes, 2023. March of Dimes

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Insomnia and Sleep Difficulties in Pregnancy.

Things to mention

Describe when you first noticed insomnia and sleep difficulties in pregnancy and how it has changed over time.
Note your baby's current age and which age-specific patterns you are seeing.
Mention if insomnia is severe and persistent, significantly affecting your daily function.
Mention if you are experiencing loud snoring or gasping during sleep, which could indicate sleep apnea.
Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

Insomnia is severe and persistent, significantly affecting your daily function
You are experiencing loud snoring or gasping during sleep, which could indicate sleep apnea
Lack of sleep is contributing to anxiety or depression

Urgent signs to report immediately

You are so exhausted that you are unable to function safely (for example, falling asleep while driving)
Insomnia is accompanied by severe anxiety, panic attacks, or thoughts of self-harm

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

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Bottom line

Most cases of insomnia and sleep difficulties in pregnancy are normal. Talk to your pediatrician if you are so exhausted that you are unable to function safely (for example, falling asleep while driving).

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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