Medically reviewed by Dr Deborah Lee, Dr Fox Online Pharmacy.
Between cravings, toilet trips and trying to get comfortable, having a restful night’s kip isn’t always easy in pregnancy.
And if you’re going through this, you’re not alone – a poll by the National Sleep Foundation shows that 78 per cent of mums-to-be have trouble sleeping.
Thankfully, a few tweaks can make sleepless nights a thing of the past (well, until your baby arrives anyway!).
Insomnia in pregnancy
According to Dr. Deborah Lee, they say: "Insomnia affects 60% of pregnant women. This might be those experiencing insomnia for the first time when they become pregnant, or it might be preexisting insomnia that could worsen.
Insomnia means poor sleep. It can mean any aspect of sleep – such as difficulty getting off to sleep, waking frequently at night, having less deep sleep or sleeping for shorter time periods. All of these factors add up to making you feel less refreshed when you wake up and sluggish, and irritable during the day, says Dr. Lee.
Women often feel more tired in pregnancy, In the first trimester hormone levels are changing, and morning sickness is common. As the pregnancy progresses, you are carrying more weight around, especially in the third trimester. You may need to get up frequently at night to pee. Acid reflux causing heartburn can disturb sleep. Anxiety and depression also impact on sleep. In addition you may be disturbed by the baby moving around.
Sleep specialists recommend that pregnant women should have 8-10 hours of sleep per night. Not getting enough sleep can affect the growth and development of the fetus. This increases the risk of pre-term delivery, pre-eclampsia, and gestational diabetes, says Dr. Lee.
Obstructive sleep apnoea (OSA) can worsen in pregnancy. In this condition the soft tissues at the back of the throat collapse during sleep, partially blocking the airway. This causes noisy breathing and snoring. In OSA the sufferer stops breathing for up to 30 seconds before they startle and start breathing again. In severe OSA this can happen up to 30 times an hour. OSA is also linked to an increased risk of low birth weight, preterm delivery, preeclampsia and gestational diabetes.
How to improve sleep during pregnancy
Note that sleeping tablets of any type are not recommended in pregnancy. Poor sleeping has to be managed by natural means.
Decide on a sleep schedule – Make sleep a priority. Decide when you will sleep to get your 8-10 hours a night and stick to it. It’s not a good idea to nap as this upsets your natural nightly sleep drive.
Stop eating 3 hours before bedtime – Your body isn’t programmed for digestion overnight. Eating meals and snacks, especially large amounts of carbs, fat or spicy food just before sleep can cause indigestion, reflux and discomfort and prevent good sleep, says Dr. Lee.
Sleep hygiene – This needs to be excellent. A cool, dark bedroom with comfortable hypoallergenic bedding and a supportive mattress. Use blackout blinds or curtains, and/or a dark eye mask. Note that the optimum temperature for sleep in pregnancy is between 60 - 68F (15.5 - 20C). The body needs to lower its temperature to sleep. Being too hot is a common reason for finding it hard to get to sleep and waking frequently at night.
Sleep position – Always sleep on your side and not on your back. When you lie on your back the weight of the pregnant uterus presses down on the blood supply to and from the placenta. Some experts recommend lying on your left side is preferable as this puts less pressure on the lungs and heart.
Sleep support – Put a pillow between your knees as this helps stop twisting your spine. Plus another pillow under your bump to give that some support too. Prop your head well up with pillows, especially if you have acid reflux.
Calcium supplements – These may be recommended for those with leg cramps or Restless legs syndrome.
Wind-down for sleep – Have a warm bath or shower, read, or listen to soft music. Your brain needs to calm itself and prepare for sleep. Writing a journal before bed can be helpful.
No electronic devices - Switch off all electronic devices 1-2 hours before bedtime. These emit blue light which prevents the release of the sleep hormone, melatonin.
No caffeine – Caffeine is a CNS stimulant which keeps you awake. Excess caffeine is linked to miscarriage, low birthweight and stillbirth. Pregnant women should have no more than 200 mg of caffeine per day (around 2 cups of instant coffee). As it has a long half-life, you should not drink coffee within 6 - 8 hours of bedtime. For those prone to poor sleep, 10 hours may be more realistic. Caffeine is also found in chocolate, tea, cola, and energy drinks.
Stop smoking – All pregnant women should be strongly encouraged and supported to stop smoking. Nicotine is a CNS stimulant. However, stopping smoking and nicotine withdrawal also interferes with sleep. Nicotine replacement products can help reduce withdrawal symptoms and cravings. There are so many benefits for you and your baby from not smoking in pregnancy. Call the National Smokefree Helpline on 0300 123 1044 for help.
No alcohol – It goes without saying that women should not be drinking alcohol during pregnancy. Alcohol does not help insomnia - it makes it worse. You may fall asleep more quickly but acetaldehyde, the main breakdown product of alcohol is a stimulant which wakes you up. Alcohol increases the risk of miscarriage, low birthweight and premature delivery. Do not think of drinking alcohol to help insomnia in pregnancy – this is one of the worst things you could do, says Dr. Lee.
Exercise daily – Take regular exercise but not within 3 hours of bedtime. Pregnant women are recommended 150 minutes of moderate intensity exercise per week. This could b 5 x 30 minutes of any exercise that makes you slightly sweaty and short of breath such as brisk walking, jogging, cycling, swimming and dancing. Swimming is especially good for pregnant women.
