A Patient’s Guide to Pregnancy Insomnia
Pregnancy is a special time of life, full of hope, love and expectation. But it can also be a sleepless time. Between the physical changes that occur within your body and the anxieties that often accompany impending motherhood, it’s common to have some difficulty drifting off to sleep or staying asleep. According to the American Pregnancy Association, 78% of pregnant women experience insomnia at some point during pregnancy.
What Is Insomnia?
Insomnia is the state of not being able to sleep or having inadequate or poor quality of sleep. Dr. Alex Dimitriu, a sleep medicine specialist who’s double board-certified in psychiatry and sleep medicine and founder of Menlo Park Psychiatry & Sleep Medicine in California, says insomnia occurs in about 20% to 30% of all people.
Insomnia is not the same for everyone. Some people have difficulty falling asleep, while others have no problem drifting off but wake up too early or have trouble getting back to sleep after wakening. Still others may be logging eight hours of shuteye, but experience poor quality sleep and awaken feeling unrefreshed.
Insomnia – More General Information
Insomnia can occur at any point during pregnancy, says Dr. Jesse Mindel, assistant professor of medicine and neurology at The Ohio State University Wexner Medical Center. Insomnia related to weight gain is naturally more common later in a pregnancy, “whereas anxiety-related symptoms tend to be more common earlier in the pregnancy.”
Dimitriu adds that the third trimester is typically the hardest time for many women to sleep, simply because so many changes have occurred in the body by then. “By the third trimester, anatomically, women have got a pretty large baby in them.” The aches and pains that come during the third trimester may lead some women to be too uncomfortable to sleep well, he says. In addition, for some women during the third trimester, there can be “a bit of mounting anxiety as the due date approaches.”
If you’re waking up not feeling refreshed, it might not exactly be insomnia but rather simple fatigue related to your pregnancy. “Physiologically during pregnancy there’s a tendency to be more tired and have an increased sleep requirement,” says Mindel. As a result, you’ll feel more tired and think that you’re struggling with insomnia when in fact you might actually be sleeping the same amount as before you were pregnant.
Either way, the feeling of not getting enough sleep – especially at a time when your body is working really hard to grow a baby – can be very upsetting and is worth asking your doctor about.
The APA reports that “it is important to understand that insomnia is not harmful to your baby,” and that it’s a normal occurrence. Still, it would be nice to be able to get some good sleep while you’re pregnant, especially given that many newborns don’t sleep through the night for the first few months – so pregnancy might be the last time you’ll have the opportunity for a solid night of sleep for a while.
As with any other symptom you experience during pregnancy, if your insomnia becomes progressively worse or especially bothersome, talk to your OB-GYN about how best to address the issue. You may also want to visit a sleep specialist to make sure there isn’t an underlying problem or other issue associated with your insomnia.
Mindel says that “insomnia can be a normal reaction to things that change in your body. During pregnancy, a woman’s whole body changes, and a lot of those changes are things that can lead to sleep disruption.”
Many factors may contribute to a loss of sleep or low sleep quality during pregnancy including:
- Changed sleeping position. The simple logistics of growing another human inside your belly leads to a lot of structural changes in the body, which may mean your normal sleeping positions are no longer comfortable. For example, if you prefer to sleep on your stomach, as your pregnancy progresses, you may not be able to assume that sleeping position. This can disrupt your ability to sleep and may make it difficult to find a comfortable sleeping position. Dimitriu says these structural changes in your body are one of the biggest reasons why pregnant women experience insomnia. “Being larger and trying to sleep with a big belly can be challenging.”
- Anxiety. Pregnancy can be a stressful time for many women, and we all know how being anxious can cause sleepless nights. Depression is also often associated with insomnia. Anxiety-related pregnancy insomnia is often linked with a tendency to wake up in the middle of the night, Mindel says. This is the same for non-pregnant people who have anxiety-related insomnia. When these individuals wake up in the middle of the night, “instead of going back to sleep, the things they tend to be anxious about tend to come out at that time.” Over time, these dysfunctional sleep patterns can become a habit.
- Back pain. The APA reports that 50% to 70% of pregnant women experience back pain, often a cause of pregnancy insomnia. Overweight women and those who’ve had back pain during a previous pregnancy are at highest risk for developing back pain. In addition, as your body readies for delivery, your hips and pelvis shift, and your posture changes. Weight gain from the growing baby and a shift in your center of gravity to accommodate all these changes may lead to more pressure on the lower back and back pain for many women.
- Hormonal fluctuations. The hormonal landscape of your body undergoes dramatic changes over the course of your pregnancy. Progesterone, the hormone that supports pregnancy, “tends to be a ‘feel-good’ and ‘rest and relax’ hormone,” Dimitriu says. So for some women, an increase in progesterone levels during pregnancy can actually lead to better sleep because this hormone can have a mild sedative effect. However, for many women, hormonal fluctuations can disrupt sleep. (A decline in progesterone in the body after menopause is one reason why some post-menopausal women struggle with insomnia.)
- Frequent urination. Changes in certain hormone levels can lead to needing to urinate more frequently, which may wake you up multiple times during the night. And, as the baby grows, things can get crowded inside your abdomen. This may mean there’s more pressure being placed on your bladder, which may make you feel the need to urinate more frequently and urgently.
