Insomnia during pregnancy can occur for many reasons. Hormone surges, middle-of-the-night trips to the bathroom, leg cramps, and discomfort from a growing belly are just a few reasons why you may lose sleep while pregnant. The good news is that your lack of sleep should not affect your baby. The bad news is that insomnia, in addition to the normal fatigue that accompanies pregnancy, can significantly decrease your ability to function. It can also persist throughout pregnancy, although sleep disturbances are most commonly reported in the first and third trimesters.
About 78 percent of women may have sleep problems in pregnancy, according to a 1998 poll conducted by the National Sleep Foundation. Insomnia is defined as difficulty falling asleep, difficulty in staying asleep, or both. Identifying the cause of your insomnia may help you get some needed rest. For instance, your insomnia could be caused by a sleep disorder, such as sleep apnea, or another medical condition that disrupts sleep.
Often insomnia during pregnancy can be managed sufficiently with simple changes to your daily routine, and sleep medications are unnecessary. As with other pregnancy symptoms, some sleep loss is normal, but too much can lead to other health problems. If you are concerned that you are not sleeping enough, contact your primary care physician or obstetrician.
Symptoms of Insomnia During Pregnancy
Insomnia symptoms often include awakening during the night and awakening too early, in addition to having trouble going to sleep and staying asleep. If you find yourself waking up during the night to urinate, you will probably not feel well rested in the morning, and you will have daytime fatigue or sleepiness.
Prolonged sleep loss over days or weeks can lead to other symptoms, such as irritability, depression, or anxiety; difficulty paying attention or focusing on tasks; increased errors or accidents; tension headaches; and gastrointestinal symptoms.
Causes of Insomnia During Pregnancy
In the early stages of your pregnancy, hormonal changes, nausea, and frequent urination during the night are most likely to blame for insomnia. As your pregnancy progresses and your abdomen increases in size, you may experience abdominal discomfort or back pain with your normal sleep positions. In the later stages of your pregnancy, fetal movements and vivid dreams may disturb sleep.
Insomnia during pregnancy may be related to stress or anxiety about labor, delivery, or balancing work and motherhood. It is easy to let your thoughts about pregnancy and the baby keep you up at night. It is important to remember that most pregnancies — even high-risk pregnancies — work out fine, and worrying is not productive.
In some instances, insomnia during pregnancy is caused by another sleep disorder or health condition. Treatment may be necessary to reduce symptoms and improve sleep. The following conditions can disturb sleep during pregnancy:
- Anxiety disorder
- Nocturnal gastroesophageal reflux (nighttime heartburn)
- Restless legs syndrome, an unpleasant feelings in the legs, which is sometimes described as creepy, tingly, or achy
- Sleep apnea, a sleep disorder in which breathing is repeatedly interrupted during sleep
How to Cope With Insomnia During Pregnancy
If you’re having trouble getting a good night’s sleep during your pregnancy, the first step is to practice good sleep habits. Here are a few do’s and don’ts for better sleep:
- Do have a bedtime routine. Go to sleep at the same time every night and do something relaxing before you get into bed (read, watch television, stretch, etc).
- Do drink your required daily amount of fluids before 6:00 or 7:00 PM, and limit fluids after that time.
- Do eat dinner early and slowly. This can prevent nighttime heartburn.
- Do whatever you need to do to be comfortable. Pillows are your best friend during pregnancy; use them for support or to help keep you on your side. Keep your bedroom temperature moderate.
- Do write down any worries or concerns you have. This will empty your mind of distractions so you can focus on relaxing.
- Do be active during the day and rest at night.
- Do minimize the use of bright light and TV or computer screens starting two hours before bedtime. The “blue light” effect can disrupt the body’s natural circadian rhythm. Dim the room lights, or better yet, consider using just candlelight after dark!
- Don’t watch the clock. Waiting to fall asleep when your mind is racing is a waste of time. Get up and redirect your mind toward some other activity until you’re tired enough to try falling asleep.
- Don’t have caffeine in the afternoon or evening.
- Don’t have a heavy meal right before bed.
- Don’t go to bed hungry. A light snack, such as a warm glass of milk and cookies, is okay at bedtime.
- Don’t lose sleep over not being able to sleep. You will fall asleep eventually—it is just a matter of when.
- Don’t lie in bed wide awake. If you can’t sleep, go to another room and read something boring, or just sit on the couch until you start to feel sleepy. Link sleepiness with being in bed.
Behavioral Treatments for Insomnia During Pregnancy
For some pregnant women, simply changing sleep habits is not enough. Although it may be tempting—and easy—to pick up an over-the-counter sleep aid, it is better to try either a psychological or behavioral treatment first. Acute insomnia, which can occur for one night or over a few weeks, may not require treatment, although some women may benefit from counseling or environmental changes. Insomnia is considered chronic when it occurs at least three nights a week for a month or longer. Pregnant women with chronic insomnia often require both psychological and behavioral treatment.
If you are still losing sleep after changing your sleep habits, you might consider trying one or more of the following alternative therapies:
- Relaxation techniques
- Cognitive behavioral therapy
- Sleep restriction
- Light therapy
- Aromatherapy (lavender)
Medications for Insomnia During Pregnancy
Always speak with your doctor before taking any over-the-counter sleep aid. Most sleep aids are not recommended for women who are pregnant or breastfeeding. Combination sleep aids containing aspirin should be avoided.
The active ingredient in over-the-counter sleep medications is most often diphenhydramine, which is an antihistamine. Diphenhydramine is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. However, antihistamines can have adverse effects, such as sleepiness, fatigue, or dizziness. And the effectiveness of these medications tends to decrease with long-term use.
A newer prescription medication called Diclegis is an FDA Category A approved medicine (proven safe in pregnancy) for morning sickness that contains the active ingredient doxylamine. This ingredient is also used in over-the-counter sleeping pills. Thus, not unexpectedly, one of the main side effects of Diclegis is drowsiness, so Diclegis may be a safe prescription sleeping medicine if the need arises.
Even if your doctor gives you the okay to take an over-the-counter sleep aid temporarily, it should be discontinued as soon as possible and definitely after a few weeks. Should your insomnia persist after that time, contact your doctor.
Prescription sleeping pills, such as zolpidem, eszopiclone, zaleplon, and ramelteon, are in FDA pregnancy category C. This means that animal reproduction studies have shown that they have an adverse effect on a fetus, and there are no adequate and well-controlled studies in humans. These medications may be used under special circumstances. For instance, if you have a sleep disorder, the potential benefits may warrant use of the drug despite potential risks.
Melatonin and valerian are two over-the-counter supplements that are marketed as sleep aids. Neither supplement has been evaluated by the FDA for safety, effectiveness, or purity, so their potential risks are unknown. Therefore these herbal remedies should be avoided during pregnancy.