Insomnia and Sleep Difficulties in Pregnancy
The short answer
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.
Parents everywhere have the same worry. You are doing the right thing by looking into it.
By Age
What to expect by age
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.
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.
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 Should You Do?
When to take action
- 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
- 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
- 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
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
Worrying about your baby means you care. That is a good thing.
Related Maternal Concerns
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.
Dealing with Abnormal Prenatal Screening Results
An abnormal prenatal screening result can be terrifying, but it is important to understand that screening tests are designed to cast a wide net and have significant false-positive rates. Most people with abnormal screening results go on to have healthy babies after further testing confirms the baby is fine. An abnormal screening is a reason for more information, not a diagnosis.
Pregnancy Over 35 (Advanced Maternal Age)
While pregnancy after 35 carries some increased risks (including chromosomal abnormalities, gestational diabetes, and hypertension), the vast majority of people over 35 have healthy pregnancies and healthy babies. The term "geriatric pregnancy" is outdated and does not reflect reality. With appropriate prenatal care and monitoring, outcomes are excellent.
Amniocentesis Questions and Fears
Amniocentesis is a diagnostic test performed between 15-20 weeks that analyzes amniotic fluid to detect chromosomal conditions and genetic disorders with over 99% accuracy. The risk of pregnancy loss from the procedure is approximately 1 in 500-1,000 when performed by an experienced provider. Understanding the actual risks can help you make an informed decision.