What to Know About Insomnia and Pregnancy

Insomnia (ongoing difficulties in falling or staying asleep) is a common complaint during pregnancy and in the postpartum period. Estimates suggest that up to 94% of people experience sleep disturbances in pregnancy.

Some expectant parents have insomnia due to hormonal, physical, behavioral, and emotional changes. Others may have trouble falling asleep due to a medical condition, such as a mental health disorder, restless legs syndrome, or sleep apnea (repeated pauses in breathing during sleep).

Lack of sleep can have a negative effect on your health and the health of your developing fetus. If you are pregnant and experiencing insomnia, there are things you can do to improve the quality of your sleep.

This article looks at some of the causes of insomnia during pregnancy, how sleep disturbances can affect you and your baby, and what you can do to get more restorative sleep.

Insomnia and Fertility

Research suggests that there is a strong association between insomnia and infertility (defined as the inability to get pregnant within 12 months of unprotected, timed sex).

Studies indicate that around 34% of infertile females have trouble sleeping on a regular basis. People with polycystic ovary syndrome (PCOS), a hormonal disorder and one of the most common causes of infertility, are around 30 times more likely to experience sleep disturbances.

The connection between sleep and fertility is not entirely understood. However, many researchers believe that the link between insomnia and infertility is likely bidirectional. In other words, sleep deprivation may make it more difficult to conceive, while having trouble conceiving can lead to sleep deprivation. Meanwhile, reproductive hormonal imbalances can contribute to poor sleep quality.

Over time, sleep deprivation can decrease the production of melatonin, a hormone involved in the sleep-wake cycle, and increase the production of cortisol, a hormone related to stress.

Both of these hormonal imbalances may disrupt your menstrual cycle, delay ovulation (release of an egg), and prevent embryo implantation. Sleeplessness also interferes with the release of luteinizing hormone (LH), which triggers ovulation.

Disruptions of the circadian rhythm (the physical, behavioral, emotional, and mental changes people go through in a 24-hour cycle) may also lower fertility. A 2016 study found that women who work the night shift have an increased risk of infertility and early miscarriage.

Psychological distress may also play a role in the link between fertility and sleep. Many people who have difficulty getting pregnant experience symptoms of anxiety and depression, both of which increase the risk of insomnia.

If you’re currently trying to get pregnant and having trouble sleeping, talk to your healthcare provider. Addressing insomnia may help to reduce your stress and improve your fertility.

Insomnia and Gestation

Insomnia during pregnancy, also called perinatal insomnia, is extremely common. Pregnant people often struggle to fall asleep, wake up more often throughout the night, and fall asleep more often during the day. They also tend to get fewer hours of rapid eye movement (REM) sleep—a stage of sleep that is involved in memory and learning.

From behavioral and physical changes to psychological stress about the challenges of parenthood, there are many reasons that you may have difficulty feeling rested while pregnant. While anyone can experience insomnia, certain factors (such as obesity, smoking, anxiety, asthma, and stress) may put you more at risk.

During the first trimester, about 13% of pregnant people have trouble sleeping. In the early stages of pregnancy, common causes of insomnia include:

• Hormonal changes, such as an increase in progesterone and estrogen
• Nausea and vomiting
• Frequent urination

Insomnia symptoms tend to increase as pregnancy progresses. By the end of the third trimester, nearly 74% of pregnant people have problems with sleep. During the later stages of pregnancy, insomnia is often caused by:

• Back pain 
• Positioning changes
• Increased fetal movement
• Leg cramps
• Shortness of breath

Other common causes of sleep disturbances for expectant parents include:

• Gastroesophageal reflux disease (GERD): Sometimes referred to as acid reflux, this disorder causes food and stomach acid to back up into your esophagus (food tube). This leads to symptoms like heartburn, hoarseness, chest pain, and nausea. Many people with GERD also have trouble falling asleep. GERD is not uncommon during pregnancy due to hormonal changes, the growing fetus pressing against your stomach, changes in diet, and decreased muscle tone in the muscle that keeps acid from coming up from the stomach. Antacids may help to relieve nighttime GERD symptoms and improve sleep.
  
