Pregnancy Insomnia: (Symptoms, Dangers, Treatment)

Insomnia is normal during pregnancy.

Current research indicates that 66% to 94% of pregnant women report sleep disturbances (1,2).

There’s a ton of research around this topic, and I spent the last week pouring over it to create this summary for you that’s a lot easier to digest.

You’ll learn why women have trouble sleeping while pregnant, and how you can treat it.

Can Pregnancy Cause Insomnia? (and Symptoms)

There is an overwhelming amount of evidence that pregnancy can cause insomnia.

However, it’s still not perfectly clear why some women are affected more than others. For now, here’s what we do know:

• Women who are more anxious and tend to worry experience more severe sleep difficulties (3,4)
• Hormonal changes (higher levels of estrogen and progesterone) affect sleep related hormones like cortisol and melatonin (5). This is the same reason many women suffer from insomnia on their periods.
• The risk of insomnia is 2.63 times higher for women with depression syndrome (6)
• Pregnant women often take CoQ10 supplements. Taking too much CoQ10 can cause insomnia.

All women need to deal with the hormonal changes, but if you’re typically relaxed and easy going, you have a much smaller chance of developing severe sleep troubles.

SummaryInsomnia is very common to varying degrees during pregnancy. It’s mainly caused by anxiety (stress), depression, and hormonal changes.

Symptoms of Insomnia

By itself, insomnia is roughly defined as (7):

Difficulty initiating, maintaining, or waking from sleep on a regular basis

There are different types of insomnia, with different levels of severity.

Prolonged insomnia can lead to stress, poor cognitive function, and a whole list of other consequences as a result of sleep deprivation.

But insomnia is even worse for pregnant women, since the causes of it aren’t particularly pleasant to deal with.

The initial causes are mainly (1,8,9,10):

• Nausea and vomiting (mainly 1st trimester)
• Increased urination (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)

These symptoms make it even harder to get back to sleep once you wake up.

Most of those symptoms begin in the second trimester, which is why first trimester insomnia isn't too common. Even if it doesn't end up causing insomnia, trouble sleeping in the second trimester is very common.

Research has also shown that women in poverty tend to have it even worse, as they are more likely to be obese and live in noisier conditions (11).

How Do You Know if You Have Insomnia?

The simplest way to self-diagnose insomnia if you can’t see a doctor is to assess yourself on The Pittsburgh Sleep Quality Index (PSQI).

It’s a short and simple test that measures the quality of your sleep, and has shown to be reliable for pregnant women (12).

Here’s a free online Pittsburgh Sleep Quality Index calculator that you can fill out.

At the end, you’ll get your final PSQI global score.

If your score is greater than 5, you’re a poor sleeper.

If your score is higher than 5, you might have insomnia (13). The higher your score, the more likely it is that you suffer from it and should seek help (the max score is 21).

When Does Insomnia During Pregnancy Occur?

In general, the further along you get, the worse the insomnia is (14). Most women find that third trimester insomnia is the worst.

The chart below from a study shows the amount of sleep women had at different check-in points during labor. You can see a steady downward trend.

While many women do start to get insomnia during early pregnancy (around 1 in 8), one study found that the “risk of insomnia was 2.03 times higher for those in the third trimester than those in the first and second trimesters” (6).

At 39 weeks (i.e. late pregnancy), up to 73.5% of women will have some degree of insomnia (although the majority is mild), with the most common difficulty reported being maintaining sleep (15).

The main cause of this is that your body secretes more oxytocin (a wake promoting hormone) shortly before labor (16).

SummaryWhile it’s not always linear, insomnia typically continues to get worse during late pregnancy. There’s more stress, chance of depression, and hormonal changes the nearer you are to labor.

Is Insomnia During Pregnancy Dangerous to Your Baby?

Insomnia does not just cause short-term effects.

Research keeps piling up showing that insomnia during pregnancy is associated with consequences during and after the birth of your child, which includes (17,18,19,20,21)

• Depressive symptoms
• Increased pain during labor
• Longer labors
• Higher chance of Caesarean section being needed (up to 5 times as much)
• Preterm birth
• Low birth weight

Not only are those terrible things for the mother, but some of those are dangerous to the health of the baby.

SummaryEven mild insomnia can have negative effects on your labor and baby, so it’s important to improve your sleep quality as much as possible.

Remedies for Insomnia During Pregnancy (Treatment Options)

Whether you’re currently pregnant or expecting, it’s good to know how to best deal with insomnia during pregnancy.

In most cases, you can’t fix it 100%, but you can minimize the effects and sleep better during pregnancy.

