Pregnancy Insomnia: Why It Happens and What Helps

Everyone warns you about the sleep you’ll lose once the baby arrives. Far fewer people mention the months beforehand.

The Life-ON study, which followed 439 women through pregnancy using home sleep monitoring, found that 34% reported poor sleep quality in the first trimester, rising to 46% by the third trimester. Restless legs affected a quarter of them.

Before anything else, one thing is worth knowing. Tommy’s is clear that feeling very tired in pregnancy will not harm you or your baby. It makes daily life harder, and that is a different thing from being dangerous.

Most women sleep reasonably well in the first trimester. What tends to hit instead is extreme tiredness from hormonal changes, along with needing to get up to go to the toilet more often. Sleep disturbance usually starts creeping in during the second trimester, and the third is where most women struggle. That said, a fair number do sleep badly early on. The Life-ON study found a third of women reported poor sleep quality during the first trimester, and daytime sleepiness peaked at that stage rather than later. So if it’s you, it isn’t unusual. Several factors can contribute, including rising progesterone, which directly affects sleep. Nausea is not limited to the mornings for most women. Increased blood volume means more frequent trips to the loo from early on. Anxiety in the first weeks of a pregnancy plays a part, too.

Sleeping badly at eight or nine weeks is therefore a normal and well-documented experience, not a sign that something is wrong. The causes tend to change as pregnancy progresses, and most respond to the practical measures set out below.

We asked Dr Zoe Williams, our resident sleep expert and an NHS GP, how the picture shifts across the three trimesters.

Usually several at once, which is why knowing what’s actually waking you helps:

• Needing the bathroom: Tommy’s puts this down to hormonal changes early on, and later to the baby pressing on your bladder. It can start in the very first weeks.
• Heartburn and indigestion: Common in pregnancy and particularly uncomfortable when lying down.
• Restless legs: That crawling urge to move your legs the moment you settle. Life-ON found it affected 25% of women, peaking in the third trimester. It’s strongly linked to low iron, which is worth mentioning at your next appointment.
• Not being able to get comfortable: Side sleeping is what’s advised from 28 weeks onwards, and it takes some adjusting if you’ve always slept on your front or back.
• A busy head: Anxiety about the birth, about work, about whether you’re doing any of it right. It tends to arrive at exactly the moment the house goes quiet.
• Back, hip, or rib pain: Pelvic and back pain can start at any stage, and rib pain often develops later. Make sure to speak to your midwife if it’s persistent, since a physiotherapy referral can help.
• Feeling hot: This can be due to hormonal changes and increased blood supply, leaving many women hot and sweaty at night. Loose cotton bedclothes and as cool a room as you can manage both help.
• A blocked nose: There’s a name for this one. Pregnancy rhinitis is persistent nasal congestion with no cold or allergy behind it, usually starting in the second or third trimester and worse at night and when lying down. It can bring mouth breathing and snoring with it. It clears on its own within a couple of weeks after birth, and it’s worth being careful with decongestant sprays in the meantime, since overuse is a known problem.
• The baby moving: A study of women in their third trimester found that around three-quarters felt strong movements in the evening and at bedtime. NHS Inform notes that some babies are liveliest at night and some during the day; what matters is getting to know your own baby’s pattern.

Timing plays its part in the heat, too. As Dr Zoe points out, “You can feel very hot and uncomfortable if you’re pregnant in the summer as well.”

Restless legs are the one thing women most often struggle to put a name to. Dr Zoe describes it like this: “People might get something called restless leg syndrome linked to pregnancy. It’s a sensation that you need to move your legs throughout the night, jumpy legs, and that can really disturb people’s sleep.”

Snoring that’s new or has got noticeably worse is worth mentioning to your midwife. It becomes far more common in pregnancy than people realise. One study found 45% of women snored habitually during pregnancy, and 85% of them had not snored before it. Most of the time, it settles after the birth, and it is still worth raising, because occasionally it points to breathing being disrupted overnight.

Then there’s the one almost everyone asks at some point. Why do I keep waking at three in the morning? Dr Zoe’s answer is that the second half of the night is different for everybody, and pregnancy stacks a few extra things on top of it.

You don’t have to do all of this. Start with whichever one sounds most like your nights:

Sleep on your side from 28 weeks

The NHS advises going to sleep on your side, left or right, once you reach 28 weeks. If you wake up on your back, that isn’t something to worry about. Just turn onto your side and go back to sleep. Our guide to sleeping positions during pregnancy goes into it further.