Cognitive behavioural therapy (CBT) – This is a type of talking therapy that has been shown to help sleep for those suffering rom insomnia. Learning more about sleep, and how to cope with symptoms and sleep issues, helps reduce anxiety and leads to improvements in the sleep quality and quantity. Your GP can refer you on the NHS for CBT, says Dr. Lee.
Antenatal classes – If worries about pregnancy and delivery are part of the problem, why not try attending some antenatal classes? NCT antenatal classes are an excellent way of getting you and your partner ready for childbirth and becoming a parent.
When to see the doctor
If your insomnia is affecting your daily activities it’s time to see your GP. This means if you cannot get to work on time, do a good day’s work, feel constantly tired, lethargic and irritable, and/or feel that lack of sleep is affecting your mental health and making you increasingly anxious or depressed – you should discuss this with your GP, midwife or Obstetrician.
Maternal sleep is recognised as being integral to the health of an unborn baby.
Medical conditions such as acid reflux, restless legs and OSA need medical intervention says Dr. Deborah Lee.
Best sleeping position in pregnancy
The safest position to go to sleep when pregnant is on your side, either left or right. You can try supporting your bump with pillows and putting a pillow between your knees to make it more comfortable.
Experts recommend avoiding sleeping on your back as research suggests that, after 28 weeks, falling asleep on your back can double the risk of stillbirth. This may be to do with the flow of blood and oxygen to the baby.
The NHS advises that if you do wake up on your back, don't worry, just turn over and go to sleep again on your side. Sleeping on your left side, particularly in your third trimester will allow blood to flow easier to your kidneys and uterus.
10 tips for sleeping safely and soundly in pregnancy
As well as choosing a good pregnancy pillow, there are other things you can do to try to ensure a good night's sleep during your pregnancy:
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Eat smart – Avoid rich, spicy or oily, fried foods to minimise heartburn.
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Relax – Utilise meditation and other breathing techniques to help teach yourself to relax.
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Go outside – One of the best ways to improve the quality of your sleep is to get outdoors in the daytime and into the sunlight. At least 30 minutes’ exposure, even if the sun isn’t at its strongest, is the best way to reinforce your sleep-wake cycle – the natural internal clock that makes sure you’re awake by day and asleep at night.
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Keep your blood sugar stable – A key factor that affects sleep during pregnancy is an imbalance in blood-sugar levels. ‘In the first trimester, most women crave carbohydrates and go off protein, but eating carbs without protein speeds up your digestion and causes highs in your blood sugar that can lead to night-time sugar lows and the need to eat,’ says nutritionist Yvonne Bishop-Weston. So, rather than three big meals a day, eat every three to four hours. Go for meals that are slow to digest, such as whole grain carbs with proteins and vegetables.
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Keep cool – Many mums-to-be find that their body temperature increases, due to the extra blood flow and raised metabolism when you’re pregnant. Being too hot can make it harder to get to sleep, so you need to make allowances for this now. ‘Although an excessively warm bedroom disturbs sleep, there is no evidence that a very cold room has a similar effect,’ says sleep expert Dr Chris Idzikowski. ‘Keep the temperature at no more than 16°C.’ Open the windows and maybe even invest in a lighter Tog duvet. Just warn your partner he may have to invest in warmer nightwear.
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Reflexology – Nothing eases the occasional pregnancy ache like a foot rub and now you have the perfect excuse to get one – a study by the University of Ulster found reflexology boosts your quality of sleep. Reflexology is fine in pregnancy – as long as you know the areas to avoid that relate to the uterus. Invest in some professional sessions for the ultimate ‘I need it for my health’ pamper.
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Bath – Having a warm bath takes the blood away from your brain to the surface of your skin, making you feel relaxed and drowsy. ‘On top of that, your body temperature drops as soon as you get out of the warm water, initiating sleepiness,’ says Sammy. ‘But don’t make the water overly hot – it will raise your temperature too much, leaving you feeling uncomfortable way past your bedtime.’ Prefer showers? You’ll get exactly the same sleep-inducing effect from a blast of warm water.
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Resist the iPad – Facebook really will still be there in the morning. As will iPlayer. Looking at a laptop, tablet, smartphone or TV will keep your mind stimulated and make it harder to drop off, according to a study by Osaka University. ‘Turn them all off an hour before bed,’ says Sammy. ‘Your body and brain will thank you for it.’
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Boost your sleep-happy hormone – It’s what got you here in the first place and orgasms release oxytocin, which makes you sleepy. But, if you’re feeling too huge or are simply too knackered for pregnancy sex, don’t worry. ‘Cuddling on the sofa or in bed releases the same sleep-happy hormone,’ says David R Hamilton, author of Why Kindness Is Good For You. ‘Any form of warm partner contact will help send you to sleep, whatever stage of pregnancy you’re in.’
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Visualise – Researchers at Oxford University found that people who visualised relaxing scenes, such as mountains or the sea, fell asleep 20 minutes faster than on nights where they counted sheep. No wonder, says Sammy – numbers and counting make us think of to-do lists, which is the last thing you need before bed. ‘A calming scene is much better, because it has no negative associations and takes us away from the here-and-now,’ she says.
Meet the expert
Dr. Deborah Lee worked for many years in the NHS, mostly as Lead Clinician within an integrated Community Sexual Health Service, Dr Deborah Lee now works as a health and medical writer, with an emphasis on women's health, including medical content for Dr Fox pharmacy. She has published several books and remains passionate about all aspects of medicine and sexual health. After completing her Medical Degree at University of Southampton Medical School in 1986, Dr Lee trained as a GP and after a number of years specialised in Sexual & Reproductive Health (S&RH).