Sleep in Pregnancy: Why It’s So Hard and What to Do About it

With the fatigue that so often accompanies pregnancy, you’d think getting the shut eye you need would be a dream but sometimes it’s anything but. Which, to be honest, feels really unfair because you know once Baby is born, sleep isn’t going to get any easier for a while!

What’s going on? Why would sleep be so elusive when we’re actively gestating? Surely growing humans in our body would require even more rest, not less. So why would it be difficult to achieve?

As a parent of eight kids, and someone who has worked closely with pregnant people for a long time at The Leaky Boob, I’m no stranger to the sleep struggle when pregnant. Here’s what I’ve learned over the years and how it may help you slip into the glorious sleep you need.

If you’re pregnant and can’t sleep, you’re not alone. Sleep in pregnancy can be hard to come by for many reasons, and your sleep challenges can be hard to solve even when you do identify what’s keeping you up. But, knowing why you’re struggling to sleep is a good start.

Throughout gestation massive hormonal fluctuations are common and some hormones remain significantly higher the entirety of pregnancy. These major changes alter our body chemistry in some pretty impactful ways outside of growing a human (or multiples) and it can take time for our body to adjust. Insomnia, particularly in the first and third trimesters, is common as a result.

Not helping anything is the increased need to urinate. Following the increased production of certain hormones, the need to pee will typically increase as well, including waking us more often during the night to empty our bladder. Combined with an increase in kidney function, an increase in blood volume and water in the body, and the growing uterus pressing on the bladder, waking often for potty breaks can make sleep challenging.

Even as early as the first few weeks of pregnancy, discomfort caused by pregnancy can make sleep challenging. And, as the pregnancy progresses, those challenges may become more difficult. The hormone relaxin can have joints feeling unstable and a growing belly can make favorite sleep positions impossible. As the uterus gets heavier, some experience additional discomfort such as sciatica and pelvic pressure that keep you awake.

You can blame those hormones again! But that’s not all, blood volume actually more than doubles in pregnancy and with it an increase in temperature is common. If you feel hot at night, that’s not surprising! You may even experience night sweats or hot flashes as your hormones fluctuate leaving you intensely hot one minute and shivering cold the next as your body rapidly cools and you’re covered in sweat.

From nausea to heartburn to congestion to leg cramps, common pregnancy symptoms can also interfere with sleep and lying down may feel impossible and even painful. These may be more than just a nuisance as they can keep you up all night and become increasingly troublesome as time goes on, leaving you even more fatigued.

So what can we do? First, be sure to check with your healthcare provider if you are experiencing difficulty sleeping in pregnancy. Sleep really is important and there may be options available for you to help you get the vital rest you need while growing your baby.

In addition to having a consistent bedtime routine that supports your brain and body, preparing for sleep and having as much natural light exposure as possible during the day (particularly morning and afternoon), here are some specific tips that may improve not only your quantity of sleep but your quality of sleep as well.

Create an incline with pillows to raise your upper body and take pressure off joints and reduce heartburn. Pelvic floor therapist and mom of five Jennifer Stone suggests that a pillow under or between the knees can relieve lower back, hip and pelvic pain, along with leg discomfort.

Synthetic fibers don’t breathe well so stick to natural fibers for your mattress, bedding, and sleepwear. A wool mattress topper is going to help regulate your body temperature with breathable support much better than a one with any kind of synthetic materials. Natural fibers in layers you can remove as needed will also make sure you don’t overheat. Because the word “natural” is vague, make sure you’re looking for “certified organic.”

Most humans sleep best at 65-68ºF but pregnant ones may like it a little cooler with all the hormone fluctuations and body changes happening. Keep it cool, run a fan, use lightweight bedding, wear loose-fitting lightweight sleepwear, and even consider taking a cool pack to bed if you really tend to overheat. A therapeutic cool rice pack stored in the freezer could be comfortingly cool.

There are foods that can help encourage sleep but when pregnant there are also certainly foods that discourage sleep. Watch your caffeine intake in pregnancy in general, and mom Suan See Lim shared that if heartburn is an issue, be sure to avoid greasy, spicy foods late in the day too.

As tempting as it may be to cut back on your fluid intake at night so you don’t wake as often to pee, staying well hydrated is actually protective of sleep in pregnancy. Dehydration will impact hormone levels, disrupting sleep and contributing to more aches and pains. Worse, dehydration can trigger “irritable uterus” or even real contractions, keeping you awake with what feels like real labor and even could be actual labor if severe enough. Being well hydrated also helps with body temperature regulation.

Dim the lights, drink a cup of herbal tea, practice meditation, do a calming activity, or stretch before bed. Guided meditation, bedtime story apps and podcasts, or even hypnosis can go a long way in improving sleep. Avoiding screens and other blue light sources for at least 30 minutes before bed can help, too.

If night wakings happen and you can’t get back to sleep, getting up and doing the same ritual can get your body and mind ready to settle back to sleep. If you wake during the night to pee (when you wake during the night to pee…) keep lights off if you can and don’t look at your phone to avoid waking yourself up fully. Mom Jennifer Rose suggests a guided meditation app to fall back asleep too.

Cuddles, hugs and massage release oxytocin, a feel good hormone that helps us relax. If you have a partner or other family member or friend who can do light massage, some gentle massage or foot massage before bed will help release anxiety and physical tension and improve sleep.

Regular exercise has a direct impact on sleep quality. Certified Nurse Midwife Sue Potts says that not only does regular physical activity such as walks, yoga or a dance class help the body adapt more readily to the physical changes of pregnancy, but also that her pregnant patients who exercise at least 3-5 days a week consistently report better sleep.

Take in some electrolytes in the evening and you might just banish leg cramps at night! Foods that can replace electrolytes include bananas, sweet potatoes, spinach, kale, avocados, broccoli, beans, almonds, peanuts, tofu, strawberries, watermelon, oranges, milk, yogurt, turkey, chicken, raisins and olives.

Talk with your care provider about supplements that may be helpful including magnesium, papaya enzymes (for heartburn), B6 and others. Magnesium sprays or creams may be safe for reducing leg cramps and helping relax to fall asleep.

If all else fails, sleep when you can. You’ll feel better if you accept sleep when and where you can get it. Napping during the day, an extra early bedtime, waking in middle of the night and then back to bed in the wee hours of the morning, whatever it takes. Sleep really is vital, get it where you can!

Chances are some of your sleep challenges will remain in some fashion and sleep is going to be restless and interrupted at times, so adjusting your expectations will also help with the frustration and give you the brain space to troubleshoot possible solutions that may work well for you. Remember, too, to give yourself a break. Adjust where and what you can in your day to make it less taxing.