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The Ultimate Pregnancy and Sleep Guide

Table of Contents

While we at Sleepopolis understand each expecting parent’s pregnancy is unique, there are some common sleep problems that can occur throughout pregnancy. As an expectant parent, you may be wondering how your sleep might be affected during pregnancy and how to address these issues.

In this article, I’ll begin by giving an overview of sleep during pregnancy. After this, I’ll break down the most common sleep-related problems for pregnant individuals. Finally, I’ll offer some tips from experts and medical research for sleeping better during pregnancy.

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.

Sleep During Pregnancy

Studies have found that most pregnancies result in sleep changes. These include alterations in one’s sleep pattern and duration, as well as sleep issues due to physical changes occurring in pregnancy. (1) Folks in the first trimester typically need more sleep, but there isn’t consensus on how many hours are necessary. (2)

Board Certified Pediatric Chiropractor, Dr. Kaleb Scroggin of Restoration Chiropractic explains that “during the first trimester the new baby is growing at a very rapid pace, needing a ton of energy from [the parent].” Because of this, according to Dr. Scroggin, the parent needs more sleep, but accommodations must be made to allow for more rest. Otherwise, the parent will likely be tired throughout the day.

During the second trimester, a parent’s sleep is affected in similar and different ways than the first trimester. As in the first trimester, back and other musculoskeletal aches and pains are common.

According to Dr. Stacy Sutton, a licensed physical therapist and board-certified Women’s Health Clinical Specialist, “this is due to a change in [the parent’s] center of gravity, increased muscle demand, and fluctuating hormone levels. The ligaments that support the joints get a little bit softer, so there is less joint stability.”

The third trimester brings its own set of sleep problems, along with the problem of back/musculoskeletal pain.

Kim Langdon, MD, of Medzino says that the third trimester consists of “overall discomfort, frequent need to urinate, [and] breathing abnormalities due to altered diaphragm movements.” These all make sleeping problematic. She explains how the third trimester often includes snoring as an issue, going on to say that “the mucous membranes of the nose and sinuses get more engorged and that impairs air flow and breathing.”

Sleep Issues During Pregnancy + How to Relieve Them

Let’s take a look at some specific issues that can affect sleep during pregnancy. Along with each issue, I’ll talk about how you can relieve it. Later in this article, I’ll dive deeper into general tips for sleeping better while pregnant.

Exhaustion

If you’re experiencing extreme fatigue, try, as Dr. Scroggin suggests, “delegating tasks, arranging naps, and curating a more sleep-friendly environment.” You’ll want to be careful how much you sleep during the day. Dr. Langdon says sleeping during the day may make it more difficult to sleep at night.

Backaches

If back pain is disrupting your sleep, try using a different mattress — one with more support might help alleviate some of your pain. In addition, studies have shown that low intensity exercises before pregnancy, and in the first trimester, are able to improve posture, increase the ability to bear weight, and help with pain after it occurs. This is because exercise can strengthen one’s abdominal, back, and pelvic muscles.

Nausea and Vomiting

If you are experiencing nausea and vomiting, you may want to consider dietary changes. A 2003 study by American Family Physician, which observed pregnant people exhibiting nausea and vomiting issues, suggested starting with dietary changes and then including medications if needed. For these changes, the study says, the solid foods you eat should taste bland, be high in carbohydrates, and be low in fat. According to the study, if you eat salty foods, it is best to do so in the morning for the optimum likelihood of tolerability. (3)

Frequent Urination

While this can occur throughout all trimesters, it is especially common during the second trimester. This is because, as Dr. Scroggin says, “as the uterus, baby, placenta, and amniotic fluid take up more and more space, it leaves less and less room for [the parent’s] bladder.” To help with this, Dr. Sutton suggests drinking water no sooner than two hours before going to sleep, while making sure to drink eight to ten glasses of eight ounces of water throughout the day.

Musculoskeletal Aches and Pains

While this can include back pain, it can also refer to other parts of the body, particularly the pelvis. Dr. Sutton says musculoskeletal aches and pains can be prevalent in every trimester. A 2008 study done by Current Reviews in Musculoskeletal Medicine, which looked at pregnant people experiencing musculoskeletal pain, suggests that exercising three times a week for 12 weeks in the latter half of the pregnancy can significantly decrease pain. (4)

Anxiety

While this can occur throughout the entire pregnancy, as time gets closer for the baby’s birth, anxiety levels can rise. To alleviate anxiety, Dr. Scroggin says you should educate yourself about your pregnancy and make sure you have a sufficient support system in place.