• Restless legs syndrome (RLS): This sleep disorder involves an uncontrollable urge to move the legs due to crawling, creeping, or other sensations in the legs. RLS affects 27%–30% of pregnant people. Warm baths, massages, getting enough exercise, and applying heat to the affected area can help to relieve RLS symptoms. Iron supplementation, if needed, is also a mainstay of treatment.
• Mental health disorders: People with mental health conditions, including major depressive disorder (MDD), other mood disorders, and generalized anxiety disorder (GAD), are more at risk for developing insomnia during pregnancy.
• Nightmares: Around half of pregnant people report having frequent, disturbing nightmares. Nightmares are especially common during the third trimester and just before childbirth.
  

Risks

Sleep plays a crucial role in physical and mental health. Over time, sleep deprivation can affect both your well-being and that of your developing baby. Uncontrolled perinatal insomnia can lead to depression, mood swings, and difficulties in parent-child bonding. 

Pregnancy insomnia has also been linked to serious health complications, such as:

Obstructive sleep apnea (OSA): Due to hormonal changes, weight gain, and enlargement of the uterus, up to 25% of pregnant people develop breathing-related sleep disorders, such as obstructive sleep apnea (OSA).

OSA causes the upper airway muscles to relax, leading to apneas (intermittent pauses in breathing), gasping, and loud snoring at night. OSA can reduce the flow of blood and oxygen to your baby, in addition to putting you at risk for serious health complications like heart disease.

The first-line treatment for sleep apnea is continuous positive airway pressure (CPAP) therapy, which involves wearing a mask to keep your airways open as you sleep.

Preeclampsia: Pregnant people with insomnia have an increased risk of gestational hypertension (high blood pressure during pregnancy) and preeclampsia—a condition that involves both high blood pressure and kidney or liver damage in the later stages of pregnancy.

If left untreated, preeclampsia can lead to complications like seizures, excessive bleeding, and stroke. 

Gestational diabetes mellitus (GDM): People with GDM, which is often called gestational diabetes, can’t create enough insulin—a hormone that controls blood sugar (glucose)—during pregnancy. People with gestational diabetes may experience labor complications and problems with fetal growth.

Research suggests that people who report poor sleep quality during the first trimester of pregnancy have a higher risk of developing gestational diabetes when they are 24–28 weeks' pregnant. 

Delivery and postdelivery complications: Chronic sleep loss during pregnancy can also increase your risk of delivery and postdelivery complications, including:

• Increased pain during labor
• Longer labor
• A higher chance of needing a cesarean delivery (C-section)
• Low birth weight
• Premature birth

It’s important to address insomnia symptoms as early in your pregnancy as possible. Talk to your healthcare provider right away to prevent any potential health problems for yourself or your baby.

Treatment

Many people are able to improve their sleep quality by making targeted lifestyle changes. Here are some of the things you can do to start getting a better night’s sleep during pregnancy:

• Limiting caffeine intake, especially later in the day
• Keeping your room dim, dark, and cool
• Establishing a consistent bedtime routine
• Waking up and going to sleep at the same times each day
• Limiting the use of smartphones or tablets close to bedtime
• Eating smaller meals throughout the day
• Quitting smoking 
• Mindfulness techniques, such as yoga or meditation
• Relaxation exercises, such as deep breathing
• Exercising regularly
• Sleeping in a different position, such as on your side
• Using a pregnancy pillow

If your insomnia symptoms don’t improve with lifestyle changes, talk to your healthcare provider about possible treatments. Some effective treatments for pregnancy insomnia include:

• Over-the-counter (OTC) sleep aids: About 10%–15% of people take antihistamines at some point during pregnancy, often to promote sleep. According to the Centers for Disease Control and Prevention (CDC), occasional use of common OTC sleep aids like Unisom (doxylamine) and Benadryl (diphenhydramine) has not been linked to birth defects. Talk to your healthcare provider before taking any medications while pregnant.
• Prenatal supplements: Pregnant people with low levels of certain vitamins and minerals have a higher risk of restless legs syndrome. Taking a prenatal supplement that contains iron and folate can help to prevent RLS.
• Psychotherapy: Studies suggest that psychotherapy, such as cognitive behavioral therapy (CBT), may improve sleep quality during and after pregnancy. Psychotherapy is particularly helpful for people who have insomnia and at least one comorbid mental health condition.
• Light therapy: Light therapy, also known as phototherapy, has been shown to reduce the effects of insomnia among pregnant people with depression.