- Heartburn. The APA reports that heartburn and indigestion are common during pregnancy, as the internal organs must shift to accommodate a growing baby, and this can put pressure on the valve that normally prevents stomach acid from flowing back into the esophagus. Risk of heartburn tends to increase in the third trimester as your belly reaches its biggest size just before delivery.
- Sleep apnea. Dimitriu says there’s “some evidence that sleep apnea might also get worse in pregnancy,” and this may be related to weight gain associated with the developing baby. Sleep apnea is a condition in which you stop breathing momentarily multiple times during the night. This can cause you to wake up frequently, and you might not even know it’s happening. Sleep apnea can be a serious condition. If you start snoring while you’re pregnant, snoring worsens or you develop any sort of breathing issue, talk with your doctor.
- Other medical conditions. Gestational diabetes and restless leg syndrome can also develop in some women during pregnancy. Symptoms of restless leg syndrome and sleep apnea – two common causes of insomnia in the general population – may also worsen during pregnancy. A host of other medical conditions that a woman may already have or develop during pregnancy can contribute to disrupted sleep. All should be evaluated by your doctor.
Pregnancy insomnia is typically diagnosed by a health care provider during a regularly-scheduled prenatal care visit, says Dr. Sherry Ross, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California. There’s no clinical exam – like a blood test – that can diagnose pregnancy insomnia.
“The diagnosis starts with a conversation between a pregnant woman and her health care provider,” Ross says. Ideally, the health care professional will ask her pregnant patient a series of questions, like how many hours of shut-eye she typically gets and how many hours she’s sleeping during her pregnancy. If the patient is sleeping fewer hours than usual and experiencing certain symptoms, she may have pregnancy insomnia. Those symptoms include feeling foggy or having trouble focusing during the day, headaches and exhibiting slower reflexes while driving.
If your doctor doesn’t ask you about your sleeping regimen during a prenatal visit, volunteer the information, Ross advises.
Managing insomnia during pregnancy is not so very different from coping with insomnia during any other time of life, and as such, there are some simple strategies and home remedies for pregnancy insomnia that may help. Maintaining good sleep hygiene is an important component of dealing with this condition.
Here are some smart sleep tactics:
- Keep a consistent bedtime and waking time. When it comes to the sleep-wake cycle, our bodies crave consistency. Therefore, rule No. 1 of good sleep hygiene is to set a regular bedtime and stick to it, no matter what. Ditto for setting the alarm in the morning, which sadly means not sleeping in on the weekend. The more consistent a pattern you can develop, the more likely you can enjoy adequate sleep.
- Keep your bedroom cool, dark and quiet. When it’s dark out, our bodies naturally begin producing melatonin, a hormone that helps the body transition to sleep. A cool, quiet room offers fewer distractions and discomforts that could wake you up.
- Keep daytime naps short. Sleeping during the day – especially if you take a long nap – can throw off your internal sleep-wake clock and make it harder to sleep at night.
- Keep your bed for sleeping only. Your bed should be reserved for sleep and sex. Everything else – surfing the web, reading, watching TV, working, eating or talking on the phone should all happen outside the bedroom so that your brain learns to associate bed with sleep and sleep alone.
- Avoid big meals before bedtime. Avoiding foods that trigger heartburn, such as fatty or spicy foods, and being sure to eat several hours before lying down so you have more time to digest a meal may help you avoid developing heartburn. If heartburn becomes a major problem, talk to your doctor about whether you should take an over-the-counter antacid or other medication to relieve it.
- Limit your intake of caffeine. Certain substances can disrupt sleep, and caffeine is one of the biggest culprits, particularly if it’s ingested later in the day. Alcohol and tobacco also can disrupt sleep, and moms-to-be should be avoiding these substances anyway.
- Employ relaxation techniques, such as meditating or taking a warm bath, to unwind before bed. Make a ritual to ready your body and brain for bedtime and you’ll be more likely to drift off faster once you do climb into bed.
- Limit or eliminate use of screens and blue-light LED devices such as smart phones and tablets for an hour or two before bed. That blue light disrupts the release of melatonin in the brain, upsetting your sleep cycle for the whole night.
- Exercise regularly and earlier during the day. Exercising in the evening can make it harder for you to unwind and fall asleep at bedtime, so aim for an earlier time. But make sure to get that exercise – regular physical activity helps support a healthy sleep-wake pattern.
Can I take a sleeping pill?
Talk to your doctor before reaching for any drug or supplement to help you sleep. Dimitriu agrees that pregnant women should seek to resolve insomnia issues with “behavioral interventions,” such as improving sleep hygiene and using non-medical approaches and natural remedies for insomnia before reaching for a medication. “My general inclination is if you don’t have to take anything, don’t.”
Any drugs you ingest – even over-the-counter medications that seem completely harmless – could have a potential impact on your baby.
Natural remedies for insomnia include:
- Drinking chamomile tea.
- Taking a soothing bath before bedtime.
Particularly for anxiety-related insomnia during pregnancy, Mindel recommends trying cognitive behavioral therapies to reprogram your sleep patterns. “These are the types of things that you would learn to do if you went to a sleep psychologist,” and may include exercises to help change your thought patterns, meditation and even talk therapy.
However, CBT for insomnia isn’t a quick fix. According to Mindel, these behavioral exercises take longer to work because people have to practice. Nevertheless, he says it’s a long-term way to improve your body’s natural ability to sleep without taking a prescription. These changes may be safer and longer lasting than simply using a sleeping pill.