Dr. Nwegbo-Banks adds that engaging in physical activity like walking, prenatal yoga, swimming, or stationary biking can all help manage anxiety during pregnancy. Meditating, journaling, and drinking teas are additional options. She notes that, “Channeling and redirecting anxious energy can help improve your mood. Counseling/therapy sessions are other options as speaking with a professional about your concerns can offer insight and healing.”

Insomnia

To explain the effects of insomnia during pregnancy, I spoke with board-certified OB/GYN Dr. Kecia Gaither, who is the director of Perinatal Services at NYC Health and Hospitals/Lincoln. Dr. Gaither cites increased rates of insomnia as being an issue particularly in the third trimester, occurring due to frequent bathroom trips, difficulty finding a comfortable position, odd dreams, leg cramps, and marked fetal movement.

But how can you fight insomnia during pregnancy?

Dr. Gaither suggests using extra pillows for support, keeping daytime naps short, avoiding caffeinated drinks, keeping a regular sleep schedule, and drinking warm milk, due to the tryptophan (a sleep-promoting neurotransmitter) it contains.

A 2013 study in The Journal of the Canadian Chiropractic Association, which observed pregnant people with insomnia, recommends trying yoga to improve sleep quality. It is best to do this prior to the start of the third trimester. (5)

Lower Back Pain

Lower back pain (LBP) is one of the most common complaints from pregnant individuals (6), affecting approximately 52.5% of pregnant people. (7) Though this may occur in the first trimester, typically, people experience LBP during their second trimester. (8) Dr. Nwegbo-Banks says LBP is most common around 28 weeks of pregnancy, during the second and third trimesters.

Dr. Langdon explains that “Under the influence of hormones, the ligaments and tendons of the pelvis become more loose and the pelvic bones can become destabilized.” She says this coincides with the growth of the baby, since the lower back curves inward as the abdomen sticks out. As a result, you end up with aching muscles. Unfortunately, she says that back pain can continue for months after birth due to weakened pelvic bones.

LBP can make it difficult for you to perform daily routine motions, such as standing up from a chair and lying down. (9) There are multiple ways you can reduce LBP, such as exercises and choosing another sleep position. I’ll discuss these tips in more detail later in this article.

Tips for Sleeping Better During Pregnancy

Quality sleep can reduce pregnancy complications, improve your health after pregnancy, and reduce health complications for your child after birth. (10) Here are a few tips from medically backed sources and experts on getting better shut-eye during pregnancy. You can pick a few to practice to see if they help.

Practice stress-relieving techniques

Stress can play a significant role in decreasing your sleep throughout your pregnancy, but especially during the second trimester. (11) Partaking in stress-reducing activities, such as yoga and deep breathing is likely to help you sleep better. (12)

Sit comfortably

Board-certified OB/GYN Dr. Peace Nwegbo-Banks of Serenity Women’s Health & Med Spa says you should only sit in chairs that offer good back support. She also recommends tucking a small pillow behind your back when you sit down.

Talk to your doctor

It’s important that you speak to your healthcare provider throughout your pregnancy about any sleep issues you may be experiencing. (13) You may want to ask them about using over-the-counter medications such as antihistamines, which can help relieve nausea and allergy symptoms. (14)

Anti-anxiety medications may also be an option. These, however, can often put you at risk for adverse side effects, such as preterm labor. (15)

You may want to avoid hypnotic medications since there’s currently not a lot of research on how common hypnotics such as Zolpidem affect pregnancy. (16)

Watch what you wear

Dr. Nwegbo-Banks says you should avoid high heels, since they can tilt your body forward and strain your lower back muscles. Instead, she recommends low-heeled shoes, such as running/walking shoes.

She also recommends wearing a lumbar support belt and/or a maternity belt to support your hips and lower back. These can help reduce pain and friction to strained muscles.

Limit what you do before bedtime

Dr. Langdon says to avoid strenuous physical activity before going to bed. She also suggests not eating large meals at least two hours before bedtime.

Getting clean before bed may also be beneficial. Dr. Nwegbo-Banks says taking a warm shower/bath before bedtime can help you sleep better, especially if you have LBP.

Reduce your LBP

Stabilization exercises, such as squatting standing on one leg, and pelvic tilt exercises can help reduce your LBP. (17) Dr. Langdon says core exercises, such as sit-ups, are particularly helpful. Alternative techniques such as yoga and acupuncture have shown to benefit pregnant folks with LBP. (18)

You should also consider sleeping on a mattress that helps LBP and keeps your spine from dipping too low. But a mattress shouldn’t be too firm, as this can lead to shoulder and/or hip pain. Especially if you’re a side-sleeper, you’ll want a mattress that is firm enough to keep your spine aligned and soft enough to provide pressure relief at your shoulders and hips.