Note that if you ever develop severe insomnia pregnancy, get help from a doctor, as it’s more likely to affect your child.

Research into insomnia treatment for pregnant women is still ongoing, but here are your main options.

A Simple Pillow Helps

One of the most basic tips for sleeping better, particularly in late pregnancy, is to put a pillow under your belly while sleeping on your side.

A study found that this reliably reduces backache (22). While there are specialty “wedge” pillows for this purpose, even a standard pillow was found to be quite effective.

Take Sleep Hygiene More Seriously

Sleep hygiene is important for everyone, but you have very little room for error when pregnant.

I won’t go into specific details on everything, but here are the most important aspects of sleep hygiene:

• Try to sleep on a regular schedule (both going to sleep and waking up)
• Minimize fluid intake in the hours leading up to sleep (particularly in late pregnancy)
• Minimize screen time at night (blue light causes insomnia)
• Set the temperature between 17-23 degrees Celsius (about 63 to 73 Fahrenheit)
• Make your bedroom as dark as possible
• Minimize caffeine intake
• Make a to-do list for the next day to minimize anxious thoughts
• Get exercise during the day (even during late pregnancy, try to do some)

SummarySleep should be a top priority during pregnancy. Ensure that your environment and diet contains good habits for sleeping.

Cognitive Behavioral Therapy (CBT)

CBT is the most preferred treatment by insomnia patients that are pregnant (23).

While CBT is a relatively new treatment style for anxiety and depression, it’s quickly become popular because it’s safe and effective.

Remember those 3 main potential causes of insomnia in pregnant women? Yup, anxiety and depression were the 2 that we can potentially improve.

If you’re not quite sure what CBT is, here’s a good summary from the Mayo Clinic:

Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy). You work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.

Essentially, you’re learning to notice what causes thoughts that produce negative emotions like anxiety, and learning to think about them in a better way.

While there hasn’t been a ton of research on CBT specifically for pregnant women, it’s starting to come.

One study found that pregnant women treated with CBT experienced: “Significant reductions in insomnia symptoms and increases in subjective sleep quality were observed over the course of the study.” (24)

Benefits that were seen included:

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

And the really good news is that almost every woman benefited from it. The responses ranged from medium to strong for most subjects.

SummaryCBT is a preferred treatment method among pregnant women. You can do some basic CBT exercises at home, but you can also get referred to a CBT specialist by your doctor.

Sleep Medication

The obvious concern over insomnia medication for pregnant women is that it might be unsafe for the child.

It’s also a temporary solution that you ideally wouldn’t have to rely on.

The effects of sleep medication vary across different types, and in a lot of cases the evidence isn’t definitive. Here’s a summary of the current research:

• Benzodiazepines (e.g. alprazolam, clonazepam, diazepam, lorazepam) - May be associated with adverse neonatal outcomes (e.g. depressive symptoms, increased pain during labor, more Caesarean sections, preterm birth, and low birth weight), but no increased risk of congenital malformations. Some evidence of “floppy infant syndrome” in babies when mothers took diazepam long-term during pregnancy (17, 25, 26)
• Zolpidem - In a study of 2497 women in Taiwan taking zolpidem, there was an increased risk of low birthweight and/or small-for-gestational age infants, preterm and/or cesarean (27). A Swedish study of women taking zolpidem (and related drugs like zaleplon and zopiclone) had no increase in risk of congenital malformations (28).
• Trazodone (antidepressant that promotes sleep) - Increased sleep duration and sleep efficiency, but no studies have looked at delivery or infant outcomes (29), so we don’t know if it’s safe.

SummarySleep medication is effective as improving insomnia symptoms in pregnant women, but many studies point to a significant risk of adverse neonatal outcomes. Ideally, it should be used as a last resort, and you should get a recommendation from your doctor, rather than an over the counter medication.

Natural Sleep Aid

Well if sleep medication might harm your baby, it’s only natural to look for a natural sleep aid while pregnant.

But there’s really no evidence that I could find to support such a thing. There’s certainly a predatory market of people who will gladly sell you oils and herbs that they claim will help, but they are unlikely to.

I mean, it rarely hurts to try them (other than your wallet) if you’d like to, but I wouldn’t have high expectations.

Acupuncture/Massage/Yoga

If you’re looking for a more natural approach to tackling sleep issues, it’s with activities that promote relaxation and happiness.

I’ve lumped all these together because there is some research on each of them, but not a ton at this point.

One study found that (30):

Acupuncture alleviates insomnia during pregnancy and further research is justified

Further studies have found that acupuncture, among increased exercise, massage therapy, and prenatal yoga may all have a beneficial effect for pregnant women with sleep difficulties (31). 

