Insomnia in First Trimester: What to Expect

Pregnancy insomnia occurs in roughly 66% to 94% of pregnant women, depending on the definition you use (1,2).

Most sleep issues really begin in the second and third trimesters, but some women start developing them early on in the first trimester.

If you’d like to learn more about why this happens, this short post should cover what you need to know.

Why Do Women Get Insomnia in Their First Trimester?

In general, there are 2 main causes of sleep trouble while pregnant: hormonal changes and anxiety (3,4).

At the start of pregnancy, hormones like progesterone and estrogen (among others) rise significantly. This can have many side effects, including the common first signs of pregnancy like nausea.

Note that while a woman may get used to elevated levels of these hormones and feel “normal” during certain periods, they continue to rise throughout the pregnancy.

The most common consequences of these hormonal changes include:

• Nausea and vomiting (mainly 1st trimester)
• Increased urination frequency (mainly 1st trimester)
• Fetal movements (2nd and 3rd trimester)
• Heartburn (2nd and 3rd trimester)
• Cramps and tingling (2nd and 3rd trimester)
• Shortness of breath (2nd and 3rd trimester)

If someone already doesn’t sleep great, a bit of nausea or urinary discomfort can push them over the edge to develop insomnia.

From there, it’s possible to become more anxious about sleep troubles and experience even worse insomnia. It’s a vicious cycle.

SummaryMost women who experience sleep trouble in their first trimester do so because of symptoms like nausea or increased urination frequency, which are mainly the result of hormonal changes. For women in a tough life position, stress is also a potential trigger of insomnia.

How Common is First Trimester Insomnia?

Sleep issues during the first trimester really aren’t very common.

One study tracked a cohort of pregnant women to see how much their sleep changed during each trimester and after birth.

They found that sleep duration during the first trimester actually increased during the first trimester compared to baseline (the first bar on the graph below) (5).

If I had to guess, my hypothesis for this surprising change would be that most women are excited about being pregnant and haven’t started thinking about the stressful things (e.g. money, effort, etc.) quite yet.

SummaryEvery person is different, so even though most women don’t have sleep issues in the first trimester, doesn’t mean it doesn’t happen. Women in this category should work with their physician to rule out any other causes.

Should You Accept the Sleep Trouble or Seek Treatment?

Insomnia has significant health consequences that most people are not aware of.

On top of the “regular” side effects of insomnia, pregnant women with insomnia are also at a higher risk of:

• Depression
• More pain during labor (and longer labor)
• Higher chance of needing Caesarean section
• Preterm birth

These are consequences that affect both the mother and child, so effort should be made to at least improve sleep quality, even if not all issues can be solved.

Treatment Options

There’s not too much you can do about symptoms like nausea and vomiting (possibly diet changes), but it is possible to work on any anxiety and existing poor sleeping habits.

There are 3 main ways to treat pregnant women with sleep trouble in their first trimester:

• Sleep hygiene improvement - Most people have terrible sleep hygiene, which leaves them vulnerable to sleep problems if any little trigger comes along. See our guide to sleep hygiene for insomnia for a detailed look at what is usually involved here.
• Cognitive behavioral therapy (CBT) - This is by far the most effective insomnia treatment for the typical patient. CBT is very effective at reducing stress and anxiety levels.
• Relaxation therapies - Research supports the use of activities like yoga and acupuncture as a way of relieving stress in those with insomnia. It’s not as effective as CBT, but is a low risk treatment option with some benefit in most.

Treatment for insomnia should always be done under the supervision of a doctor. Professional supervision is arguably even more important for pregnant women.

Medication is usually a last resort for pregnant women due to concerns over drug interactions that could impact the health of the baby.

Will Sleep During Your Second Trimester Be Worse?

Typically, sleep troubles really begin in the second and third trimesters. See our guide to sleep troubles in the second trimester for more details.

That being said, the last thing a pregnant woman in her first trimester with sleep issues should do is start worrying even more about future sleep troubles.

Every pregnancy is different and there is no guarantee that sleep quality will worsen through each trimester. The best thing to do is focus on dealing with any issues that can be dealt with and minimize any side effects from the sleep trouble.

References

1. Sleep disturbance in pregnancy. A subjective survey
2. Sleeping patterns during pregnancy in Japanese women
3. Sleep disturbances during pregnancy
4. Sleep patterns and sleep disturbances across pregnancy
5. Effects of pregnancy on mothers' sleep