What to Know About Insomnia and Pregnancy

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If you have difficultly sleeping during pregnancy, you’re not alone. Research shows that pregnant people frequently experience insomnia, with rates ranging between 12 to 38% in early gestation, rising to over 60% in the third trimester of pregnancy.

Insomnia comes in a few different forms. You can have trouble falling asleep when you try to go to bed, or you can wake up in the middle of the night and have trouble going back to sleep. The various physical discomforts of pregnancy and hormonal changes can contribute to poor sleep.

Lack of sleep and tiredness are known to contribute to many serious health concerns, such as:

Insomnia may also have an impact on fertility and the postpartum period. It’s important to speak to your healthcare provider if you are experiencing sleep issues that are impacting your day-to-day life.

Learn more about how insomnia can affect fertility, gestation, and postpartum.

Uncomfortable Black pregnant woman sleeping in bed

JGI / Jamie Grill / Getty Images

Insomnia and Fertility

You may find the stress of trying to conceive is keeping you awake, or you may be one of the 35% of Americans who gets less than seven hours sleep a night. Either way, it’s thought a lack of sleep may have an impact on fertility.

Although little research has been undertaken to investigate the relationship between sleep and fertility, researchers from the University of Pennsylvania Medical Center and Drexel University found that sleep influences fertility in these key ways:

  • Exerting stress on the body affects reproductive hormones, menstruation, and can even interfere with follicle development. Since insomnia can produce stress responses in the body, it makes sense that insomnia may also have a relationship with fertility.
  • Fertility-related hormones have their own 24-hour cycle that is largely influenced by sleep. Disruption to our body clocks has been associated with negative reproductive outcomes, with shift work, in particular, found to negatively affect the secretion of reproductive hormones.
  • Sleep deprivation may also trigger inflammatory responses in the body, which can affect the immune system. Interleukin-6, a chemical produced in the body wherever there is inflammation, has been found to play a role in unexplained infertility.

Insomnia and Gestation

It’s normal to have trouble sleeping at any point during pregnancy, but many pregnant people experience insomnia starting in the second to third trimesters, as other pregnancy symptoms intensify. Fortunately, many of the difficulties related to poor sleep during pregnancy will resolve once the baby is delivered.

When you’re pregnant, many things can cause you to lose sleep, including:

  • Backache: As your center of gravity shifts forward, your back muscles overcompensate and become sore.
  • Frequent nighttime trips to the bathroom.
  • Heartburn: This can be caused by hormonal changes and the growing baby pressing against your stomach.
  • Leg cramps and restless legs syndrome: Changes in your circulation and pressure from the baby on nerves and muscles can make your legs cramp up. You may also get an overwhelming urge to move your legs at night, known as restless legs syndrome (RLS). RLS is thought to affect up to one-third of pregnant people in their third trimester of pregnancy.
  • Vivid or disturbing dreams: These are common in pregnancy and may disturb your sleep.
  • Snoring: Your nasal passages may swell up during pregnancy, which can make you snore. Extra pressure from your increasing weight can also make snoring worse. Changes like these may briefly block breathing during sleep (known as sleep apnea).
  • Anxiety: Pregnancy can be worry-inducing, and it’s common to have anxious thoughts running through your head when you are trying to sleep.

Risks

Getting quality sleep during pregnancy is important for both you and your baby. Sleep plays a major role in memory, appetite, mood, and decision making—all important when preparing to have a baby.

Increasing evidence indicates that sleep problems in pregnancy may be associated with adverse maternal and fetal outcomes and may make you more likely to experience:

  • Preterm birth
  • Increased chance of cesarean section
  • Worse labor pain
  • Depression

Treatment

Treating insomnia is a little more challenging when you’re pregnant, as many prescription sleep medicines aren’t considered safe for pregnant people and their babies. But there are other ways to treat a sleep disorder during pregnancy.

Your healthcare provider may recommend cognitive behavioral therapy (CBT) to help with insomnia. One randomized control trial showed remission of insomnia was attained by 64% of pregnant people who undertook cognitive behavioral therapy, compared to 52% in the control group.

Lifestyle Changes to Treat Insomnia

Lifestyle changes can safely improve your sleep. If you can, stick to a regular early bedtime, and keep your bedroom quiet, dark, and cool at night. Also, try to:

  • Limit caffeinated beverages.
  • Hydrate, but stop drinking a couple of hours before bedtime so you don’t have to wake up to go to the bathroom.
  • Avoid heartburn triggers like chocolate and greasy or spicy foods, and avoid eating for a few hours before bed.
  • If anxiety is keeping you awake, talk through your worries with a loved one or therapist.
  • Gently stretch your leg muscles before bed if you have leg cramps at night.

Also, other over-the-counter sleep aids are considered safe for occasional use in pregnancy, including Unisom, Tylenol PM, Sominex, and Nytol, but always check with your doctor before taking these or any kinds of herbal preparations. You should also try not to take sleep aids every night.

