Why is Prenatal Sleep so Exhausting?

Experts: Mar De Carlo Oscategui, BS; Ilene Rosen, MD, MSCE

Lousy sleep is one of pregnancy’s most common complaints, and it’s fueled by so many factors. While you won’t be experiencing anything like your pre-pregnancy sleep any time soon, there are things you can do to improve your snooze quality as you ride out these 40 weeks. 

Sleep is essential to our overall health and wellness, especially during pregnancy. Besides the obvious benefits of increased energy, elevated mood, and enhanced performance, sleeping well also helps to balance stress hormones, says Mar De Carlo Oscategui, BS, founder of the International Maternity & Parenting Institute and author of Awakening Through Sleep. Because stress hormones can negatively affect the baby and the labor and delivery process, sleeping soundly (or as soundly as possible) is a must. Oscategui says, “When [a birthing parent] is well-rested, [they are] more physically and mentally prepared for labor, greatly diminishing the risk of any complications.”­­

The solution to your poor prenatal sleep could be as simple as investing in a good pregnancy pillow, or it could be complex enough that it’s best to get your OB-GYN involved. However, in order to determine how to fix the problem, you first have to know the root cause of your restless nights. 

Too Sick to Sleep

Morning sickness—the poorly chosen name for nausea that often accompanies the early stages of pregnancy—can keep you up at night, too, as your churning gut refuses to settle. While many birthing parents leave this stage behind after the first trimester, some deal with it into late pregnancy.

Solution: Keep something in your stomach at all times, even at night. Have some crackers with peanut butter—or any other satisfying snack—before you hit the hay, and keep some sustenance by your bedside so that if you wake feeling weak in the gut, you can quickly grab something to munch or drink. If your nausea is still persistent enough to keep you from getting enough sleep, talk to your health care provider about prescription anti-nausea meds.

Constantly Waking Up to Pee  

In the first trimester, hormonal changes will have you peeing more often. Later on, a growing uterus will force your bladder into smaller accommodations, inviting frequent evacuations by day and in the middle of the night.

Solution: Nicole Comforto, mom in Seattle, says, “Frequent peeing was my biggest sleep enemy, especially in my third trimester. I tried limiting liquids before bed but still had to get up every few hours.” Less liquid before bed, along with a last-call trip to the restroom, will certainly help. Still, your bladder will likely wake you up at least once a night. When you make your midnight pilgrimage, keep the lights off (a well-placed night-light may come in handy), do your business, and get right back to bed to avoid more stimulation than necessary.

Side Sleeping Discomfort

“Many parents-to-be find sleeping on their left side beneficial,” says Ilene Rosen, MD, MSCE, associate professor of medicine at the hospital of the University of Pennsylvania. “This increases blood flow to the baby, uterus, and kidneys.” Sleeping on the right side is the second best sleep position, but by the second and third trimesters, sleeping flat on your back is trouble, as the position can compress a major blood vessel and reduce blood flow to your baby. Also, at a certain point, facedown snoozing is no longer an option. 

Solution: There’s a pillow for that! You’ll find a plethora of pregnancy pillows on the market, all designed to make side sleeping more comfortable no matter what pregnancy week you’re in. A half-moon wedge pillow is perfect for supporting the girth of the belly, pillow sleep positioners help prevent you from rolling onto your back during the night, and giant C-shaped or U-shaped body pillows do it all—supporting the head, back, hips, and belly.

Loud Snoring

Some birthing parents find themselves snoring for the first time during pregnancy, a state of affairs that presents difficulty sleeping (doubly so if you share your bed with a partner). 

Solution: To deal with snoring, first identify the factors causing it. Dr. Rosen says, “About 30% of pregnant people experience snoring due to hormone changes, weight gain, and fluid retention, which can lead to swelling in the upper airway.” Simple remedies include sleeping on your side, using nasal strips, and running a humidifier.

