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.

Insomnia is common in the first trimester. The Life-ON study found that a third of women reported poor sleep quality during the first trimester, and that daytime sleepiness peaked at that stage rather than later in pregnancy. 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.

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.

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 birth, and it is still worth raising because it occasionally indicates disrupted breathing overnight.

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.

Move your fluids earlier in the day

Drinking less in the couple of hours before bed can mean fewer trips to the loo overnight, so keep topping up earlier in the day instead. This one is about timing, not drinking less overall.

Eat earlier in the evening

Heartburn has far less to work with if there’s a decent gap between your last meal and bedtime, and propping yourself up a little instead of lying flat takes the edge off, too.

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.

Nap if you need to, and keep it short

A study that tracked 161 pregnant women with sleep diaries and wrist monitors found that daytime naps had minimal effect on their sleep that night, and the researchers described napping as a useful counter to the broken sleep pregnancy brings. Long nappers were the exception, showing slightly poorer sleep quality, so short is the thing to aim for.

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.

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.