Sleeping difficulties can impact a staggering number of pregnant people. Sleep disturbances, particularly insomnia, can be an infrequently discussed or unexplored side effect of pregnancy. Yet, sleep is vital for your health and your developing baby. What is insomnia, what potential impact can it have on your health and pregnancy, and what can you do about it?
Sleeping difficulties affect over 90% of pregnancies by the third trimester.
There are many causes of pregnancy insomnia.
Sleep deprivation can have negative consequences for your health and your pregnancy.
There are many remedies, natural and pharmacological, the can improve your sleep.
What is pregnancy insomnia?
An estimated 66–94% of pregnancies are impacted by sleeping difficulties, with prevalence rising in the later trimesters. Insomnia is either the inability to fall asleep or frequent night awakenings with difficulty returning to sleep. Pregnancy insomnia can begin as early as the first trimester, possibly related to hormone changes. Symptoms can also start or worsen through the second and third trimesters, with night waking being the biggest complaint.
Sleeping difficulties may be discounted or not fully addressed by the pregnant person or even by healthcare providers. It is essential for the health of the expectant parent, the pregnancy, and the baby to address the causes of sleep troubles and insomnia.
Causes of pregnancy insomnia
Pregnancy is a time of physical and emotional changes that may significantly impact sleep quality. Some reasons for insomnia include the following:
- Hyperemesis (significant nausea and vomiting during pregnancy)
- Frequent night urination
- Uncomfortable sleeping positions
- Vivid dreams or nightmares
- Pelvic or back pain
- Nasal congestion
- Fetal movements
Other complications during pregnancy that can contribute to insomnia include:
- Sleep disordered breathing (SDB). Includes sleep apnea and other upper airway obstructions that can cause snoring, nighttime awakenings, headaches, dry mouth, and extreme fatigue.
- Restless leg syndrome (RLS). Is a movement disorder characterized by unpleasant feelings in the legs, including creeping, crawling, burning, and itching that occurs or worsens at night. The cause of RLS during pregnancy is not fully understood, but a link to iron deficiency has been identified. Pregnancy is a risk factor for iron deficiency, and iron supplementation may be helpful.
- Anxiety or mood disorders. Such as major depressive disorder, bipolar disorder, generalized anxiety disorder, post-traumatic stress disorder, or obsessive-compulsive disorder can all contribute to pregnancy insomnia.
Risks of insomnia during pregnancy
Sleeping difficulties, disturbances, and insomnia are associated with increased risks of:
- Depression and anxiety during pregnancy and postpartum
- Low-birth-weight newborns
- Preterm delivery
- Prolonged labor
- Cesarean section
Will my insomnia harm the baby?
The risks associated with insomnia can have consequences for your baby, particularly preterm birth and low birth weight. The more preterm the delivery and the lower the birth weight of the newborn, the higher the risk of complications. Babies born before 37 weeks have an increased risk of:
- Breathing difficulties
- Feeding difficulties
- Cerebral palsy
- Developmental delays
- Hearing and vision problems
Does insomnia cause miscarriages?
A few studies have shown a causal relationship between sleep deprivation and pregnancy losses. The association may be attributed to insomnia due to sleep-disordered breathing in some cases. If you suffer from recurrent miscarriages, investigating the potential role of SDB is worthwhile.
Tips for naturally managing your insomnia
Healthy sleep hygiene is the first line of defense for insomnia treatment. Non-pharmacological approaches include:
- Evaluate your sleep environment. It should be dark and slightly cool.
- Maintain a regular sleep-wake cycle. Limit naps to the earlier part of the day.
- Drink more fluids during the first half of the day. Limit intake closer to bedtime to decrease nighttime urination.
- Avoid caffeine. You should not drink caffeine in the afternoon or before bed.
- Eat frequent, light meals throughout the day. Avoid heavy meals and spicy or fried foods before bed to decrease the chance of acid reflux.
- Get 30 minutes of daily exercise. If approved by your healthcare provider;
- Avoid screens before bed. You should stop using your TV, cell phone, tablet, or computer at least 30 minutes before bedtime.
- Get out of bed and do a non-stimulating activity. If you cannot sleep, consider an activity such as reading.
- Sleep on your side. Support yourself with .
- Consider alternative therapies. Acupuncture, acupressure, massage, and meditation can help alleviate sleep challenges.
- Consider cognitive behavioral therapy. This can be especially helpful if your insomnia is due to a mood or anxiety disorder.
Additional treatment may be appropriate if you suffer from RLS, SDB, or an anxiety or mood disorder. Your obstetrician or midwife will be able to guide you.
Can I take melatonin during pregnancy?
Melatonin is a neurotransmitter, a chemical message from the brain, that assists in regulating your sleep cycle. Melatonin secretion has been shown to positively impact pregnancy, from maternal egg quality through birth. Studies have shown that melatonin has a developmental impact on a developing baby's nervous and endocrine systems. Melatonin, as an antioxidant, protects developing organs from oxidative stress.
It is for all these reasons that sleep is vital during pregnancy. However, supplementing melatonin for sleep purposes during pregnancy is not currently recommended. While this supplement is easily accessible, its quality is not regulated by the FDA. Additionally, there have been limited studies of melatonin use in pregnant and lactating persons. Consult your obstetrician or midwife if you want melatonin supplementation for your insomnia.
Can I take sleep aid medication while pregnant?
Sleep aid medication could be an option during pregnancy if your sleep has been significantly impacted and natural remedies offer no relief. Always speak with your obstetrician or midwife about your sleeping difficulties and interest in trying other solutions. Over-the-counter medications like Benadryl and Unisom are considered safe. But not all prescription sleep aids are considered safe during pregnancy, including benzodiazepines, Ambien, and barbiturates.
Sleeping difficulties are often overlooked during pregnancy as “par for the course.” But poor sleep quality can significantly impact the expecting person and their unborn baby.
- Obstetric Medicine. Insomnia and sleep deficiency in pregnancy.
- Acta Obstetrician et Gynecologica Scandinavica. Sleep disturbances in pregnancy: Why and how should we manage them?
- Pakistan Journal of Medical Sciences. Insomnia during pregnancy: Diagnosis and rational interventions.
- Brazilian Journal of Psychiatry. Melatonin use during pregnancy and lactation: A scoping review of human studies.
- Journal of Medicine and Life. Role of melatonin in embryo fetal development.
- Sleep Medicine. Restless legs syndrome in pregnancy is connected with iron deficiency.
- Medical Hypotheses. Is sleep-disordered breathing associated with miscarriages? An emerging hypothesis.
- Public Library of Science. Associations between insomnia and pregnancy and perinatal outcomes: Evidence from mendelian randomization and multivariable regression analyses.
- Centers for Disease Control and Prevention. Preterm birth.