If your snoring is accompanied by daytime sleepiness, morning headaches, and choking or gasping during sleep, you might have sleep apnea. Talk to your OB-GYN about your symptoms, and ask if they would recommend seeing a sleep specialist for additional medical advice. If you have sleep apnea, CPAP therapy or a customized mouthguard could be prescribed. The good news? “After the baby is born, it is possible that the snoring will disappear,” says Dr. Rosen.

Restless Legs Syndrome

Restless legs syndrome (RLS) is a common but less talked about pregnancy and sleep problem. Keri Hughes, a mom in Draper, Utah, experienced RLS during her second and third pregnancies but didn’t recognize it at first. “I just thought it was insomnia,” says Hughes. “Adding iron solved the problem, but I had to get that advice from a friend—my doctor didn’t make the connection either.”

Solution: RLS will manifest itself as an urge to move your legs or as a tingly, uncomfortable sensation in your legs that gets worse at night. To ease discomfort and symptoms, try moderate exercise earlier in the day, massaging the legs, wearing compression socks or stockings, and instituting relaxation techniques at bedtime. Certain nutritional supplements, painkillers, and prescription medications may also be considered, but you should always talk to your provider before exploring these types of treatment.

Aches and Pains

Back and hip pain are common offenders that often worsen as pregnancy goes on and can cost you a good night’s sleep.

Solution: Mom Kasey Tross of Chesterfield, Virginia, says, “I didn’t realize how much belly weight was pulling on my spine until I started sleeping with a pillow under my belly and another behind my back, which helped so much!” An additional pillow between the knees can help to straighten the hips, reduce hip pain, and aid the spine. Applying heat to your back, getting a prenatal massage, and practicing good posture during the day may also help those lower back muscles. If you work on your feet, lower back pain can really give you cause for complaint. Lessen the inevitable end-of-day ache by wearing supportive shoes and taking breaks to sit down when needed.

Heartburn

Call it heartburn or acid reflux; it’s the nasty burning sensation in your chest and throat that keeps many birthing parents up at night. Depending on how bad your heartburn gets, it also can take the enjoyment out of eating or meal—or even drinking a cold glass of water.

Solution: Start by looking at your diet. Any spicy, fried, or acidic foods are more likely to trigger heartburn. Caffeine and carbonation are also common culprits, so put down the soda. Try eating smaller meals to avoid being overly full, and don’t eat too close to bedtime. If you’re still having issues with heartburn at night—despite the dietary changes—try sleeping propped up at an incline to keep the stomach acid down. Chewable antacids (like TUMS) and over-the-counter pills such as Zantac and Pepcid AC are generally cleared for use in pregnancy, but check with your health care provider before taking these medications to make sure.

Racing Thoughts

You’re facing some major life changes—it’s no wonder if excitement or worry keeps you from getting a restful night’s sleep. (Spoiler alert: Racing thoughts about your baby will probably stick around long after pregnancy is over, but you’ll eventually—hopefully!—be able to accept rest when it’s offered.)

Solution: It can be helpful to face your feelings during the day rather than waiting until bedtime to process pent-up emotions. Talk to a friend or your partner about your pregnancy, delivery, and parenting worries. Read pregnancy-related books that help reassure you about what you’re experiencing, such as the classic What to Expect When You’re Expecting or Emily Oster’s Expecting Better. Meet with a therapist if you feel the need.

Also, don’t forget to get out for fresh air during the day. Exercise and time in nature will help you feel more settled at the end of the day. Walk, swim, stretch, practice yoga—whatever helps you to unwind and release your emotions. If you reach bedtime and still find yourself unable to put down the anxieties running through your mind, try keeping a notebook by the bed. Writing down your feelings can be liberating.

You are bound to experience some struggles in the sleep department during pregnancy, but hopefully, with just a few small changes, you can start catching more quality Z’s. If not, be sure to bring the problem up with your health care provider so they can help you come up with a more effective solution.

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