Insomnia During Pregnancy: How to Sleep Better

Many pregnant women feel tired but still cannot sleep well. Some have difficulty falling asleep, while others wake up many times at night because of frequent urination, heartburn, leg cramps, baby movements, back pain or anxiety.

Insomnia during pregnancy is common, especially as the body changes. ACOG notes that many women have trouble sleeping during pregnancy because of physical and hormonal changes, including rising oestrogen and progesterone levels, weight gain, snoring and possible sleep apnoea. [1]

Although occasional poor sleep is normal, ongoing insomnia can affect mood, energy, concentration and daily functioning. The good news is that many sleep problems can improve with practical habits, better positioning and treatment of underlying discomforts.

What Is Pregnancy Insomnia?

Pregnancy insomnia means having regular trouble falling asleep, staying asleep or waking too early and not feeling rested. It may happen in any trimester, but the reasons may change as pregnancy progresses.

• First trimester: Hormonal changes, nausea, breast tenderness, fatigue and frequent urination may disturb sleep.
• Second trimester: Some women sleep better, but heartburn, vivid dreams, anxiety or body discomfort may continue.
• Third trimester: A larger belly, back pain, pelvic discomfort, baby movements, leg cramps and frequent toilet trips may make sleep harder.

Why Is It Hard to Sleep During Pregnancy?

1. Hormonal changes

Pregnancy hormones can change sleep patterns and make some women feel sleepy in the day but restless at night. Hormonal changes may also contribute to nausea, mood changes and more frequent urination.

2. Frequent urination

Pregnant women may need to pass urine more often because of hormonal changes, increased blood volume and pressure from the growing uterus. Night-time toilet trips can interrupt sleep repeatedly.

3. Heartburn and indigestion

Pregnancy can relax the muscle between the stomach and oesophagus, making reflux and heartburn more likely. Lying down soon after eating may worsen symptoms.

4. Back pain, hip pain and pelvic discomfort

As the pregnancy progresses, the growing belly changes posture and body balance. This can cause discomfort when lying down or changing position in bed.

5. Leg cramps and restless legs

Some pregnant women experience painful leg cramps or an uncomfortable urge to move the legs at night. Medical literature notes that insomnia in pregnancy may be related to conditions such as restless legs syndrome, mood disorders or breathing-related sleep disorders. [2]

6. Anxiety and overthinking

It is common to think about baby’s health, delivery, finances, work, childcare arrangements or whether you will cope after birth. These worries may become louder at night when everything is quiet.

7. Snoring or sleep apnoea

Pregnancy weight gain and swelling in the airway may increase snoring. ACOG notes that weight gain can make the airway swell, which may lead to snoring and obstructive sleep apnoea. [1]

How to Sleep Better During Pregnancy

1. Keep a consistent sleep routine

Try to sleep and wake around the same time each day, including weekends. A regular routine helps train your body to recognise when it is time to rest.

A simple bedtime routine may include:

• A warm shower
• Gentle stretching
• Reading something calming
• Listening to soft music
• Deep breathing or relaxation exercises

HealthHub Singapore advises people with insomnia to wake at approximately the same time each morning, avoid excessive daytime naps and make the sleep environment conducive to rest. [3]

2. Make your bedroom sleep-friendly

Keep your room cool, dark and quiet. In Singapore’s warm weather, a fan or air-conditioning may help. Use curtains, an eye mask or earplugs if light and noise disturb your sleep.

Try to keep your bed mainly for sleep and rest. If you regularly work, scroll social media or handle stressful tasks in bed, your brain may start linking the bed with alertness instead of sleep.

3. Limit screens before bedtime

Bright screens, social media and work messages can make it harder to wind down. Try reducing phone use at least 30 to 60 minutes before bed. If you need your phone nearby, switch on night mode and avoid stressful content.

4. Watch caffeine timing

Caffeine can make sleep more difficult. Coffee, tea, cola, energy drinks and chocolate may contain caffeine. Pregnant women who are sensitive to caffeine may need to stop earlier in the day or reduce intake further.

HealthHub advises avoiding caffeine before bedtime as it is a stimulant that can keep you awake. [4]

5. Avoid heavy meals close to bedtime

A very full stomach can worsen heartburn and make lying down uncomfortable. Try to finish dinner earlier and keep late-night snacks light.

If you are hungry before bed, choose a small snack such as yoghurt, wholegrain crackers, milk, banana or a small slice of wholemeal bread.

6. Manage heartburn before sleep

If reflux keeps you awake, these steps may help:

• Eat smaller meals more often
• Avoid spicy, oily or very acidic foods if they trigger symptoms
• Do not lie down immediately after meals
• Raise your upper body slightly with pillows if comfortable
• Ask your doctor about pregnancy-safe heartburn medicine if symptoms persist

7. Use pillows for support

Pillows can reduce strain on the back, hips and belly. Try placing:

• One pillow between your knees
• One pillow under your belly for support
• One pillow behind your back to prevent rolling flat
• A wedge pillow under the upper body if heartburn is a problem

You do not need an expensive pregnancy pillow if normal pillows work well for you.

8. Sleep on your side in later pregnancy

Side sleeping is usually more comfortable in the second half of pregnancy. If you wake up on your back, do not panic. Simply turn back to your side.

Many pregnant women find the left side comfortable, but either side may be acceptable depending on your doctor’s advice and your comfort. If you have a high-risk pregnancy or specific medical condition, ask your gynae what sleeping position is best for you.