However, the limited data makes it impossible to draw definitive conclusions.

SummaryExercise and relaxation therapies like acupuncture may help reduce your insomnia symptoms (by reducing anxiety and depressive feelings), and there’s little to no risk of trying them.

Will Insomnia Continue After Pregnancy?

To wrap up, let’s think ahead a bit.

Let’s say you’re unable to get a great handle on your sleep issues during your pregnancy. Will you still have insomnia after pregnancy?

One study that looked at this topic found (32):

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.

Essentially, you’ll still probably sleep less (obviously checking on the baby factors into this), but you’ll have higher quality sleep. When it comes to sleep, quality is more important than quantity in most cases.

See our detailed guide to insomnia after having a baby for more details.

SummaryWhile you’ll still be a bit tired and fatigued on a regular basis, you likely won’t have the same stress and anxiety from during pregnancy.

Summary

We’ve seen that insomnia and sleep difficulties in general during pregnancy is incredibly common.

Hormones play a role, but so does anxiety, and depression in some women. It’s understandable to be anxious about things like the health of your baby, but it’s counterproductive if it’s affecting your sleep.

And while there’s no treatment that’s 100% effective for everyone, you do have options:

• Cognitive Behavioral Therapy
• Improving sleep hygiene
• Acupuncture and stress-releasing exercise activities
• Sleep medication (although ideally as a last resort)

Scroll up to the previous sections for more detail.

Frequently Asked Questions About Pregnancy Insomnia

Can insomnia be a sign of early pregnancy?

Trouble sleeping isn’t necessarily an early sign of being pregnant (although it could be). Other causes of insomnia include stress (even just being worried about being pregnant could do it), or even PMS.

Is insomnia in late pregnancy a sign of labor?

Insomnia is at its worse right before labor as your body secretes more oxytocin, which is a wake promoting hormone. So while insomnia could be a sign of labor in late pregnancy, it’s hard to self assess this accurately.

Is insomnia more likely if you are pregnant with twins?

Studies suggest that insomnia is more likely if you are pregnant with twins, but almost entirely because of the added stress and anxiety that comes with it (33).

References

1. Sleep disturbance in pregnancy. A subjective survey
2. Sleeping patterns during pregnancy in Japanese women
3. A cognitive model of insomnia
4. Psychological distress in pregnant women in insomnia
5. Women and insomnia
6. Insomnia in Pregnancy and Factors Related to Insomnia
7. Classification of Sleep Disorders
8. Sleep disturbances during pregnancy
9. Sleep patterns and sleep disturbances across pregnancy
10. A postal survey of maternal sleep in late pregnancy
11. Insomnia, Short Sleep, And Snoring In Mid-To-Late Pregnancy: Disparities Related To Poverty, Race, And Obesity
12. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research
13. Psychometric Properties of the Pittsburgh Sleep Quality Index (PSQI) in a Cohort of Peruvian Pregnant Women
14. Effects of pregnancy on mothers' sleep
15. Is insomnia in late pregnancy a risk factor for postpartum depression/depressive symptomatology?
16. Sleep impairment during pregnancy: possible implications on mother-infant relationship
17. Insomnia and sleep deficiency in pregnancy
18. Assessing sleep during pregnancy: a study across two time points examining the Pittsburgh Sleep Quality Index and associations with depressive symptoms
19. Sleep quality and depression during pregnancy: a prospective study
20. Sleep in late pregnancy predicts length of labor and type of delivery
21. Sleep Deprivation during Pregnancy and Maternal and Fetal Outcomes: Is There a Relationship?
22. Evaluation of a Maternity Cushion (Ozzlo Pillow) for Backache and Insomnia in Late Pregnancy
23. Insomnia Treatment Preferences During Pregnancy
24. Sleeping for Two: An Open-Pilot Study of Cognitive Behavioral Therapy for Insomnia in Pregnancy
25. Drugs in Pregnancy and Lactation 8th Edition: A Reference Guide to Fetal and Neonatal Risk
26. Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: neonatal outcome and congenital malformations
27. Increased risk of adverse pregnancy outcomes in women receiving zolpidem during pregnancy
28. Are hypnotic benzodiazepine receptor agonists teratogenic in humans?
29. Insomnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: a randomized clinical trial
30. Acupuncture for Insomnia in Pregnancy – a Prospective, Quasi-Randomised, Controlled Study
31. Non-pharmacological interventions for sleep quality and insomnia during pregnancy: A systematic review
32. Can Insomnia in Pregnancy Predict Postpartum Depression? A Longitudinal, Population-Based Study
33. Twin Pregnancies: Evaluation of Major Depression, Stress, and Social Support