Insomnia During Third Trimester: Is It Normal?

Pregnancy insomnia affects the majority of women, and it’s a problem that can affect the health of both mother and child.

We’ve previously looked at why sleeping problems usually begin in the second trimester, but the bad news is that sleeping issues are usually worse during the third trimester.

Let’s look at why this happens, and potential treatment options at this late stage.

How Common Is Third Trimester Insomnia?

One study found that the (1):

Risk of insomnia was 2.03 times higher for those in the third trimester than those in the first and second trimesters

In total, research shows that just under 74% of women will have some degree of insomnia by 39 weeks (i.e. third trimester) (2). However, note that the severity of symptoms differs, and the most common issue is maintaining sleep.

Another way to look at how sleep duration declines through pregnancy is the graph below.

The “D3->4” bar is the change from second to third trimester, with the final bar showing the transition to after delivery.

It’s not a huge change between the second and third trimester, but the variation was higher. In other words, some women were able to adjust somewhat to sleep issues, while others progressively got worse.

SummaryMost women have at least some degree of trouble sleeping, with frequent wake-ups, during the third trimester. Overall, sleep duration is slightly lower than in the second trimester for most women.

The Main Causes of Sleep Trouble in the Third Trimester

There are 3 main reasons of sleep issues during pregnancy:

• Anxiety - Stress from having sleep trouble and from worries about raising a child (or the birth itself) (3).
• Hormonal changes - There are multiple hormones involved in pregnancy, and they all rise dramatically until the end of pregnancy (4). This is the cause of many symptoms including heartburn, cramps, and shortness of breath (5).

• Physical changes - By the third trimester, the extra weight from the baby can cause back pain and other physical discomfort that makes sleep difficult (let alone disturbances like kicking).

SummaryThere are 3 very common triggers for insomnia during late pregnancy. Sleep quality can rapidly deteriorate depending the severity and number of applicable factors here.

Is Insomnia During Pregnancy Dangerous to Your Baby?

Insomnia is not something that you want to ignore and hope it goes away. Even a short duration of sudden insomnia can lead to chronic insomnia that worsens someone’s health for years to come.

The risks are even greater for pregnant women. Research shows a correlation between insomnia during pregnancy and several negative side effects, including (6,7,8,9,10):

• Greater risk of depression
• More pain during labor
• Longer labor
• Higher chance of Caesarean section being needed (up to 5 times as much)
• Preterm birth
• Low birth weight

SummaryInsomnia during pregnancy can have significant consequences for the health of both the mother and the baby.

Treatment Options for Late Pregnancy Insomnia

Insomnia in this situation should be treated by a comprehensive treatment plan that is designed and supervised by a physician. It’s especially important to have professional guidance here in the case of medication, as some medications can be dangerous to take while pregnant.

Here are the most common treatment options that are prescribed by doctors at this stage.

Cognitive Behavioral Therapy (CBT)

CBT is the most effective treatment method for almost any case of insomnia, but especially those that are mainly caused by stress and anxiety.

A study looking at using CBT for pregnant women found that almost every subject benefitted at least a bit (11):

Significant reductions in insomnia symptoms and increases in subjective sleep quality were observed over the course of the study.

The studied showed that overall, most women saw benefits including:

• Less time in bed
• Shorter time to fall asleep
• Increased total sleep time
• Lower anxiety
• Fewer symptoms of depression
• Less fatigue

The only real downside of CBT is that it’s not an immediate effect. It takes time to examine thoughts and “rewire” your brain in a positive way.

Maternity Support Pillows

For women with back pain, or just general pain around the abdomen caused by the baby itself, a support pillow can have a significant effect.

One study found that putting a maternity cushion under the belly was able to reliably reduce backache in subjects (12).

While there are “fancy” wedge-shaped cushions, even a normal pillow will help if cost is an issue.

Relaxation Therapies for Anxiety

The most commonly studied relaxation options that show promise in improving insomnia symptoms are yoga, acupuncture, and massage therapy.

Even though pregnant women are a bit limited in what they can do in terms of exercise, there are yoga classes for pregnant women. Exercise can help a great deal with hormonal and stress issues.

Will Insomnia Continue After Pregnancy?

Some women will naturally sleep better after delivering their baby, but some will not recover without treatment.

In general, research shows that overall sleep quality goes up after delivery, but sleep duration declines even further (13):

Although women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased.

That’s still not a “good” overall sleep quality.

And as alluded to before, short term sleep issues can become long term chronic insomnia if not taken seriously and treated.

References

1. Insomnia in Pregnancy and Factors Related to Insomnia
2. Effects of pregnancy on mothers' sleep
3. Sleep disturbance in pregnancy. A subjective survey
4. Sleep patterns and sleep disturbances across pregnancy
5. Sleep disturbances during pregnancy
6. Insomnia and sleep deficiency in pregnancy
7. Assessing sleep during pregnancy: a study across two time points examining the Pittsburgh Sleep Quality Index and associations with depressive symptoms
8. Sleep quality and depression during pregnancy: a prospective study
9. Sleep in late pregnancy predicts length of labor and type of delivery
10. Sleep Deprivation during Pregnancy and Maternal and Fetal Outcomes: Is There a Relationship?
11. Sleeping for Two: An Open-Pilot Study of Cognitive Behavioral Therapy for Insomnia in Pregnancy
12. Evaluation of a Maternity Cushion (Ozzlo Pillow) for Backache and Insomnia in Late Pregnancy
13. Can Insomnia in Pregnancy Predict Postpartum Depression? A Longitudinal, Population-Based Study