How to sleep better while pregnant

Key takeaways

• Sleep usually gets worse as pregnancy goes on. In a 2021 review of 24 studies, insomnia symptoms were reported by 25.3% of women in the first trimester and 39.7% in the third.

• Most causes are physical, and the NHS lists small fixes. Hormones, bathroom trips, heartburn, back pain, and leg cramps all have small fixes, such as meal and drink timing, sleep position, and pillows.

• Side sleeping is the standard guidance in later pregnancy. The NHS says to avoid going to sleep on your back after 28 weeks, based on observational studies. Either side counts, and waking on your back is not a reason to worry.

• Ask before you take anything. That includes sleep aids, melatonin, herbal products, and over-the-counter medicines. A midwife, doctor, or pharmacist can say what’s suitable for you.

• Some symptoms aren’t sleep problems. Sudden swelling, a severe headache, vision changes, or a change in your baby’s movements need an urgent call to your midwife, doctor, or maternity unit.

Why pregnancy changes your sleep

If you’re sleeping worse than before, you’re in large company. A 2021 meta-analysis pooled 24 studies and 15,564 women and found that 38.2% reported insomnia symptoms during pregnancy. A 2018 sleep laboratory study of 123 women in early pregnancy, 97 of whom returned in late pregnancy, found shorter and more broken sleep later on, with more awakenings and less deep and REM sleep.

The causes are mostly ordinary and physical.

• Hormones. The NHS says hormonal changes can leave you tired, nauseous, and emotional, especially in the first 12 weeks.

• Bathroom trips. Needing to pee often starts early. Later on, the NHS says the baby’s head presses on your bladder.

• Heartburn. Hormones relax the muscle between your stomach and gullet, and the growing baby presses on your stomach, according to the NHS.

• Back pain. Ligaments soften and stretch to prepare for labor, which can strain the lower back and pelvis.

• Cramps and restless legs. Cramps tend to strike at night, and restless legs symptoms are worse when you’re resting.

• Vivid dreams. The NHS says strange dreams or nightmares about the baby and birth are normal.

What’s typical in each trimester

These are group averages from published studies, so your own pregnancy can look different.

First trimester

Tiredness is the main complaint. The NHS says it’s common to feel exhausted and that feeling tired won’t harm you or your baby. Nausea and bathroom trips can interrupt sleep too. Restless legs are less common now. A 2018 meta-analysis of 27 studies and 51,717 pregnant women put the rate at 8% in the first trimester.

Second trimester

Insomnia is slightly more common than in the first trimester. In the 2021 review, 27.2% of second-trimester women reported insomnia symptoms. Heartburn is more common from 12 weeks onward, according to the NHS, and the 2018 meta-analysis found restless legs rising to 16%.

Third trimester

This is when sleep problems are most common. The NHS says that as your bump grows, lying down can be uncomfortable and bathroom trips multiply. In the studies, 39.7% reported insomnia symptoms and restless legs reached 22%. If you wake at odd hours, our post on waking up at 3am covers general causes.

Side sleeping, and what the research on position says

The NHS says the safest position to go to sleep in is on your side, left or right. It says that after 28 weeks, going to sleep on your back has been linked to a higher risk of stillbirth, and that if you wake up on your back you can turn over and go back to sleep on your side.

That advice rests on observational studies, which show a pattern but can’t prove a cause.

• Auckland, 2011. In a case-control study of 155 women with a late stillbirth (28 weeks or later) and 310 women with ongoing pregnancies, sleeping on the back the previous night was linked to higher odds of stillbirth than sleeping on the left (adjusted odds ratio 2.54). The absolute figures were 1.96 per 1,000 for women who went to sleep on their left and 3.93 per 1,000 for those who didn’t.

• Sydney, 2015. Among 103 women with a late stillbirth and 192 controls, 10 and 4 reported sleeping on their backs (adjusted odds ratio 6.26). The confidence interval was very wide, 1.2 to 34, because the numbers were small.

• Combined analysis, 2019. Pooling individual data from five case-control studies (851 cases, 2,257 controls) gave an adjusted odds ratio of 2.63 for going to sleep on the back compared with the left side. Right-side sleeping looked the same as left (1.04). The authors estimated that if everyone in late pregnancy went to sleep on their side, late stillbirths could fall by 5.8%.

• International survey, 2019. An internet-based study of 153 women who had a stillbirth and 480 who hadn’t found no link with going-to-sleep position, though only 2.4% reported going to sleep on their backs. It did find links with other factors, including sleeping more than 9 hours a night and waking on the right side.

The combined-analysis authors named their own limits. Women reported sleep positions after the fact, so memory could skew results, and no randomized trials were available. The NHS still advises avoiding going to sleep on your back after 28 weeks, and also says not to worry if you wake up on it.

Pillows and comfort

The NHS suggests supporting your bump with pillows and putting one between your knees. For heartburn, it says propping your head and shoulders up can keep stomach acid down, and sleeping on your left side can help. For back pain, it suggests a mattress that supports you properly. If your pillows have gone flat, our guide to replacing a pillow lists the signs.

