“Sleep while you can” is considered good pregnancy advice. But what if you can’t sleep? Insomnia in pregnancy seems like a cruel joke; at exactly the time you should capitalize on sleep before a newborn arrives, there is often a relentless inability to fall or stay asleep. What is insomnia in pregnancy, and what can you do about it?
Insomnia is the inability to fall asleep, difficulty returning to sleep after waking up during the night, or waking up too early from sleep. Sleep deprivation, although not considered insomnia, is insufficient sleep of less than seven hours a night.1
Do not worry! You’re not the only pregnant woman who has trouble sleeping. Difficulty sleeping and insomnia affect an estimated 66%-94% of pregnancies.4 The more pregnant you are, the greater your difficulty sleeping.1
You or your obstetric provider may not fully recognize or address the lack of sleep quality. Adequate sleep is essential for a healthy pregnancy. Carefully consider any sleep challenges or insomnia you may be experiencing. Discuss these with your provider and be proactive in finding ways to combat insomnia in pregnancy.
Unfortunately, first-trimester insomnia and sleep challenges can affect approximately 13% of pregnancies.1,3 Hormones and classic pregnancy symptoms in the first trimester can cause insomnia in early pregnancy. Insomnia and sleep challenges may begin or worsen as pregnancy progresses. Third-trimester insomnia can affect up to 75% of pregnancies, with night waking being the most important complaint.1
Pregnancy is a time of intense physical, hormonal, and emotional changes in the body that have the potential to significantly affect the quality and duration of sleep. Causes of insomnia in pregnancy may include:1,3
Other pregnancy-related complications can contribute to or cause insomnia. Talk to your obstetric provider if you have concerns that you may be experiencing any of the following:
SDB includes obstructive sleep apnea that can cause snoring, nighttime awakenings, headaches, dry mouth, and extreme fatigue.3,7 SDB can increase your risk of miscarriage.7
RLS is characterized by uncomfortable sensations in the legs, often described as creeping, crawling, burning, and itching. These feelings are usually worse at night when your body is resting. The cause of restless leg syndrome during pregnancy is not fully understood. Several studies have found an association between RLS and iron deficiency. Pregnancy is a risk factor for iron deficiency, and an iron supplement may help.7
Mental health disorders such as major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD) can negatively contribute to pregnancy insomnia or difficulty sleeping.3
Unfortunately, sleep difficulties do not necessarily end once the pregnancy is over. Pregnancy insomnia can last well into the postpartum period.8 Sleep challenges and insomnia can be further complicated by spending a lot of potential sleep time caring for your new baby. A full night’s sleep may not be possible in this early postpartum period, but many of the tips below, in addition to addressing any mental health issues, can provide a more restful night’s snooze.
Sleep greatly affects critical female hormone cycles, including estrogen, progesterone, and prolactin.7 Pregnancy also requires physical, internal and external. Pregnant women need adequate rest for optimal functioning and a successful pregnancy. Sleep difficulties, restlessness, and insomnia during pregnancy are associated with an increased risk of the following:1,3
Developing healthy sleep hygiene habits and trying non-pharmacological strategies is the first line of defense for treating insomnia:1,3,6
- Establish a regular sleep-wake cycle.
- Reserve naps for earlier in the day
- Maintain a dark, cool sleeping environment
- Avoid caffeine before bed
- Avoid screens before bedtime
- Limit fluids in the latter half of the day to limit night waking (be sure to hydrate earlier in the day adequately)
- Eat frequent, light meals throughout the day while avoiding heavy meals at night.
- Aim for 30 minutes of daily exercise or movement if approved by your health care provider.
- If you have trouble falling asleep, do a non-stimulating activity like reading.
- Prioritize sleep comfort with pillows for support
- Consider alternative therapies such as acupuncture, acupressure, massage, and meditation
Your obstetric provider can guide you in finding a strategy that may work for you. Additionally, other treatments may be needed if you suffer from irregular breathing, restless leg syndrome, or anxiety or mood disorders.
Melatonin is a frequently used and highly marketed supplement that can promote a more restful sleep. But can you take melatonin while pregnant?
Melatonin is a hormone produced by your body that helps regulate your sleep cycle. It is also important during pregnancy. Several studies have concluded that melatonin secretion positively affects pregnancy, from the quality of the mother’s egg to birth. Melatonin has developmental effects on your baby’s nervous and endocrine systems. It can also act as an antioxidant to protect developing organs from oxidative stress.5
Although studies are limited, many have suggested that melatonin use in pregnant and breastfeeding women is likely to be safe and without side effects.4,5 However, melatonin supplementation for sleep purposes during pregnancy is not officially recommended. Because the Food and Drug Administration does not regulate the quality of melatonin supplements, product safety cannot be guaranteed.4
Consult your obstetric provider if you have questions about taking melatonin during pregnancy.
If the use of melatonin during pregnancy is up for debate, what about other sleep aid medications? If you experience significant difficulty sleeping and natural remedies have proven ineffective, sleep aid medication may be an option.
Over-the-counter antihistamine medications such as diphenhydramine (Benadryl) and doxylamine (Unisom) are considered safe during pregnancy.9 However, not all prescription sleep aids are considered safe during pregnancy and postpartum, including benzodiazepines, zolpidem (Ambien), and barbiturates. But that doesn’t mean they can’t be taken, especially if the benefits outweigh the risks.10,11 Always talk to your obstetrician or midwife about your sleep difficulties and interest in medication options.
Poor sleep quality and symptoms of insomnia during pregnancy should not be ignored. A good night’s sleep is important for your growing baby and your well-being during pregnancy and postpartum. Don’t hesitate to discuss your challenges and symptoms with your obstetric provider. Together, you can find solutions for a better night’s sleep during this perinatal period.
