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How to Sleep When Pregnant: Tips for Every Trimester

The changes of each trimester bring reasons for sleep loss. Use this guide to understand why sleep is important for pregnancy and how to sleep when pregnant.
Published
2022-02-09
Updated
18 MINS
Pregnant woman sleeping on her side

All the pregnancy books you've read likely agree on one thing: Sleep is vital when you're expecting. Yet, when morning sickness strikes in the middle of the night and your leg cramps seem to last for hours, shut-eye seems completely out of reach. If only your books told you the secret of how to sleep when pregnant.

If you have trouble sleeping, know that you aren't alone — sleep problems are commonplace among pregnant women. Unfortunately, too little is made known about sleep, circadian alignment, and pregnancy.

But don't despair, as there are things you can do for better sleep tonight. We've written this guide to clear up some of the obscurity surrounding sleep and pregnancy. Keep reading to find out you can enhance your sleep wellness for the sake of your (and Baby's) overall health.

Disclaimer: This post is not intended as medical advice. If you have any concerns regarding your sleep patterns while pregnant, please speak to a licensed healthcare professional, such as your OB-GYN.

Sleep and Pregnancy — It’s a Catch-22

Meeting your sleep need is always important, but it’s exceptionally so when you're carrying a child. Your body is hard at work, undergoing life-changing developments to help you birth a new human at the end of 40 weeks.

Unfortunately, the changes that support your baby's development are also the culprits behind your sleep troubles. For instance, morning sickness commonly rears its head during the first trimester (and beyond), thanks to the following hormonal changes:

  • The placenta formed during pregnancy produces a hormone called human chorionic gonadotropin (hCG). A rise in hCG levels correlates with a peak in nausea and vomiting among pregnant women. 
  • Progesterone and estrogen levels increase and relax the smooth muscle contractions of the digestive system. This could affect gastric acid emptying, leading to heartburn and nausea.

As you've probably experienced firsthand, the constant puking and digestive discomfort make it hard to doze off and get the sleep you need. 

To make matters worse, sleep becomes more challenging to attain with every trimester. For example, scientific data indicates that restless legs syndrome (RLS) is typically a distant possibility before pregnancy. Yet, its likelihood skyrocketed to 23% by the third trimester. As a neurosensory disorder that starts in the evening, the twitching, crawling sensations associated with RLS makes it more difficult for you to sleep.

With various disruptions to your nighttime sleep, it's no wonder that you struggle with high sleep debt and possibly facing circadian misalignment, too. (More on this in the next section.)

High Sleep Debt = Higher Odds of a High-Risk Pregnancy

RISE app screenshot showing how much sleep debt you have
The RISE app shows the amount of sleep debt you've accumulated in the past 14 days.

Sleep debt is the amount of sleep you've missed out on in the past 14 days relative to your sleep need (which is genetically determined, like your eye color or height). Contrary to popular misconception, not everyone needs eight hours of sleep per night. A more accurate gauge would be somewhere between 7.5 and nine hours

Sleep debt can be classified as:

  • Acute sleep debt: Debt accumulated over the past 14 days
  • Chronic sleep deprivation: Debt that’s persisted over months, years, and decades

Pregnant women everywhere may be wondering, "Should I aim for zero sleep debt?" While that may sound perfect in theory, we all know life happens. Instead, aim to keep your sleep debt below five hours to feel and function at your best (or as close to it as possible).

But what happens when you go over the limit and accrue more than five hours of sleep debt? Let's find out in the next section.

It’s Complicated With Pregnancy-Related Complications

No expecting mother wants to hear words like "preeclampsia" and "preterm birth" at the gynecologist's office. But if you don't get enough sleep, the odds of these pregnancy-related complications gets higher.

Research hypothesizes that sleep disturbances at the start of your pregnancy (i.e., during the first 20 weeks) amplify your body's inflammatory response. To clarify, sleep disturbances include:

  • Poor sleep continuity, in which you experience fragmented sleep
  • Short sleeping (you don't meet your sleep need)
  • Poor subjective sleep quality

What's more, systemic inflammation (as a result of chronic sleep deprivation) can incite sleep disturbances, too. This culminates in a vicious cycle of sleep loss and body inflammation that predisposes you to metabolic illnesses such as Type 2 diabetes and obesity.

Most worryingly, impaired nighttime sleep makes you more susceptible to heart disease, a major risk factor associated with pregnancy-related complications such as:

  • Preeclampsia, a medical condition that features high blood pressure and organ damage (mainly in the liver and kidneys)
  • Preterm birth, in which a baby is delivered earlier than its due date
  • Intrauterine growth restriction (IUGR), which refers to suboptimal fetal development

A bidirectional relationship is also observed between these complications and sleep loss. For instance, individuals with preeclampsia "have poorer sleep quality and continuity" than those without the condition.