Some medications that are commonly prescribed to treat insomnia, such as benzodiazepines, are associated with a higher risk of birth defects. Talk to your healthcare provider about potential side effects before taking any medicines for sleep.

Concerning Symptoms

If you experience any of the following symptoms, you may have insomnia or another sleep disorder:

• Frequent difficulty falling asleep 
• Night wakings
• Not feeling rested after waking up in the morning
• Falling asleep during the day
• Daytime fatigue or sleepiness
• Difficulty focusing on daily activities 
• Irritability
• Loud snoring
• Waking up gasping for breath

Reach out to your healthcare provider to discuss how you can start getting more rest during pregnancy.

Insomnia and Postpartum

Most new parents expect some fatigue after having a baby. However, some people experience more severe signs of disordered sleep in the postpartum period.

Some of the causes of postpartum insomnia may include:

• Postpartum discomfort, pain, and physical changes 
• Hormonal changes
• Night feedings, which can disrupt circadian rhythms and throw off the sleep-wake cycle
• Psychological stress

While many people think that sleep deprivation is a natural part of the newborn phase, postpartum insomnia can significantly affect your health. Chronic sleep loss may make it harder for you to recover from childbirth and cope with the stress of parenthood. 

Impact on Recovery

Over time, postpartum insomnia can have a negative impact on many aspects of health, healing, and well-being after delivery. 

Complications of postpartum insomnia may include:

• Irritability 
• Mood swings
• Anxiety
• Delayed physical healing 
• Daytime fatigue
• Headaches
• Relationship conflicts
• Lowered cognitive function
• Higher risk for car accidents
• Difficulties with bonding with the infant

It’s important to make your sleep health a priority after giving birth. There are many ways you can start to get more rest in the postpartum period, including:

• Sharing the nighttime feeding schedule with your partner or relative(s)
• Asking your friends and/or family for help
• Sleeping when the baby sleeps
• Getting enough exercise
• Deep breathing exercises
• Relaxation techniques
• Taking daytime naps or going to sleep earlier
• Light therapy
• Psychotherapy
• Medications, upon the advice of your healthcare provider

Postpartum insomnia also increases the risk for and may be an early sign of postpartum depression (PPD). 

While many people experience symptoms of the "baby blues,” such as mood swings and crying spells, PPD is less common and more serious. It refers to moderate or severe depression experienced by a new parent within the first year after birth.

If you begin to notice signs of PPD, such as feelings of hopelessness, worthlessness, or despair, reach out to your healthcare provider for support and treatment.

Breastfeeding

Prolactin, a hormone involved in lactation, works to lower stress and promote sleep.

One study showed fully breastfed infants sleep more consistently and for longer stretches than formula-fed infants (though the breastfed infants did have more night awakenings).

Research suggests that it may be safe to use a low-dose OTC sleep aid (such as Benadryl or Unisom) occasionally while nursing. When you breastfeed, only a very small amount of most medications is passed on to your baby. However, in larger doses or when used frequently, antihistamines may reduce your milk supply. 

Talk to your healthcare provider about any medications you’re taking or planning to take while nursing.

Summary

Insomnia can sometimes affect your ability to get pregnant. Most people experience problems with sleep at some point during pregnancy. In the first trimester, some of the most common causes of insomnia include frequent urination, nausea and vomiting, and psychological stress.

In the later stages of pregnancy, many people have trouble falling asleep because of restless legs syndrome (RLS), back pain, and problems with sleep positioning. 

It’s important to talk to your healthcare provider about your sleep health during pregnancy. Lack of sleep has been linked to many maternal health complications, including gestational diabetes mellitus, preeclampsia, and postpartum depression.

Treatments may include healthy sleep habits, positioning changes, medication, relaxation techniques, mindfulness exercises, and psychotherapy.

A Word From Verywell

Pregnancy involves many changes—from hormonal and physiological shifts to psychological stress, new lifestyle habits, and more. Many of these changes can lead to sleep disturbances, including insomnia. 

While insomnia is common during pregnancy, it still isn't easy to deal with. Over time, sleep deprivation can affect your physical and emotional well-being, as well as the health of your developing fetus. 

If you are struggling to get enough sleep during pregnancy, reach out to your healthcare provider. They can recommend lifestyle changes and treatments to improve your sleep and reduce your stress. They can also refer you to a board-certified sleep physician or another specialist if needed.