Sleep During Pregnancy: Trimester by Trimester

First trimester

Rising progesterone often causes strong daytime sleepiness and fatigue. Nausea and needing to urinate more often can interrupt nights. Rest when you can, keep a regular schedule, and eat small, frequent snacks if nausea wakes you.

Second trimester

Many people sleep better in the second trimester as nausea eases. Heartburn, leg cramps and vivid dreams can begin. This is a good time to establish comfortable side-sleeping with pillow support.

Third trimester

Sleep is often most disrupted late in pregnancy, with discomfort, back pain, heartburn, frequent urination, the baby's movements, leg cramps and anxiety. Short naps and earlier bedtimes can help make up for broken nights.

Go to sleep on your side from 28 weeks

UK NHS guidance, based on research including a large international study, advises that from 28 weeks of pregnancy it is safer to go to sleep on your side than on your back, because going to sleep on your back in late pregnancy is associated with a higher risk of stillbirth. Either side is fine. If you wake up on your back, do not worry; just turn onto your side. Pillows between the knees and under the bump, or a pregnancy pillow, can make side sleeping more comfortable.

Snoring and sleep apnea

Snoring becomes more common in pregnancy because of nasal congestion and weight gain. Snoring and obstructive sleep apnea in pregnancy are associated with high blood pressure, preeclampsia and gestational diabetes. Tell your care team if you snore loudly, someone notices pauses in your breathing, or you are very sleepy during the day. Sleep apnea can be diagnosed and treated during pregnancy, often with CPAP.

Restless legs and cramps

Restless legs syndrome is more common during pregnancy, especially in the third trimester, and is linked to low iron. Your care team can check your iron levels. Gentle stretching, walking and massage may help leg cramps. Do not start supplements without asking your clinician.

Heartburn and comfort tips

• Eat smaller meals and avoid eating in the 2 to 3 hours before bed.
• Raise the head of the bed or use a wedge for heartburn.
• Drink plenty of fluids earlier in the day and less in the evening.
• Keep the bedroom cool; many people run warmer in pregnancy.
• Ask your care team before taking any sleep aid, including melatonin or herbal products.

Insomnia and mood

Insomnia is common in pregnancy. CBT-I techniques are drug-free and can be used during pregnancy. Tell your care team if poor sleep comes with persistent low mood or anxiety, before or after birth, as perinatal depression and anxiety are common and treatable.