Sleep and pregnancy

Good sleep is important for a healthy pregnancy. Yet, pregnancy is a time of increased sleep disturbance making getting a good night’s sleep a challenge just when you need it most.

Epidemiologic studies suggest there is an increased need for sleep during pregnancy. The high levels of the hormones human chorionic gonadotropin and progesterone that are required to maintain pregnancy also promote daytime sleepiness and a desire for early bedtimes. At the same time there is growing evidence linking sleep disturbances with adverse outcomes and showing the positive role sleep can play in promoting better health for both mama and baby (1).

The American Academy of Sleep Medicine (AASM) says that one of the ways for expectant mothers to help give their baby a better chance of a healthy and full-term birth is to practice good sleep hygiene.


How pregnancy affects sleep

If you are having trouble sleeping, you aren’t alone. Experts say that most pregnant women struggle with sleep problems and problems start with the first trimester. At least 50% of pregnant women suffer from sleep issues according to the Sleep Foundation

“During the first trimester, women experience frequent waking at night, often related to frequent trips to the bathroom during the night and nighttime nausea,” says Dr. Jodi A. Mindell, a professor of psychology at St. Joseph’s University in Philadelphia, and associate director of the Sleep Center at the Children’s Hospital of Philadelphia.

In the early days of pregnancy many women experience overwhelming daytime and evening fatigue and want to sleep longer at night. During the second and third trimester, it can be difficult to find a comfortable sleeping position. Heartburn, back pain, and leg cramps all contribute to sleep disruption.


Why sleep is so important

There are many benefits to sleep and some are specific to pregnancy. Sleep plays a major role in memory, learning, appetite, mood, and decision-making. Mom brain, also called momnesia, is actually a real thing (2) and one of the primary symptoms of mom brain is sleep issues. Sleep contributes to your overall health and can have a positive influence on reducing stress. Sleep deprivation can have negative effects while good sleep increases the likelihood of a full-term pregnancy (3).


More successful breastfeeding

Improving sleep may improve maternal health and breastfeeding. Studies show that women with better sleep efficiency and more stable nightly sleep time are less likely to experience delayed onset of lactogenesis, the process of developing the ability to secrete milk (4). 

Better baby sleep habits and better temperament

Emerging evidence suggests that maternal sleep problems before and during pregnancy may predict sleep problems and crying in babies once they are born. Infants whose mothers had poor sleep quality and slept for less than 6 hours tended to cry more intensely and were associated with preterm birth and child sleep problems and temperament. On the plus side, since maternal sleep duration was positively associated with childhood sleep duration, focusing on better sleep can have a positive effect as well (7-8).


Sleep and the immune system

Getting enough sleep is important to supporting a healthy immune system. Poor sleep quality and quantity during pregnancy can disrupt normal immune processes and lead to lower birth weights and other complications, according to a new study (11). 


Sleep and high blood pressure or preeclampsia

Multiple research studies show that poor quality sleep may contribute to high blood pressure and preeclampsia, a condition that can lead to preterm delivery and lasting complications for the mother’s heart, kidney, and other organs.  Pregnant women who get too much or not enough sleep in early pregnancy are prone to developing high blood pressure in the third trimester. Severe sleep deprivation in early pregnancy may also raise the risk of preeclampsia, (12).


Sleep and better labor

The amount of sleep you get in late pregnancy may predict the length of labor and likelihood of cesarean delivery. Research shows that women who experience sleep problems in late pregnancy have longer labors and are more likely to need a cesarean section (13). In one study, women who slept less than 6 hours at night had longer labors and were 4.5 times more likely to have cesarean deliveries. Women with severely disrupted sleep had longer labors and were 5.2 times more likely to have cesarean deliveries (14). 


Sleep and breathing

Some research suggests sleep-disordered breathing may be a risk factor for miscarriage (17). Nasal congestion and the extra weight of pregnancy can lead many women to start snoring, which may be a risk factor for high blood pressure. It is thought to affect as many as 1 in 5 pregnant women. Treating sleep-disordered breathing can be beneficial to avoiding negative outcomes (20).


Sleep and reflux

Another common cause of sleep issue during pregnancy is gastroesophageal reflux. Heartburn or acid reflux causes an uncomfortable burning sensation in the esophagus, especially when lying down. It’s thought to affect one-quarter of pregnant women in the first trimester (21). 