On top of that, sleep apnea (a common sleep disorder that disrupts or shortens sleep) may trigger insulin resistance and glucose intolerance. These metabolic side effects potentially heighten the risk of infertility and miscarriages, especially among pregnant women who already struggle with polycystic ovary syndrome (PCOS).

Hard(er) Labor in the Delivery Room

Giving birth is an arduous process. But when you factor in sleep debt, you're in for an even more agonizing time.

An observational study of 131 women in late pregnancy unveiled a disquieting association between sleep disturbances and labor time. It found that "women who slept less than 6 hours at night had longer labors and were 4.5 times more likely to have cesarean deliveries." Those who had more difficulty getting a good night's sleep spent even longer in the delivery room and "were 5.2 times more likely to have cesarean deliveries."

To tone down your agony during childbirth, meeting your sleep need is definitely in your best interest.

Circadian Misalignment Spells Trouble for Expectant Mothers

RISE app screenshot showing your energy peak and dip times
The RISE app shows your daily energy peaks and dips on your Energy Schedule.

Circadian alignment is, as always, an essential predicate to low sleep debt.

It all traces back to your circadian rhythm, aka your internal clock, which regulates every biological process, including your sleep-wake cycle and daily energy fluctuations. On the RISE app, your Energy Schedule represents your circadian rhythm as it tells you the exact timing of your energy peaks and dips.

Aside from helping you keep your sleep debt low, your internal clock also directly affects your gestation period. Data-driven research suggests circadian alignment is the key to a successful pregnancy. An inverse relationship between the transcript level of the circadian clock gene, PER2, and the number of miscarriages shows that timing is everything for conception to take place.

In a 2014 meta-analysis involving more than 100,000 female shift workers, researchers unveiled an elevated risk of miscarriages among those working the night shift. Another study of more than 2,000 female flight attendants highlighted that those who work during sleep hours were more likely to miscarry in the first trimester.

How to Sleep When Pregnant in Each Trimester

Just like how the leaves change with each season, sleeping during pregnancy evolves with each trimester.

In the first trimester, expect increased drowsiness and longer sleep times. The opposite rings true when the second trimester approaches. On the whole, sleep becomes increasingly fragmented and restless as your pregnancy progresses.

So, are there any tips to protect and promote maternal sleep when you're in the family way? Yes, as you'll see below.

First Trimester

Remember when we said your body's progesterone synthesis goes into overdrive? Turns out this hormone also exerts a hypnotic effect, making you sleepier than usual. Coupled with the peak in estrogen and hCG production, these biochemical changes raise your body's temperature, creating a warming sensation that makes you feel drowsy.

The same hormonal changes may also bring about breast tenderness. Increased progesterone and hCG synthesis cause the tissues in your chest area to swell as they prepare to supply breast milk for your little one.

During your first trimester, recall that morning sickness plays a starring role. You may also experience more frequent urination, leading to more bathroom trips. Calf cramps also typically begin in the first trimester, persisting into the second trimester before peaking in the third.

RISE recommends:

  • Nap during your afternoon dip: As mentioned earlier, you probably have no trouble nodding off during the day. Try to schedule your daytime naps during your afternoon dip to keep yourself circadianally aligned and in a better position to keep sleep debt low. The RISE app tells you the exact timing of your afternoon dip so you can block off time for a well-deserved siesta.
  • Cool yourself before bed: A higher core body temperature may make it harder to fall asleep at night. Do whatever you can to keep yourself cool — turn on the air conditioner, take a warm bath, or wear lightweight fabrics — so that it's easier to meet your sleep need.
  • Cut off your water intake at the right time: Waking up five times (or more) in the middle of the night to pee will only make it more exhausting on your preggers self. Pace your water intake throughout the day, making sure to slow down by the late afternoon or early evening. Cut off all fluid consumption at least two hours before your target bedtime.

Second Trimester

Pregnant woman holding her lower back while standing

On top of the (possibly) recurring morning sickness and frequent restroom visits (courtesy of a growing uterus), you may encounter other sleep-detracting physical developments.

For starters, weight gain and elevated estrogen levels inflate your risk of sleep-disordered breathing (SDB), a common pregnancy sleep problem. SDB typically shows up as snoring, sleep apnea, shortness of breath, and excessive daytime sleepiness. Most worryingly, SDB is associated with a heightened risk of preeclampsia, high blood pressure, and underdeveloped babies.

Your growing bun in the oven is now squishing vital organs, such as the kidneys and the digestive tract. That's why you constantly feel the need to pee and grapple with uncomfortable heartburn.