Heartburn, cramps, and restless legs

Heartburn. The NHS suggests small meals often, no eating within 3 hours of bed, sitting up straight while you eat, and cutting back on caffeine and rich, spicy, or fatty foods. Medicines exist, but tell the pharmacist you’re pregnant because some antacids aren’t suitable. If diet changes and medicines aren’t enough, or you have trouble swallowing, a persistent cough, or weight loss, talk to your midwife or doctor.

Leg cramps. These are a sudden, sharp pain in the calf or foot, most common at night. The NHS suggests regular gentle exercise, especially ankle and leg movements, and foot exercises.

Restless legs. This is a strong urge to move your legs, usually when resting. The NHS lists pregnancy and low iron as possible links and says treatment depends on the cause. Its tips include daytime exercise, a regular bedtime, a warm bath, and no caffeine after midday. If it’s keeping you awake, the NHS says to see a doctor.

Bathroom trips

If you’re getting up at night to pee, the NHS says to cut back on drinks in the late evening, but to drink plenty of caffeine-free drinks during the day. Later in pregnancy, rocking back and forth on the toilet can help you empty your bladder properly. Pain or blood when you pee can mean an infection, and the NHS says to contact your doctor within 24 hours.

Naps, exercise, and caffeine

• Naps. The NHS says it’s best not to nap in the afternoon or evening, since it can leave you less tired at bedtime. Our post on nap length explains how timing and length change the effect.

• Exercise. The NHS says exercise is safe in pregnancy, may improve sleep, and should aim for 150 minutes of moderate activity a week. In later pregnancy, avoid lying flat on your back for more than a few minutes.

• Caffeine. The NHS says no more than 200 mg a day, and estimates about 100 mg in a cup of instant coffee, with filter and coffee shop coffee able to contain more. For timing, see our post on how late you can drink coffee.

Sleep aids and medicines

This is one to ask about before acting. The NHS says most medicines taken in pregnancy reach the baby, so check with a pharmacist, midwife, or doctor before taking any, including painkillers and anything bought in a pharmacy or shop. It also says not all natural or herbal remedies are safe in pregnancy. So if you’re considering melatonin or any other sleep aid, ask first. Never stop a prescribed medicine without checking with the doctor who prescribed it.

Snoring and breathing pauses

The NHS lists breathing that stops and starts, gasping or choking noises, loud snoring, waking a lot, and heavy daytime tiredness as sleep apnea symptoms. A partner may notice them before you do.

In a 2005 study of 155 women followed through pregnancy, breathing-related symptoms rose on average, and 11.4% reported a clinically significant increase. In a 2010 study of 189 first-time mothers, 18.5% reported frequent snoring, and gestational diabetes was more common in that group (14.3% versus 3.3%). These are small studies. A reasonable step is to mention loud snoring or pauses at your next appointment.

When to call a midwife or doctor

Contact your midwife, doctor, or maternity unit if any of these apply, and treat the first three as urgent.

• Possible pre-eclampsia signs. The NHS lists a severe headache that doesn’t go away with simple painkillers, vision problems such as blurring or flashing lights, pain below the ribs, sudden swelling of the face, hands, or feet, heartburn that won’t go away with heartburn medicine, feeling very unwell, or vomiting. It says any of these need to be checked immediately.

• A change in your baby’s movements. The NHS says to call right away if your baby is moving less than usual, even in the middle of the night.

• Urine or back symptoms. The NHS says to contact your GP or midwife urgently for back pain with fever, vaginal bleeding, pain when peeing, or pain in your sides under the ribs.

• Low mood. The NHS says sleeplessness with feeling hopeless or losing interest in things can sometimes signal depression, and treatment can help.

Frequently asked questions

Is it normal not to sleep well while pregnant?

Yes. In a meta-analysis of 24 studies, 38.2% of pregnant women reported insomnia symptoms, and it was more common in the third trimester. The NHS lists hormones, bathroom trips, heartburn, and a growing bump as common causes.

What is the best position to sleep in when pregnant?

The NHS says the safest position to go to sleep in is on your side, left or right, and to avoid going to sleep on your back after 28 weeks. Pillows between your knees and under your bump can make that easier.

What if I wake up on my back?

The NHS says not to worry. You can turn over and go back to sleep on your side. Most of the research looks at the position women went to sleep in, though some studies found links with other sleep habits too.

How can I stop waking up to pee at night?

The NHS suggests cutting back on drinks in the late evening while still drinking plenty of caffeine-free drinks during the day. Pain or blood when you pee needs a call to your doctor.

Can I take something to help me sleep?

Ask a pharmacist, midwife, or doctor first. The NHS says to check before taking any medicine, and that not all herbal or natural remedies are safe in pregnancy. The same caution is sensible for melatonin or any other sleep aid.

How much caffeine can I have when pregnant?

The NHS says no more than 200 mg a day. A cup of instant coffee has about 100 mg, and filter or coffee shop coffee can have more.