Vivid dreams during pregnancy

You may notice more active dreaming and even more anxious or fearful dreams. This, too, is normal, especially in the third trimester. Sleep experts say that late pregnancy is a period of markedly increased dysphoric dream imagery that can impair your sleep (22). Remember they are only dreams and the result of changes in your body and practice self care to bring calm.


How much sleep do you need?                

The ideal sleep for a pregnant mama tends to be about 9 hours a night. Surprisingly, too much sleep has the same effect on blood pressure as too little. Both increase blood pressure. Experts at the Alaska Sleep Education Center say to watch out for less than 6 hours and more than 10 hours.

Tips for a good night’s sleep

  • Make sleep a priority. Try going to bed and waking up at the same time each day and allot more than eight hours of time in bed to allow for some inevitable disruptions.
  • Try side-sleeping on your left side. Sleeping on the left side improves blood flow to the heart, kidneys, uterus, and to your baby because it keeps baby from putting pressure on the vein carrying blood back to the heart from your legs. You’ll also be more comfortable on your side with your knees bent. It’s okay to switch sides, but it’s best not to sleep on your back.
  • Try a sleep pillow. Using pillows under your belly or between your legs can make you more comfortable. Relieve pressure at the small of your back by adding a pillow or rolled-up blanket. A special foam mattress pad can give extra relief if your hips get sore and there are several pillows designed specifically for pregnancy to help you sleep more comfortably.
  • Avoid caffeine, sugar, and simple carbohydrates. 
  • Avoid drinking too much liquid in the hours just before bed to manage how much you awaken to use the bathroom. 
  • Avoid heavy meals or spicy foods close to bedtime, especially if you experience reflux. Some women find it helpful to eat a big breakfast and lunch, then have a smaller dinner. If nausea is keeping you up, try eating a few crackers before you go to bed. 
  • Exercise. Regular daily exercise can help you sleep but avoid doing it right before bed since exercise raises body temperature which affects your ability to sleep. 
  • Relax before bed. Take the time to unwind from your day. Try soaking in a warm bath for 15 minutes, or having a warm, caffeine-free drink.
  • Create a comfortable environment. Make your bedroom dark, quiet, and set a comfortable temperature. Avoid blue light from screens in the hour before bedtime.
  • Nap during the day if you can.
  • Make sure you’re getting enough iron and folate — anemia can contribute to restless legs syndrome
  • Manage stress. Try writing down your worries in a journal, so you can let go of them before you sleep. Childbirth classes can help you prepare for the life changes ahead.
  • Don’t rely on sleep medications, as they may have side effects.

Sleep and nutrition: nutrients for better sleep

A healthy diet will support your pregnancy in many ways, including helping you get better sleep. Here are some important nutrients to look for.

Vitamin D has both a direct and an indirect role in the regulation of sleep. Vitamin D receptors and the enzymes that control their activation and degradation are expressed in several areas of the brain involved in sleep regulation. Vitamin D is also involved in producing melatonin. There is some new exploration suggesting that vitamin D might affect sleep indirectly by helping with restless legs and sleep apnea. Spend some time outside every day if you can and  look for ways to include vitamin D in your diet as well as supplements like Vitamin D Drops.

Folate has been shown to help with sleep. Among key findings, there is an inverse association between folate and sleep disturbance (25). 

Vitamin B12. B-12 deficiency can be linked to sleep issues in several ways, including altered sleep patterns, difficulty falling asleep, or lack of sleep. Proper levels of serum vitamin B-12 has been associated with sleep duration. Vitamin B-12 also works closely in the body with the hormone melatonin. Melatonin is responsible for regulating the circadian rhythms within our bodies, affecting our sleep patterns. High levels of vitamin B-12 can increase your melatonin production, causing you to go to sleep sooner (26). 

In addition to a healthy diet, look for prenatal multivitamins that include these important nutrients like Mama Bird Prenatal Multi+ and Mama Bird AM/PM Prenatal Multi+.

Getting a good night’s sleep isn’t always easy while you’re pregnant, but follow some of these tips, pay attention to healthy nutrition, and do what you can to get your best rest. You’ll feel better and be better prepared for baby’s arrival.


