Tips and Tricks for Battling Pregnancy Insomnia

“Sleep while you still can” is considered good pregnancy advice. But what if you cannot sleep? Pregnancy insomnia seems like a cruel joke; at the exact time you should be capitalizing on sleep before a newborn arrives, there is often an unrelenting inability to fall or stay asleep. What is pregnancy insomnia, and what can you do about it?

What Is Pregnancy Insomnia?

Insomnia is the inability to fall asleep, difficulty falling back to sleep following nighttime awakenings, or waking too early from sleep. Sleep deficiency, while not considered insomnia, is inadequate sleep of less than seven hours a night.¹

Don’t worry! You are not the only pregnant one struggling with sleep. Sleeping difficulties and insomnia impact an estimated 66%-94% of pregnancies.⁴ The more pregnant you are, the greater your sleeping difficulties may be.¹

You or your obstetric provider may not fully recognize or address the lack of quality sleep. Adequate sleep is essential for a healthy pregnancy. Carefully consider any sleeping challenges or insomnia you may experience. Discuss them with your provider and become proactive in finding ways to battle pregnancy insomnia.

When Does Pregnancy Insomnia Start?

Unfortunately, first-trimester insomnia and sleep challenges can impact about 13% of pregnancies.^1,3 Hormones and classic first-trimester pregnancy symptoms may cause early pregnancy insomnia. Insomnia and sleep challenges may start or worsen as pregnancy progresses. Third-trimester insomnia can affect nearly 75% of pregnancies, with night waking being the most significant complaint.¹

Causes of Pregnancy Insomnia

Pregnancy is an intense time of physical, hormonal, and emotional body changes that have the potential to impact sleep quality and duration significantly. Causes of pregnancy insomnia may include:^1,3

• Nausea and vomiting
• Hyperemesis gravidarum
• Frequent urination
• Pelvic or back pain
• Nasal congestion
• Fetal movements
• Contractions
• Heartburn
• Uncomfortable sleep positions
• Intense dreams or nightmares

Other Causes of Pregnancy Insomnia

Other pregnancy-related complications can contribute to or cause insomnia. Speak with your obstetric provider if you have concerns that you may be suffering from any of the following:

Sleep Disordered Breathing (SDB)

SDB includes obstructive sleep apnea that can cause snoring, nighttime awakenings, headaches, dry mouth, and extreme fatigue.^3,7 SDB may increase your risk of miscarriage.⁷

Restless Leg Syndrome (RLS)

RLS is characterized by troublesome feelings in the legs, often described as creeping, crawling, burning, and itching. These feelings are generally worse at night when your body is at rest. The cause of restless leg syndrome during pregnancy is not fully understood. Some studies have discovered an association between RLS and iron deficiency. Pregnancy is a risk factor for iron deficiency, and iron supplementation may be helpful.⁷

Anxiety or Mood Disorders

Mental health disorders such as major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD) can all negatively contribute to pregnancy insomnia or sleeping difficulty.³

How Long Does Pregnancy Insomnia Last?

Unfortunately, sleeping difficulties do not necessarily end when pregnancy does. Pregnancy insomnia can last well into the postpartum period.⁸ Sleep challenges and insomnia can be further complicated by spending many potential sleeping hours caring for your new baby. A whole night’s sleep may not be possible in this early postpartum period, but many of the tips below, in addition to addressing any mental health issues, can provide a more restful night’s snooze.

Complications of Pregnancy Insomnia

Sleep can greatly influence critical female hormone cycles, including estrogen, progesterone, and prolactin.⁷ Pregnancy is also physically demanding, internally and externally. Pregnant people require adequate rest for optimal function and a thriving pregnancy. Sleeping difficulties, disturbances, and insomnia during pregnancy are associated with increased risks of the following:^1,3

• Perinatal depression and anxiety
• Postpartum depression
• Gestational diabetes
• Low birth weight newborns
• Preterm delivery
• Prolonged labor
• Cesarean section

Tips for Coping With Pregnancy Insomnia

Developing healthy sleep hygiene habits and trying non-pharmacological strategies is the first defense for insomnia treatment:^1,3,6

• Establish a regular sleep-wake cycle.
• Reserve naps for the earlier part of the day
• Maintain a dark, cool sleep environment
• Avoid caffeine before bed
• Avoid screens before bedtime
• Limit fluids in the later half of the day to limit nighttime awakenings (be sure to hydrate earlier in the day adequately)
• Consume frequent, light meals throughout the day while avoiding heavy meals in the evening.
• Aim for 30 minutes of daily exercise or movement if your healthcare provider approves.
• If you have difficulty falling asleep, do a non-stimulating activity like reading.
• Prioritize sleep comfort using pillows for support
• Consider alternative therapies such as acupuncture, acupressure, massage, and meditation

Your obstetric provider can guide you in finding an approach that may work for you. Additionally, other treatments may be necessary if you suffer from sleep-disordered breathing, restless leg syndrome, or an anxiety or mood disorder.

Can I Take Melatonin During Pregnancy?

Melatonin is a frequently used and highly marketed supplement that can promote a more restful sleep. But can you take melatonin while pregnant?

Melatonin is a hormone produced by your body that assists in regulating your sleep cycle. It is also vital during pregnancy. Some studies have concluded that melatonin secretion positively impacts pregnancy, from maternal egg quality through birth. Melatonin has a developmental impact on your baby’s nervous and endocrine systems. It can also act as an antioxidant to protect the developing organs from oxidative stress.⁵

Though the studies are limited, several have suggested that melatonin use in pregnant and lactating persons is probably safe and without side effects.^4,5 However, melatonin supplementation for sleep purposes during pregnancy is not officially recommended. Because the Food and Drug Administration does not regulate the quality of melatonin supplements, the product’s safety cannot be assured.⁴

Consult your obstetric provider if you have questions about taking melatonin during pregnancy.

Can I Use Sleep Aid Medications During Pregnancy?

If melatonin use during pregnancy is up for debate, what about other sleep aid medications? If you are experiencing significant sleeping difficulties and natural remedies have proved ineffective, sleep aid medication may be an option.

Over-the-counter antihistamine medications such as diphenhydramine (Benadryl) and doxylamine (Unisom) are considered safe during pregnancy.⁹ However, not all prescription sleep aids are considered safe during pregnancy and postpartum, including benzodiazepines, zolpidem (Ambien), and barbiturates. But that doesn’t mean they can’t be taken, especially if the benefits outweigh the risks.^10,11 Always speak with your obstetrician or midwife about your sleeping difficulties and interest in medication options.

Poor sleep quality and insomnia symptoms during pregnancy are not something to overlook. Restful sleep is vital for your growing baby and your well-being during pregnancy and postpartum. Do not hesitate to discuss your challenges and symptoms with your obstetric provider. Together, you may find solutions for a more restful night’s sleep during this perinatal period.