Why is it so hard to sleep while pregnant?

If you've come to on your back this minute with that jolt of fright, the NHS has a sentence for exactly this moment: if you wake up on your back there's no need to worry, as you can turn onto your side and go back to sleep²2 NHS, 2026n. Why so relaxed about the rest of the night? The research behind the side-sleeping advice is about the position you fall asleep in, from twenty-eight weeks on²³3 Cronin et al., 2019. That's the position most people stay in longest³, so it's the one the studies asked about. The advice asks something of you at bedtime and nothing while you sleep. Your right side counts the same as your left³, which means you can face whichever way your hip will let you.

The other wakings have their reasons too. When a team surveyed more than two thousand pregnant women online, the commonest reason they gave for broken nights was needing to pee⁴4 Mindell et al., 2015b, and what breaks yours up changes as the months go by.

It is, and it isn't only how it feels. A US team recorded women's sleep overnight in a lab early in their pregnancy, then brought the same women back late on. On the later nights they slept less and woke more, with less deep and REM sleep⁶6 Izci-Balserak et al., 2018. So if you feel you're resting less than you used to, that's what the recordings found in women like you.

What shifts over the months is which things do the waking. Early on it's mostly tiredness and sickness. Late on it's size, pressure and a baby with a timetable of their own.

In the first twelve weeks, hormonal changes can make you tired, sick and emotional, and the tiredness itself won't harm you or the baby²2 NHS, 2026n. So you may find yourself asleep on the sofa soon after dinner and then lying awake in the small hours with your stomach turning, while the rest of the house sleeps on.

Pregnancy sickness can come at any time of the day or night, and it usually clears by sixteen to twenty weeks without putting the baby at extra risk⁷7 NHS, 2026m. What tends to help is something plain, like dry toast or a plain biscuit, small and frequent snacks high in carbohydrate and low in fat such as crackers, with sips of drink little and often⁷. A few crackers and a glass of water by the bed are one way of keeping that within reach when you wake queasy at 2am, so you needn't pad to the kitchen and stand in the light of the fridge. Foods with ginger in them can help too, though it's worth checking with a pharmacist before taking ginger as a supplement⁷.

Many women find a pause somewhere in the middle, once sickness usually eases by sixteen to twenty weeks⁷7 NHS, 2026m and before the late discomforts arrive. The insomnia numbers fit that shape: insomnia stays about level through the first two trimesters and climbs in the third⁸8 Sedov et al., 2021. Nobody has measured the lull itself, though. It's pieced together from those two findings, and an average across thousands of women can't tell you how your own months will run.

In the last months, turning over can mean waking right up to shift a pillow and the bump together, and just as you get comfortable, a small heel may press up under your ribs. As the bump grows, lying down gets harder to make comfortable²2 NHS, 2026n, and specialists count stretching ligaments, tightenings of the womb and the baby's movements among the things that break sleep up¹⁰10 Miller et al., 2020.

The bladder is back too, because the growing bump means needing the bathroom a lot². Drinking less just before bed is one of the steps sleep specialists suggest for nighttime peeing¹⁰, though nobody has tested it on its own.

Heartburn has its own reasons for choosing the night. It grows more common from twelve weeks on, because hormones relax the valve at the top of the stomach and the growing baby presses against it⁵5 NHS, 2026k. Then you lie down, and acid can come back up⁵. So the evening is where you can head it off. Smaller meals more often, with nothing in the three hours before bed, can help⁵, and so can sitting up for a while after you eat⁵. In bed, there's the extra pillow and the left side⁵. If it still wakes you, a pharmacist can suggest an antacid or alginate if you tell them you're pregnant, since some antacids aren't suitable⁵. If you take iron or folic acid, it's worth leaving two hours between that and an antacid⁵.

When a calf seizes in the night, it pulls you awake in a moment. Researchers who reviewed the trials found that no supplement has yet been shown to help, magnesium included¹¹11 Luo et al., 2020, so if you're tempted to buy one for cramps, it's one to ask your midwife about first. Once the cramp lets go, getting comfortable on your side again is the whole job, and the pillows you set up for that² are still there.

If your nose is stuffed up at night in these months, or you feel a little short of breath lying flat, part of the reason is that pregnancy hormones and extra fluid can swell the lining of the nose and airway, and late on the lungs hold less air at rest, especially lying on your back¹⁰.