(1) Sleeping for Two: The Great Paradox of Sleep in Pregnancy, J Clin Sleep Med. 2015 Jun 15; 11(6): 593–594.

(2) Nature Neuroscience, volume 20, pages 287–296 (2017).

(3) Pregnant Women: Good Sleep is One of the Best Ways to Assure a Healthy Baby, American Academy of Sleep Medicine, September 26, 2007.

(4) Delayed Lactogenesis II is Associated With Lower Sleep Efficiency and Greater Variation in Nightly Sleep Duration in the Third Trimester. J Hum Lact. 2019 Nov;35(4):713-724.

(5) Sleep Disturbances and Symptoms of Depression and Daytime Sleepiness in Pregnant Women. Birth. 2016 Jun;43(2):176-83.

(6) Poor sleep quality of third-trimester pregnancy is a risk factor for postpartum depression. Med Sci Monit. 2014 Dec 20;20:2740-5.

(7) Association of maternal sleep before and during pregnancy with preterm birth and early infant sleep and temperament. Sci Rep. 2020 Jul 6;10(1):11084.

(8) Children's Sleep May Depend on Maternal Sleep Duration During Pregnancy: A Retrospective Study. Nat Sci Sleep. 2020;12:197-207. Published 2020 Mar 10. 

(9) Associations of sleep duration, sedentary behaviours and energy expenditure with maternal glycemia in pregnancy, Sleep Med, 2020 Jan;65:54-61. doi: 10.1016/j.sleep.2019.07.008. Epub 2019 Jul 22.

(10) The role of sleep duration and sleep disordered breathing in gestational diabetes mellitus. Neurobiol Sleep Circadian Rhythms. 2017 Nov 28;4:34-43.

(11) University of Pittsburgh Schools of the Health Sciences. "Poor sleep in pregnancy can disrupt the immune system and cause birth-related complications." ScienceDaily. ScienceDaily, 17 July 2013.

(12) Associations of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders in pregnancy. Sleep. 2010 Oct;33(10):1363-71.

(13) Sleep in late pregnancy predicts length of labor and type of delivery, Am J Obstet Gynecol, 2004 Dec;191(6):2041-6. doi: 10.1016/j.ajog.2004.05.086.

(14) Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol. 2004 Dec;191(6):2041-6.

(15) Restless Legs Syndrome and Sleep-Wake Disturbances in Pregnancy. J Clin Sleep Med. 2017 Jul 15;13(7):863-870.

(16) Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron. J Womens Health Gend Based Med. 2001 May;10(4):335-41.

(17) Is sleep-disordered breathing associated with miscarriages? An emerging hypothesis Med Hypotheses, 2014 Apr;82(4):481-5. doi: 10.1016/j.mehy.2014.01.031. Epub 2014 Feb 7.

(18) Obstructive sleep apnea and the risk of preterm delivery Sleep Breath, 2016 Sep;20(3):1111-7. doi: 10.1007/s11325-016-1339-7. Epub 2016 Apr 8.

(19) Associations between Maternal Sleep Quality Throughout Pregnancy and Newborn Birth Weight, Behav Sleep Med, Jan-Feb 2021;19(1):57-69. doi: 10.1080/15402002.2019.1702551. Epub 2019 Dec 12.

(20) Treatment of sleep disordered breathing reverses low fetal activity levels in preeclampsia. Sleep. 2013 Jan 1;36(1):15-21.

(21) A prospective longitudinal cohort study: evolution of GERD symptoms during the course of pregnancy. BMC Gastroenterol. 2012 Sep 24;12:131.

(22) Disturbed dreaming during the third trimester of pregnancy. Sleep Med. 2014 Jun;15(6):694-700.

(23) The Importance of Sleep during Pregnancy, Alaska Sleep Education Center, Dec 22, 2020.

(24)Vitamin D and Sleep Regulation: Is there a Role for Vitamin D? Curr Pharm Des. 2020;26(21):2492-2496.

(25) Serum Nutritional Biomarkers and Their Associations with Sleep among US Adults in Recent National Surveys. PLOS ONE 9(8): e103490.

(26) Serum Nutritional Biomarkers and Their Associations with Sleep among US Adults in Recent National Surveys. PLOS ONE 9(8): e103490.