Sleeping During Pregnancy

Expectant parents know that it'll be harder to get a good night's sleep after their little one arrives, but who would have guessed that catching enough ZZZs during pregnancy could be so difficult?

Actually, you may sleep more than usual during the first trimester of your pregnancy. It's normal to feel tired as your body works to protect and nurture the developing baby. The placenta (the organ that nourishes the fetus until birth) is just forming, your body is making more blood, and your heart is pumping faster.

It's usually later in pregnancy that most women have trouble getting enough deep, uninterrupted sleep.

Why Sleeping Can Be Difficult

The first and most pressing reason behind sleep problems during pregnancy is the increasing size of the fetus, which can make it hard to find a comfortable sleeping position. If you've always been a back or stomach sleeper, you might have trouble getting used to sleeping on your side (as doctors recommend). Also, shifting around in bed becomes more difficult as the pregnancy progresses and your size increases.

Other common physical symptoms may interfere with sleep as well:

  • the frequent urge to pee: Your kidneys are working harder to filter the increased volume of blood (30% to 50% more than you had before pregnancy) moving through your body, and this filtering process results in more urine. Also, as your baby grows and the uterus gets bigger, the pressure on your bladder increases. This means more trips to the bathroom, day and night. The number of nighttime trips may be greater if your baby is particularly active at night.
  • increased heart rate: Your heart rate increases during pregnancy to pump more blood, and as more of your blood supply goes to the uterus, your heart will be working harder to send sufficient blood to the rest of your body.
  • shortness of breath: At first, your breathing may be affected by the increase in pregnancy hormones, which will cause you to breathe in more deeply. This might make you feel as if you're working harder to get air. Later on, breathing can feel more difficult as your enlarging uterus takes up more space, resulting in pressure against your diaphragm (the muscle just below your lungs).
  • leg cramps and backaches: Pains in your legs or back are caused in part by the extra weight you're carrying. During pregnancy, the body also produces a hormone called relaxin, which helps prepare it for childbirth. One of the effects of relaxin is the loosening of ligaments throughout the body, making pregnant women less stable and more prone to injury, especially in their backs.
  • heartburn and constipation: Many women experience heartburn, which occurs when the stomach contents reflux back up into the esophagus. During pregnancy, the entire digestive system slows down and food tends to remain in the stomach and intestines longer, which may cause heartburn or constipation. These can both get worse later on in the pregnancy when the growing uterus presses on the stomach or the large intestine.

Your sleep problems might have other causes as well. Many pregnant women report that their dreams become more vivid than usual, and some even experience nightmares.

Stress can interfere with sleep, too. Maybe you're worried about your baby's health, anxious about your abilities as a parent, or feeling nervous about the delivery itself. All of these feelings are normal, but they might keep you (and your partner) up at night.

Finding a Good Sleeping Position

Early in your pregnancy, try to get into the habit of sleeping on your side. Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses. It also makes your heart's job easier because it keeps the baby's weight from applying pressure to the large vein (called the inferior vena cava) that carries blood back to the heart from your feet and legs.

Some doctors specifically recommend that pregnant women sleep on the left side. Because your liver is on the right side of your abdomen, lying on your left side helps keep the uterus off that large organ. Sleeping on the left side also improves circulation to the heart and allows for the best blood flow to the fetus, uterus, and kidneys. Ask what your doctor recommends — in most cases, lying on either side should do the trick and help take some pressure off your back.

But don't drive yourself crazy worrying that you might roll over onto your back during the night. Shifting positions is a natural part of sleeping that you can't control. Most likely, during the third trimester of your pregnancy, your body won't shift into the back-sleeping position anyway because it will be too uncomfortable.

If you do shift onto your back and the baby's weight presses on your inferior vena cava, the discomfort will probably wake you up. See what your doctor recommends about this; he or she may suggest that you use a pillow to keep yourself propped up on one side.

Try experimenting with pillows to discover a comfortable sleeping position. Some women find that it helps to place a pillow under their abdomen or between their legs. Also, using a bunched-up pillow or rolled-up blanket at the small of your back may help to relieve some pressure. In fact, you'll see many "pregnancy pillows" on the market. If you're thinking about buying one, talk with your doctor first about which might work for you.

Tips for Sleeping Success

Although they might seem appealing when you're feeling desperate to get some ZZZs, remember that over-the-counter sleep aids, including herbal remedies, are not recommended for pregnant women. Instead, these tips may safely improve your chances of getting a good night's sleep:

  • Cut out caffeinated drinks like soda, coffee, and tea from your diet as much as possible. Restrict any intake of them to the morning or early afternoon.
  • Avoid drinking a lot of fluids or eating a full meal within a few hours of going to bed at night. (But make sure that you also get plenty of nutrients and liquids throughout the day.) Some women find it helpful to eat more at breakfast and lunch and then have a smaller dinner. If nausea is keeping you up, try eating a few crackers before you go to bed.
  • Get into a routine of going to bed and waking up at the same time each day.
  • Avoid rigorous exercise right before you go to bed. Instead, do something relaxing, like soaking in a warm bath for 15 minutes or having a warm, caffeine-free drink, such as milk with honey or a cup of herbal tea.
  • If a leg cramp awakens you, it may help to press your feet hard against the wall or to stand on the leg. Also, make sure that you're getting enough calcium in your diet, which can help reduce leg cramps.
  • Take a class in yoga or learn other relaxation techniques to help you unwind after a busy day. (Be sure to discuss any new activity or fitness regimen with your doctor first.)
  • If fear and anxiety are keeping you awake, consider enrolling in a childbirth or parenting class. More knowledge and the company of other pregnant women may help to ease the fears that are keeping you awake at night.

When You Can't Sleep

Of course, there are bound to be times when you just can't sleep. Instead of tossing and turning, worrying that you're not asleep, and counting the hours until your alarm clock will go off, get up and do something: read a book, listen to music, watch TV, catch up on letters or email, or pursue some other activity you enjoy. Eventually, you'll probably feel tired enough to get back to sleep.

And if possible, take short naps (30 to 60 minutes) during the day to make up for lost sleep. It won't be long before your baby will be setting the sleep rules in your house, so you might as well get used to sleeping in spurts!

Reviewed by: Larissa Hirsch, MD
Date reviewed: October 2013