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How to Sleep in
Pregnancy: Hormones,
Problems, and Best
Positions
Changes and Disruptions of Sleep Vary by Trimester
By Brandon Peters, MD - Reviewed by a board-certified physician.
Updated July 14, 2016

Whether you're in your first trimester or the beginnings of labor,

pregnancy can have profound effects on your ability to sleep: hormonal
changes may alter the nature of a pregnant womans sleep, preexisting
sleep difficulties may worsen, and new ones may show up with each
phase of pregnancy, introducing new challenges. Review how to sleep
best in pregnancy, including the role of hormones, possible sleep
problems, and the best positions.

The Effects of Pregnancy on Sleep

The wide-ranging effects of pregnancy on sleep cannot be understated:

changes occur in quality, quantity, and the very nature of sleep. For
those who have an underlying sleep disorder, these conditions may
worsen. Moreover, there are many sleep problems that first appear in
life during pregnancy. Although these issues may start soon after
conception, they typically increase in frequency and duration as the
pregnancy progresses. Nearly all women notice increased nighttime
awakenings, especially during the third trimester. There can be physical
discomfort, psychological adjustments, and hormonal changesall of
which can impact sleep and result in excessive daytime sleepiness and
fatigue.

How Hormones Change Sleep

As any pregnant woman can attest, there are dramatic hormonal

changes that accompany pregnancy. These changes affect many aspects
of the body and mind, including mood, physical appearance, and
metabolism.

The hormone changes also affect the pattern of sleep, or sleep

architecture.

Progesterone relaxes smooth muscle and may contribute to frequent

urination, heartburn, and nasal congestionall of which may be
disruptive to sleep. It also decreases wakefulness during the night, and
reduces the amount of rapid eye movement (REM) sleep, the state of
sleep characterized by vivid dream imagery.

In addition, it reduces the amount of time it takes to fall asleep.

Another important hormone in pregnancy, estrogen can also affect sleep

if it makes blood vessels larger through a process called vasodilation.
This may lead to swelling or edema in the feet and legs, and may also
increase congestion of the nose and disrupt breathing during sleep. In
addition, like progesterone, estrogen can decrease the amount of REM
sleep.

Other hormones may also change during pregnancy, with varying

effects. Studies have shown that melatonin levels are higher during
pregnancy, and increased levels of prolactin in the body may lead to
more slow-wave sleep. During the night, higher levels of oxytocin may
cause contractions that disrupt sleep. This increase in oxytocin may also
lead to a higher incidence of labor and delivery during the night.

Studies Reveal Changes in Sleep Patterns in

Pregnancy

The patterns of sleep change dramatically during pregnancy. Studies

with polysomnography have shown how the characteristics of sleep
change. One of the general themes is that the amount of time spent
asleep while in bed, or sleep efficiency, gradually decreases. This is
mostly due to an increased number of awakenings during the night.

First Trimester (First 12 weeks): Around week

10 of pregnancy, the total sleep time increases
with a longer sleep period at night and frequent
 daytime naps. Sleep becomes less efficient with
frequent awakenings, and the amount of deep or
slow-wave sleep decreases. Many women
complain of poor sleep quality.

Second Trimester (Weeks 13 to 28): Sleep

tends to improve with better sleep efficiency and
less time spent awake after going to sleep at night.
By the end of the second trimester, however, the
number of awakenings during the night again
increases.

Third Trimester (Weeks 29 to term): Women in

their final trimester of pregnancy experience more
nighttime awakenings and spend more time
awake at night. They also nap more frequently
during the day, so sleep efficiency is again
reduced. In addition, sleep is lighter with more
frequent stage 1 or 2 sleep.

Possible Sleep Problems in Pregnancy

What sleep problems occur during pregnancy? Aside from the changes
in the patterns of sleep and sleep stages as described above, there can
also be important symptoms and sleep disorders that may appear in
pregnancy. Women with an underlying sleep disorder such as sleep
apnea or restless legs syndrome may find that it worsens in pregnancy.
Moreover, some women will suffer from a sleep disorder for the first
time in their lives during pregnancy. These problems can be broken
down by trimester and culminate with the effects of labor and delivery:

First Trimester: The first trimester of

pregnancy may result in fatigue and excessive
daytime sleepiness. Studies have shown that
women who are younger or who have low levels of
iron before pregnancy have increased fatigue. Up
to 37.5% of pregnant women at 6 to 7 weeks
complain of sleepiness. This is thought to relate to
the increased levels of the hormone progesterone,
 and the resulting fragmentation of sleep. A variety
of physical changes and symptoms may also
undermine sleep, including: nausea and vomiting
(morning sickness), increased urinary frequency,
back pain, breast tenderness, increased appetite,
and anxiety. Anxiety can be especially problematic
if the pregnancy was unplanned or if there is a
lack of social support. This may result
in insomnia.

Second Trimester: The good news is that sleep

typically improves during the second trimester of
pregnancy. Nausea and urinary frequency
decrease as energy levels and sleepiness improve.
Towards the end of this period, women may
experience irregular contractions (called Braxton-
Hicks contractions) or stomach pain that may
disrupt sleep. In addition, movements of the fetus,
heartburn, and snoring due to nasal congestion
may affect sleep. Many women have increased
energy and improved mood during this time.

Third Trimester: Sleep becomes more restless

and disturbed during the final trimester. Studies
suggest that 30.3% of pregnant women will have
restless sleep during this time, and multiple
nighttime awakenings affect 98% of them. The
issues that affect sleep during this period of
pregnancy are numerous, including:

Frequent urination

Leg cramps

Shortness of breath

Heartburn

Forced body position in bed

 Back pain

Joint pain

Carpal tunnel syndrome (numbness in the hands)

Breast tenderness

Itching

Vivid dreams or nightmares

Anxiety

All of these problems may lead to a loss of sleep, and daytime sleepiness
may affect 65% of women. It may be difficult to find a comfortable
sleeping position, and you may need to use pillows to provide more
lumbar support to reduce back pain. In addition, the incidence of sleep
apnea and restless legs syndrome increases. More women will
experience nocturnal heartburn or gastro-esophageal reflux disease
(GERD). Some women like to use a wedge pillow to reduce these
symptoms. It is also during this phase of pregnancy
that preeclampsia may occur, which has an impact on the timing of
sleep or circadian rhythm.

Labor and Delivery: Not surprisingly, labor

and delivery can also have a negative impact on
sleep. Due to the elevation of oxytocin that peaks
during the night, many women will experience
forceful contractions that begin in the night. The
accompanying pain and anxiety associated with
contractions while laboring may adversely affect
sleep, and the medications used during this period
may also impact sleep. Unfortunately, many
pregnant women are unable to sleep while
laboring, even with the use of sleep aids.

Sleep can profoundly change during the major trimesters of pregnancy.

Hormones affect the structure of sleep, and physical ailments that
accompany the pregnant state may lead to disrupted sleep. Fortunately,
many of the difficulties related to poor sleep during pregnancy will
quickly resolve once the baby is delivered.

Source:

Kryger, MH et al. "Principles and Practice of Sleep Medicine." ExpertConsult, 5th edition, 2011, pp. 1572-1576.