Dr. Langdon says that if you’re a stomach-sleeper, you’ll likely find it difficult to sleep during pregnancy. Since this may require changing your sleep position, sleeping on the best mattress for you is key.

In addition, Dr. Langdon offers the following additional tips for reducing LBP:

  • Practice good posture
  • Wear good support shoes
  • Consider a pregnancy harness that helps support your expanding belly and relieve lower back strain
  • Use a whole-body pillow

Dr. Nwegbo-Banks says using hot or cold packs on your lower back muscles can soothe them. She also recommends using acetaminophen (Tylenol) to maintain the pain.

Last Word From Sleepopolis

While these are just some common sleep problems, we understand that every pregnancy presents its own unique sleep challenges. Keep in mind that practicing stress-relieving techniques, watching what you wear, and limiting what you do before bedtime are all ways that can help you sleep better while pregnant. Please remember that we are not medical experts, so be sure to speak with your healthcare provider if you have any medical questions.

References

  1. Pien G and Schwab R. Sleep disorders during pregnancy. SLEEP, Nov 1, 2004
  2. Chang, J et al. Sleep Deprivation during Pregnancy and Maternal and Fetal Outcomes: Is There a Relationship? Sleep Medicine Reviews. Jul 21, 2009.
  3. Quinlan, J. and Hill, D. Nausea and vomiting of pregnancy. American Family Physician, July 1, 2003.
  4. Sabino J and Grauer J. Pregnancy and low back pain. Current Reviews in Musculoskeletal Medicine, June 2008.
  5. Hollenbach, D, et al. Non-pharmacological interventions for sleep quality and insomnia during pregnancy: A systematic review. The Journal of the Canadian Chiropractic Association. Sep, 2013.
  6. Acharya, R et al. Prevalence and severity of low back- and pelvic girdle pain in pregnant Nepalese women. BMC Pregnancy and Childbirth. Jul 15, 2019.
  7. Ayanniyi, O et al. Prevalence and Pattern of Back Pain among Pregnant Women Attending Ante-Natal Clinics in Selected Health Care Facilities. African Journal of Biomedical Research. Sep 2006.
  8. “Back Pain During Pregnancy. Cedars Sinai. https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/back-pain-during-pregnancy.html
  9. Morino, S et al. Low back pain and causative movements in pregnancy: a prospective cohort study. BMC Musculoskeletal Disorders. Oct 16, 2017.
  10. Romero, R. A role for sleep disorders in pregnancy complications: challenges and opportunities. American Journal of Obstetrics & Gynecology. Jan 1, 2014.
  11. Gao, M et al. Association of sleep quality during pregnancy with stress and depression: a prospective birth cohort study in China. BMC Pregnancy and Childbirth. Nov 27, 2019.
  12. “Get a Good Night’s Sleep During Pregnancy.” Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/staying-healthy-during-pregnancy/get-a-good-nights-sleep-during-pregnancy
  13. Palagini, L. et al. Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome. Sleep Medicine. Aug 2014.
  14. Okun, M et al. A review of sleep-promoting medications used in pregnancy. American Journal of Obstetrics and Gynecology. Apr 2015.
  15. Reichner, C et al. Insomnia and sleep deficiency in pregnancy. Obstetric Medicine. Dec 2015.
  16. Hashmi, A et al. Insomnia during pregnancy: Diagnosis and Rational Interventions. Pakistan Journal of Medical Sciences. Jul 2016.
  17. Sehmbi, H et al. Low Back Pain in Pregnancy: Investigations, Management, and Role of Neuraxial Analgesia and Anaesthesia: A Systematic Review. Gynecologic and Obstetric Investigation. Sep 2017.
  18. Dunn, G et al. Trajectories of lower back, upper back, and pelvic girdle pain during pregnancy and early postpartum in primiparous women. Women’s Health. Apr 17, 2019.
Vanessa Osorio & Paul Joe Watson

Vanessa Osorio & Paul Joe Watson

This article was co-written by Vanessa Osorio, a member of the team here at Sleepopolis, and Paul Joe Watson, a regular contributor to our sleep health content. A member of our expert panel, Stacy Sutton PT, DPT, WCS, provided medical insight on how pregnancy impacts sleep and how expectant parents can get better sleep at different stages. Read Vanessa’s full bio on our about us page, and learn more about Paul in his full bio.