One of the less well-known symptoms of pregnancy is how tired you might get before the baby even arrives. Also known as: pregnancy insomnia.

The fact that women experience fatigue and disrupted sleep during pregnancy is well-established in medical literature. Having a hard time sleeping can be caused by lots of different elements of pregnancy, ranging from frequent urination in the middle of the night to hormonal changes (especially in the first trimester) to the sheer physical challenge of getting comfortable in the third trimester.

There are things you can do to help get more sleep. It’s also important to discuss sleep problems with your doctor, as there is some evidence that some causes of poor sleep may be associated with additional challenges in your pregnancy, like gestational diabetes, gestational hypertension, and preeclampsia (often identified by high blood pressure). (Keep in mind, just because there is some evidence doesn’t mean it is definitively true.)

How bad is my pregnancy insomnia?

If you are having trouble sleeping while pregnant, you can take comfort in the fact that you aren’t alone. And this lack of sleep can happen whether women are in the first trimester, second trimester, or third trimester.

An online survey of 2,427 women found that, perhaps no surprise to you, pregnancy can mean significant sleep disruption or sleep deprivation. Researchers found that 76 percent of pregnant women surveyed had “poor sleep quality,” regardless of how far along their pregnancy was. That is nearly twenty-five points higher than women overall.

The survey found…

• …it took about 50 minutes on average to fall asleep, compared to the 15-20 minutes that is considered normal
   
• …women reported waking up two times a night on average
   
• …when they woke up, women said they were up for over an hour on average
   
• …a third said “being too hot” disturbed their sleep more than three times a week
   
• …nine percent said they took sleep medications in the past month
   
• …near 60 percent had “Insomnia Severity Index” right below the clinical definition of insomnia, and 14 percent were bad enough to get a diagnosis of clinical insomnia.

What can I do about pregnancy insomnia?

The first recommendations you might get are the basics of good sleep hygiene:

• Go to bed and wake up at the same time every day
• Stop using devices that emit blue light, like a smartphone, 30 minutes before bed
• Cut down on the amount of liquids you have before bedtime
• Avoid caffeine and naps in the afternoon
• Use pillows under your abdomen and behind your back to reduce back pressure and find a comfortable sleeping position

If those tactics don’t work, you can also ask your doctor about taking an antihistamine, like Unisom or Benadryl, to help you get some sleep.

A 2015 review of studies on additional drugs sometimes prescribed for pregnant women with trouble sleeping, like benzodiazepines, found there wasn’t enough evidence to clearly determine what is safe. The authors called for additional research.

What about snoring?

If you find yourself snoring so much that it wakes you up, it could be time to talk to your doctor. While studies have shown more women report snoring while pregnant, severe cases of snoring (for example, if you wake up with the feeling that you are choking) could indicate having obstructive sleep apnea, or OSA.

If you have OSA, you may be at higher risk for other challenges in your pregnancy, including preeclampsia. There are ways to treat OSA, one common approach is to use continuous positive airway pressure therapy, or CPAP. It is a mask-like device that you wear to bed that helps keep airways open. It is important to talk to your doctor if you think you might have OSA. 

What about restless legs?

If you keep waking up because you have the urge to move or leg cramps, you might be part of the estimated 20 percent of pregnant women who have restless legs syndrome, or RSD. This disorder often makes people feel like they have to move or a “creepy-crawly” feeling, most often on their legs. RSD gets worse as pregnancy progresses, with the worst symptoms around the seventh to eight month of pregnancy.

For the large majority of women, RSD goes away after delivery. For help while you are still pregnant, talk to your doctor about strategies to alleviate RSD, get enough sleep, and to check if your iron is low. If it is, your doctor might recommend taking iron supplements.

For further reading, see:

• A role for sleep disorders in pregnancy complications: challenges and opportunities by R. Roberto and M. Badr at the American Journal of Obstetrics and Gynecology
• Sleep patterns and sleep disturbances across pregnancy by J. Mindella, et al., at Sleep Medicine
• A review of sleep-promoting medications used in pregnancy by M. Okun, et al., at the American Journal of Obstetrics and Gynecology 

As always, this article is for informational purposes only, consult a health professional before making any decisions.