Why Sleep During Pregnancy Matters More Than You Think (And What You Can Actually Do About It)

You are growing a human. You are exhausted. And yet — somehow — you cannot sleep. If this sounds familiar, you are not alone. Sleep disturbances affect 75% of pregnant people, peaking in the third trimester. Despite being incredibly common, poor sleep during pregnancy is often brushed off as “just part of it.” But the science tells a different story: sleep health during pregnancy is a serious maternal health issue — one that is treatable, and worth taking seriously.

· "Cecilia" is a 30-year-old woman in Birmingham, Alabama expecting her first child. As she enters her second trimester, she has experienced some difficulty with falling asleep and staying asleep. She is tired during the day. She is unsure if this is normal in pregnancy. Her friends and family have assured her that some fatigue is normal. However, she has been having more difficulty with her day-to-day activities. Her spouse has expressed some concerns. She plans to ask at her next OB/GYN checkup.

· "Jordan" is a 37-year-old woman in Huntsville, Alabama who is pregnant with her second child. Jordan expects to have some difficulty sleeping based on her experience in her first pregnancy. With a toddler at home, she has found it difficult to prioritize her own sleep. One thing that is different this pregnancy is a feeling of needing to move her legs at bedtime. The sensations in her legs make it difficult to fall asleep and she started waiting a little longer to go to bed each night.

The Scope of the Problem

Pregnancy brings a wave of physical, hormonal, and emotional changes that can conspire against a good night’s rest. The three most common sleep disturbances during pregnancy are:

1) Insomnia — affecting around 60% of pregnant people

2) Restless Leg Syndrome (RLS) — affecting about 20%

3) Sleep Apnea — affecting approximately 15%

And the consequences go beyond just feeling tired. Poor sleep during pregnancy has been linked to gestational diabetes, hypertension, preterm birth, cesarean delivery, and preeclampsia.

Postpartum Risks

Left untreated, insomnia during pregnancy can increase the risk of postpartum depression. Approximately 12% of women experience postpartum depression, a medical condition characterized by mood changes and difficulty functioning. Postpartum depression can impact bonding with the baby as well as the health of the mother. Sleep deprivation in pregnancy can increase your risk. Working on sleep during pregnancy can be a protective factor.

Why Sleep Is Impacted

There is no single culprit — pregnancy can disrupt sleep from multiple angles at once. Physical changes like pressure on the bladder and pressure on the lungs affect breathing and rest. Hormonal shifts in estrogen and progesterone alter sleep architecture. Lifestyle stressors — the mental load of preparing for a baby, relationship changes, financial pressures — can keep the mind racing long after the lights go out. Underlying medical and psychiatric conditions can also surface or worsen during pregnancy: anxiety, depression, GERD, anemia, and chronic pain can all make sleep harder. Even some common medications — including certain antidepressants, bronchodilators, and antihistamines — can disrupt sleep as a side effect. It is also worth recognizing that not everyone faces the same barriers. Research highlights significant health disparities in sleep: Black individuals are less likely to be diagnosed or treated for sleep apnea; people from marginalized communities are more likely to work night shifts or irregular hours; and neighborhood-level factors like noise, pollution, and safety concerns can directly interfere with sleep quality.

Healthy Sleep in Pregnancy

Pregnant people should aim for 8-10 hours of sleep each night. This exceeds the recommended amount for adults of 7-9 hours. A regular sleep schedule is recommended with consistent bedtime and wake time. Adding pillows for the midsection, lower back, and knees can be helpful. Sleeping on the left side is often recommended to improve blood flow and reduce swelling.

The Three Most Common Sleep Diagnoses During Pregnancy

Insomnia

Insomnia is not just a bad night here and there. It is difficulty falling asleep, staying asleep, or waking up too early or a combination of these. These problems occur with regularity and cause difficulty with next day functioning. Clinically, it breaks down into three types:

· Chronic Insomnia Disorder: Sleep problems occurring at least 3 times per week for 3+ months

· Acute Insomnia Disorder: Sleep disruption lasting less than 3 months, often tied to a specific stressor

· Other Insomnia Disorder: Sleep difficulties that don’t neatly fit the above categories

Obstructive Sleep Apnea (OSA)

OSA during pregnancy is associated with serious risks, including increased maternal morbidity and mortality and a higher risk of complications during anesthesia. The most common sign is loud, frequent snoring or gasping for air. Those with pre-existing sleep apnea should know that CPAP settings may need to be adjusted during pregnancy.y

Restless Leg Syndrome (RLS)

RLS is diagnosed by four key criteria: an urge to move the legs accompanied by unpleasant sensations; symptoms that worsen with rest or inactivity; symptoms that ease with movement; and symptoms that are worst in the evening. It can be a primary condition or secondary to other factors — including iron deficiency, which is especially relevant during pregnancy.

What Actually Improves Sleep During Pregnancy

Sleep Hygiene

Good sleep hygiene is a foundation, not a fix. On its own, it will not resolve chronic insomnia — but it is an essential starting point. The basics include:

· Going to bed and waking at consistent times, even on weekends

· Turning off screens 30 minutes before bed

· Avoiding large meals close to bedtime

· Getting regular exercise (approximately 150 minutes per week)

· If your mind races at night, try writing a to-do list or journaling before bed.

· If you are not asleep after 15- 20 minutes, get out of bed and do something quiet in low-light until you feel sleepy again.

CBT-i: The Gold Standard

Cognitive Behavioral Therapy for Insomnia (CBT-i) is the first-line treatment for chronic insomnia — even during pregnancy. It consists of 6–8 sessions and addresses sleep from multiple angles:

A pregnancy-adapted version of CBT-i is available that accounts for the unique demands of the perinatal period, with modified sleep efficiency guidance and a focus on newborn and family-related dynamics.

When Medication Is Considered

Medication is generally considered when non-pharmacological approaches have not worked, when insomnia is severe, or when benefits clearly outweigh the risks. Even over-the-counter sleep aids can create unique risks in pregnancy and impact fetal development. For example, melatonin can cross the placenta and impact fetal development. This is always a conversation to have carefully with your healthcare provider. It is important to seek evidence-based information about medication safety during pregnancy and breastfeeding.

Practical Tools You Can Use Now

Your Bedtime Routine: Think of a bedtime routine the way you would think of one for a child — your body needs consistent cues that it is time to wind down. Pick a target bedtime, work backwards, and build your routine around it. Considering the extra sleep needs of pregnancy, this will likely look different than pre-pregnancy sleep.

Ask for a Sleep “Prescription”: Some providers offer a simple written note that patients can share with family and friends, explaining that rest is medically important. Loved ones can offer support by making meals, handling household tasks, caring for other children. Having something tangible to hand to a partner or family member can make asking for help much easier.

Know Your Resources:

MotherToBaby (mothertobaby.org) — Evidence-based information on medication and substance exposures during pregnancy and breastfeeding.

LactMed (ncbi.nlm.nih.gov/books/NBK501922) — Database of drugs andchemicals that breastfeeding parents may be exposed tobabysleep.com — Expert guidance on newborn and infant sleep.

The Bottom Line

Sleep during pregnancy is not a luxury — it is a health issue. Poor sleep has real consequences for both parent and baby, and it does not have to be accepted as inevitable. Whether the solution is better sleep hygiene, a course of CBT-i, a conversation with your provider about underlying causes, or a combination of approaches, there are real options. If you are struggling to sleep during pregnancy, bring it up at your next appointment. You deserve to be taken seriously — and you deserve rest.