Use pillows to take the weight off

You could try using one to support your bump and another between your knees. Pregnancy pillows do the same job in one piece, and plenty of ordinary pillows work just as well. Take a look at our guide to sleeping while pregnant for more information.

Keep the room cool and the bedding light

Pregnancy tends to make you run warmer, so aim for 16°C to 18°C and open a window if you need to. Loose cotton or bamboo bedclothes hold onto heat far less than synthetics. Our guide to sleep temperature and our breathable bedding both help with that.

Stay active, earlier rather than later

Yoga, a swim or a walk can ease the aches that keep you awake. Just make sure to avoid vigorous exercise in the four hours before bed.

Go easy on caffeine

Tommy’s advises reducing caffeine as much as possible in pregnancy anyway, and avoiding it in the evening particularly, so this one helps twice over.

Get up if you’ve been awake for around twenty minutes

This comes straight out of CBT-I, where the aim is to stop your brain from associating bed with lying awake. Somewhere dim and dull for a few minutes usually resets things better than waiting it out.

Tackle restless legs, heartburn and night-time loo trips

Restless legs respond to a few specific things rather than general sleep advice. Here’s what Dr Zoe suggests: “Daily exercise, a warm bath, a sleep schedule, and avoiding caffeine, especially later in the day, can help. And make sure your iron levels have been checked, because iron deficiency can increase that.”

Heartburn is much the same, in that two small changes do most of the work. In Dr Zoe’s words: “Try not to eat in a couple of hours’ window before you go to bed, and having an extra pillow to try and elevate the upper part of the body a little bit can help.”

On the loo trips, she splits it into what you do before bed and what you do at night. For the evening: “Empty your bladder before going to bed and try to drink most of your fluids earlier in the day, rather than just before bedtime. It’s important to stay well hydrated throughout pregnancy.”

For the night itself, the aim is to stay as close to sleep as you can. Dr Zoe’s advice is brisk: “If you do need the toilet, get up and go straight to the toilet and then get back in bed.” Light is the other thing to manage, and she has a simple fix for it. “Have one of those plug-in night lights, so that at least then you don’t have to turn any bathroom lights on.”

Nap earlier in the day and keep it short

Naps are the thing women tend to feel guilty about, and Dr Zoe would rather they didn’t.

Check with your midwife or GP before starting anything, including over-the-counter products and anything that calls itself natural. Tommy’s is clear that sleep medication isn’t usually recommended in pregnancy, and that covers prescription tablets, herbal remedies and over-the-counter aids alike. If sleep loss is affecting your mental health or your ability to get through the day, say so, because there are options your GP can talk through with you.

Melatonin comes up most. It’s prescription-only in the UK and easy enough to buy abroad or online, which is exactly why people ask. A 2022 review of the human studies on melatonin in pregnancy and breastfeeding found that there still isn’t much evidence either way. Nobody can tell you it’s unsafe, and nobody can tell you it’s safe. Your midwife, GP or pharmacist is the right person to ask.

The alternative is cognitive behavioural therapy for insomnia, or CBT-I, which works on the thoughts and habits keeping sleep broken. A randomised controlled trial gave pregnant women five sessions and found 64% reached remission against 52% in the comparison group, with a greater improvement in low mood too. It can be delivered remotely as well as face-to-face. Ask your GP or midwife what’s available locally.

A run of bad nights isn’t, on its own, something to take to anyone. As Dr Zoe puts it: “If it’s just a few days, then you probably don’t need to see a doctor. Generally, a few bad nights aren’t medically concerning in themselves.”

Your midwife would rather hear from you than have you lie awake wondering. Get in touch if any of this applies:

• You’re getting so little sleep that you can’t function during the day.
• You feel very tired, and it isn’t getting better.
• You’re snoring heavily, gasping or waking up short of breath.
• You’re experiencing anxiety or low mood.
• Your heartburn is severe or isn’t responding to the usual measures.
• You’re itchy at night. Mild itching is common in pregnancy, and Tommy’s advises always telling your midwife about it, because occasionally it points to a liver condition called intrahepatic cholestasis of pregnancy.

Dr Zoe’s own steer is about how persistent it is and what else is going on alongside it.