9. Stay active in the day if your doctor says it is safe

Regular gentle activity may help sleep, mood, circulation and body aches. Walking, swimming and prenatal yoga may be suitable for many pregnant women, but always follow your doctor’s advice.

Avoid intense exercise close to bedtime if it makes you feel more alert.

10. Take short naps wisely

Short naps can help if pregnancy fatigue is strong. However, long or late afternoon naps may make it harder to sleep at night. If naps affect your night sleep, try keeping them short and earlier in the day.

HealthHub Singapore suggests that some mums-to-be may take frequent short rests or naps to recharge when sleep is disrupted. [5]

11. Calm your mind before bed

If worries keep you awake, try writing them down before bedtime. You can divide them into two lists:

• Things I can do tomorrow
• Things I cannot solve tonight

This helps signal to your brain that the thoughts have been “parked” for now.

You can also try slow breathing:

• Breathe in slowly for 4 counts
• Hold gently for 1 to 2 counts
• Breathe out slowly for 6 counts
• Repeat for a few minutes

What If You Wake Up and Cannot Fall Back Asleep?

If you are awake for a long time, try not to lie in bed getting frustrated. Get up briefly and do something quiet and calming in dim light, such as reading a few pages of a book or listening to relaxing audio. Return to bed when you feel sleepy again.

Avoid checking the time repeatedly. Watching the clock often increases stress and makes sleep harder.

Are Sleeping Pills Safe During Pregnancy?

Do not take sleeping pills, antihistamines, herbal sleep remedies, melatonin or supplements for sleep without asking your doctor. Even products labelled “natural” may not be suitable during pregnancy.

If insomnia is severe, your gynae or doctor can check for underlying causes and discuss pregnancy-safe options. Sometimes treating heartburn, pain, anxiety, restless legs, anaemia or sleep apnoea is more helpful than taking a sleep medicine.

When Should You Speak to Your Doctor?

Speak to your doctor or gynae if:

• You cannot sleep well for many nights in a row
• Insomnia is affecting work, mood, driving or daily life
• You feel very anxious, low, tearful or hopeless
• You snore loudly or your partner notices pauses in breathing
• You wake up choking, gasping or short of breath
• You have severe heartburn, pain or leg cramps
• You feel an uncontrollable urge to move your legs at night
• You are taking any sleep supplement or medication

Seek Urgent Medical Advice If You Have These Symptoms

Some symptoms should not be treated as “just poor sleep”. Seek urgent medical advice if you have:

• Severe headache
• Blurred vision or seeing spots
• Chest pain or severe shortness of breath
• Sudden swelling of face or hands
• Severe abdominal pain
• Thoughts of harming yourself
• Severe anxiety or panic that feels unmanageable

These symptoms may need prompt medical assessment, especially if they happen with high blood pressure, reduced baby movement or feeling very unwell.

How Partners Can Help

Pregnancy insomnia can be exhausting, especially if the mother still has to work, care for older children or manage household responsibilities. Partners can help by:

• Taking over some night or morning chores
• Reducing noise and bright lights at night
• Helping prepare a comfortable sleep setup
• Encouraging medical review if snoring, anxiety or severe insomnia occurs
• Being patient if the mother is tired or emotional

FAQ: Insomnia During Pregnancy

Is insomnia common during pregnancy?

Yes. Many women experience sleep problems during pregnancy because of hormonal changes, frequent urination, body discomfort, heartburn, anxiety, baby movements, snoring or leg cramps.

Why do I feel tired but cannot sleep while pregnant?

Pregnancy can make the body physically tired while hormones, discomfort, frequent urination, reflux or worries keep the brain and body alert at night.

What sleeping position is best during pregnancy?

Side sleeping is usually more comfortable in the second half of pregnancy. Many women prefer the left side, but either side may be comfortable. If you wake up on your back, simply turn to your side again.

Can I take melatonin for pregnancy insomnia?

Do not take melatonin or any sleep supplement during pregnancy without checking with your doctor. Your doctor can advise whether it is suitable and whether another cause of insomnia needs treatment.

What can I do if heartburn keeps me awake?

Try smaller meals, avoid trigger foods, do not lie down soon after eating, and raise your upper body slightly. If symptoms continue, ask your doctor about pregnancy-safe heartburn treatment.

When should I worry about poor sleep during pregnancy?

Speak to your doctor if insomnia affects daily life, mood or safety, or if you have loud snoring, breathing pauses, severe anxiety, depression, pain, restless legs or symptoms such as severe headache, blurred vision or shortness of breath.

Key Takeaway

Insomnia during pregnancy is common, but it can still be frustrating and exhausting. Better sleep habits, a calming bedtime routine, side sleeping, supportive pillows, caffeine control, light exercise and managing heartburn or pain can all help.

If sleep problems are severe, persistent or linked to anxiety, low mood, snoring, breathing pauses, pain or restless legs, speak to your gynae or doctor. You do not have to simply endure sleepless nights throughout pregnancy.

References

• [1] American College of Obstetricians and Gynecologists, Sleep Health and Disorders.
• [2] Hashmi AM et al., Insomnia During Pregnancy: Diagnosis and Rational Interventions, Pakistan Journal of Medical Sciences.
• [3] HealthHub Singapore, Insomnia.
• [4] HealthHub Singapore, Are You Getting Quality Sleep?
• [5] HealthHub Singapore, Recharged and Ready for Baby.
• [6] NHS, Tiredness and Sleep Problems in Pregnancy.