Concerning Symptoms

A significant number of pregnant people develop snoring and sleep apnea during pregnancy.

Pauses in breathing (apnea) may be associated with surges in blood pressure. These surges can lead to changes in the blood vessels and increase overall blood pressure. This may reduce the blood volume pumped by the heart, a reduction in cardiac output. As a result, blood flow to the fetus via the placenta can be compromised.

Although often benign, snoring may also be a warning sign of a more severe condition. Research shows that snoring is correlated with preeclampsia, high blood pressure, and gestational diabetes, while sleep apnea may increase the risk of maternal morbidity.

Prevalence of Insomnia During Pregnancy

In a 2015 study published in the journal Obstetric Medicine, in the last trimester of pregnancy, up to 69.9% of pregnant people reported difficulty in maintaining sleep, 34.8% described early morning awakenings, and 23.7% reported difficulty falling asleep.

Insomnia and Postpartum

There’s an important distinction to be made between postpartum insomnia and not sleeping because of the demands of a newborn.

If you’re continually having a hard time falling and/or staying asleep after your infant wakes up during the night, or you can’t sleep when your baby is asleep, this could indicate insomnia or another sleep disorder.

In the weeks following birth, sleep disturbance due to hormonal changes is common. These adjustments can affect your circadian rhythm, which regulates not only sleep, but also mood, appetite, and other bodily functions.

Postpartum Depression and Sleep

Postpartum depression, or perinatal depression, can be another obstacle to sleep. This can cause extreme sadness, anxiety, and fatigue. Approximately one in eight pregnant people will experience postpartum depression. Insomnia may be a catalyst or a symptom of postpartum depression.

Impact on Recovery

Sleeping poorly is very common in the days and weeks immediately following birth, particularly if you had a cesarean section. But quality sleep is important, not only to help the healing process but to soothe frayed nerves. A well-rested person will also be better equipped to deal with the stresses of recovery.

Breastfeeding

Breastfeeding can actually help with insomnia and sleep issues. When nursing, you have a built-in biological advantage for peaceful sleep. The hormone prolactin is released during nursing and promotes feelings of relaxation and calm.

That said, when breastfeeding you may still suffer from sleep problems. The consequences of being overly tired with a newborn prompt many to seek help for sleeplessness.

Frequently Asked Questions

What causes insomnia during pregnancy?

Insomnia may be caused by hormonal changes, but as your body undergoes drastic changes during pregnancy, other factors may be keeping you awake at night, including:

  • Pregnancy heartburn, constipation, or morning sickness
  • Frequent trips to the bathroom
  • Aches and pains, including headaches and tender breasts
  • Leg cramps and restless legs syndrome
  • Vivid or disturbing dreams
  • Difficulty getting comfortable in bed with your growing belly
  • The movement of the fetus
  • Pre-birth anxiety

What can I take for insomnia during pregnancy?

It’s best to avoid taking medications if possible, but if other options don’t appear to be helping, you can try using a short-term sleep aid.

Over-the-counter sleep aids that are considered safe for occasional use in pregnancy include Unisom, Tylenol PM, Sominex, and Nytol, but always check with your doctor before taking these or any kinds of herbal preparations. Some safe sleep aids can be addictive even when taken short term.

When does pregnancy insomnia go away?

Insomnia related to the physical changes that happen to your body during pregnancy should resolve once the baby is delivered.

Sleep loss is a common, normal experience after the arrival of a baby. However, if you develop difficulty falling asleep or returning to sleep, you should seek help. Tackling sleep problems as soon as possible may help to reduce the risk of postpartum depression.

There is a lack of research assessing the quantity and quality of sleep in postpartum people, but one research study found the prevalence of postpartum insomnia was 60% at eight weeks after birth and remained high at 41% at year two postpartum.

What herbs are safe for insomnia while pregnant?

Some medications, vitamins, and herbal remedies can be harmful to a fetus and should not be taken while you are pregnant.

There are dozens of herbal products that claim to help you sleep, but most of them haven’t been studied to find out whether they’re safe to use while pregnant or breastfeeding. Dietary supplements aren’t regulated by the Food and Drug Administration, so it’s best to avoid taking any extra vitamins or minerals during pregnancy unless your doctor has specifically told you to do so.

A Word From Verywell

Between physical discomfort, hormonal changes, and increased stress, sleeping well during pregnancy isn’t always easy. Your healthcare provider can give you more information about treatment options available so you can get ample rest before the baby arrives.

Insomnia can also affect your body before or after pregnancy. Don’t assume your sleep issues are normal. Speak with a healthcare provider.

Good sleep hygiene, which includes going to bed at the same time each night, and avoiding caffeine and high-stress activities before bedtime, can make a huge difference in how deeply you sleep.

For most pregnant people, insomnia will pass once the baby arrives. If your insomnia continues weeks or months after you’ve delivered the baby or is impacting your ability to function, speak to your doctor.

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