RISE recommends:

  • Review your sleeping position: Back sleeping is usually frowned upon as the weight of your body (and Baby's) compresses the inferior vena cava, a major blood vessel that carries deoxygenated blood. Aside from lower blood pressure, sleeping on your back also restricts blood flow to the fetus and may even amplify the risk of stillbirth. Instead, sleep on your left side, the best sleeping position for pregnant women. It promotes blood circulation and may even tamp down heartburn. You can also use pregnancy pillows like a body pillow to make side sleeping even more comfortable.
  • Consult your OB-GYN: If medical conditions like SDB affect your sleep, speak to your OB-GYN for treatment options. For example, nasal continuous positive airway pressure (CPAP) is proven effective in managing SDB in the pregnant populace.
  • Avoid large meals before bed: Those who experience heartburn and other forms of digestive discomfort should avoid large evening meals. If you're using the RISE app, add the "Avoid Late Meals" habit to your Energy Schedule. You'll receive in-app notifications to stop eating at least three hours before bed.

Third Trimester

By now, heartburn, round-the-clock bathroom trips, and leg cramps are your constant companions. But these aren't the only things you have to contend with when it comes to your sleep.

First up, insomnia is probably knocking on your bedroom door every night. While it can occur in any one of the three trimesters, it's most prevalent in the third trimester. Swollen ankles, RLS, and back pain also make an appearance during the last leg of your pregnancy. 

On top of the physical discomfort, you may experience vivid dreams that often take on a nightmarish tone. As you know, bad dreams translate to more frequent middle-of-the-night awakenings and greater sleep loss. If you're wondering what's up with that, science suggests a positive link between daytime stress and nightmare frequency.

RISE recommends:

  • Avoid caffeine consumption too close to bed: If you consume caffeine while pregnant, avoid drinking it too close to your bedtime. Caffeine can stay in your system for up to 10 hours, making it harder to fall asleep and stay asleep throughout the night. To prevent said scenario, add the "Limit Caffeine" habit to your Energy Schedule in the RISE app.
  • Prioritize your evening wind-down: Your wind-down routine before bed is an effective countermeasure against disturbing dreams and insomnia. Use relaxation techniques (like those in the RISE app) to defuse the day's stress and tension. This way, your mind is sufficiently relaxed for naturalistic, healthy sleep to set in. Body massages with sleep-promoting essential oils, like lavender oil, simultaneously tackle body aches and insomnia.

Post-Pregnancy: Your Sleep Troubles Aren’t Over Yet ...

Mother carrying her baby

It would seem like all your sleep troubles would disappear once you've given birth. While that may be true on some levels, data suggests that your child, as compared to your partner or spouse, exerts a strong influence on your sleep-wake patterns that extend far into the future.

Most significantly, a 2010 study pointed out that even though "sleep and circadian variables improved slightly” after childbirth, “they had not returned to the levels of the non-pregnant control group even by the 15th postpartum week."

Moreover, in the first two days after delivering a baby, new mothers averaged only 9.7 hours of total sleep time. Unfortunately, there's a strong correlation between self-reported sleep loss and postpartum depression several weeks after birth. Research also showed that pregnant women who struggled with insomnia while expecting were more likely to experience postnatal anxiety and obsessive-compulsive disorder (OCD).

To avoid becoming one of the above statistics, be devout in your pursuit of good sleep hygiene best practices before, during, and after your pregnancy. Sure, it may be more challenging with a newborn taking up much of your attention and time. But a tool like RISE can help you better keep up with sleep-promoting behaviors 24/7. This way, you’re more likely to meet your sleep need so that you feel and function at your best to give your little one the care they need.

How to Sleep When Pregnant Still Needs More Research

Just like other facets of women's health, there's still a woeful lack of investigation on the topic of sleep and pregnancy, particularly regarding sleep deprivation and circadian misalignment.

The current scientific literature admits more needs to be done to meet the sleep needs of pregnant women. One of the above studies on inflammation and sleep highlighted that "small sample sizes and cross-sectional designs preclude clear conclusions" on how sleep disturbances relate to negative pregnancy outcomes.

While scientists continue the important work of uncovering the explicit relationship between sleep and pregnancy, there are things you can do to better your sleep wellness for a smoother-sailing birth. For starters, close adherence to healthy sleep hygiene protocols should be at the top of your list. 

That's where the RISE app can help. Based on your unique chronobiology, the app prompts you to do the right things at the right time to keep your sleep debt low and your circadian rhythm on the right track.

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Rise is the only app that unlocks the real-world benefits of better sleep.

Instead of just promising a better night, we use 100 years of sleep science to help you pay down sleep debt and take advantage of your circadian rhythm to be your best.

Over the past decade, we've helped professional athletes, startups, and Fortune 500s improve their sleep to measurably win more in the real-world scenarios that matter most.

Rise Science is backed by True Ventures, Freestyle Capital, and High Alpha; investors behind category winners Fitbit, Peloton, and Salesforce Marketing Cloud.
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