That creeping, fizzing need to move your legs just as you lie still is restless legsrestless legs syndrome An urge to move your legs, often with uncomfortable feelings in them, that comes on when you rest, especially in the evening, and eases when you move.. It turns up in about one in five pregnant women, building toward the third trimester and mostly going after the birth⁹9 Chen et al., 2018.

The international guideline for restless legs in pregnancy starts with reassurance, exercise and avoiding what makes the legs worse, and it sets out a reason for iron¹²12 Picchietti et al., 2015. Specialists suggest iron when a blood test of your iron stores, called ferritinferritin A protein that stores iron, measured with a blood test. The level shows roughly how much iron the body has in reserve., comes back low, with more tests to follow¹⁰10 Miller et al., 2020. So iron is something to start after that test, on your midwife's or doctor's word. If those first steps aren't enough, they can weigh up other treatments with you. It's worth raising even if it seems minor. Many pregnant women with restless legs have symptoms bad enough to harm their sleep, and some studies have linked it with high blood pressure in pregnancy¹⁰¹². Why do my legs feel restless at night? has more on it outside pregnancy.

You've probably been told to sleep on your side. From twenty-eight weeks, what the advice asks of you is the side you're on as you go to sleep²³2 NHS, 2026n3 Cronin et al., 2019. Where did it come from? Researchers talked with women late in pregnancy, some who had lost their baby and some whose pregnancies were going on, and asked each how she had gone to sleep in the weeks before. When they pooled five of those studies, going to sleep on the back was linked to 2.6 times the odds of stillbirth from twenty-eight weeks, compared with going to sleep on the left side³. Going to sleep on the right side was no riskier than the left³, so in these data the two sides come out the same.

Nobody has tested this in a trial. The link comes from women recalling their sleep after the event³. The researchers think the reason is that lying on your back late in pregnancy lets the womb press on the large vein and artery behind it, reducing blood flow to the baby³, though that's a proposed explanation, and no one has shown it's the cause. Even so, the NHS advises going to sleep on your side from twenty-eight weeks². For a finding like this, and an ask this small, going to sleep on either side from then on seems well worth it.

If you're earlier in pregnancy, the side-sleeping advice begins at twenty-eight weeks², so until then the way you fall asleep isn't something you need to watch. A US study of first-time mothers agrees. The women described how they went to sleep before anyone knew how their pregnancy would end, and going to sleep on the back or the right side up to thirty weeks wasn't linked to stillbirth, a small baby or high blood pressure¹³13 Silver et al., 2019. Its stillbirths were few, and it couldn't speak to the last two months¹³.

Snoring often starts or grows in pregnancy, reaching up to a third of women by the third trimester¹⁰10 Miller et al., 2020, and the swelling of the nose and airway that comes with pregnancy¹⁰ is part of why.

Breathing problems in sleep become more common through pregnancy, and observational studies have linked them with high blood pressure and diabetes in pregnancy¹⁴14 Pamidi & Kimoff, 2018. If your snoring is heavy, and especially if your partner or anyone else in the room hears you pause in your breathing or gasp, or you wake yourself with a gasp, that's worth telling your midwife or doctor. Snoring on its own can't show whether your breathing is being disturbed in sleep¹⁴, and they can help you find out. Whether treatment changes how pregnancies go isn't yet known¹⁴. Do I have sleep apnea? explains what a test involves.

The thoughts that come at 3am in pregnancy are about real things, the birth, money, whether the baby is well, and at that hour each one looks bigger than it will over breakfast. Strange dreams and nightmares about the baby, labor and birth are normal in pregnancy, and talking them over with a partner or midwife, along with relaxation and breathing, can help with the anxiety²2 NHS, 2026n. What can I do when worry keeps me awake? has some ways to try.

If the bad nights have turned into insomniainsomnia Trouble falling asleep, staying asleep or waking too early, that keeps happening and affects how you feel or get on during the day. that's gone on for weeks, there's a treatment without drugs that has been tested in pregnant women, and specialists in sleep and pregnancy put approaches like it first¹⁰10 Miller et al., 2020. In one US trial, pregnant women with insomnia had either CBT for insomniaCBT for insomnia Cognitive behavioral therapy for insomnia: a short course of practical, talking-based techniques that help retrain sleep. It’s the first treatment doctors recommend for long-term insomnia. or another therapy built on imagery, and nearly two in three of those who had CBT reached remission, a little more than with the comparison, and they got there sooner¹⁵15 Manber et al., 2019. Why only a little more? The comparison was a real therapy too, and the women who had it improved as well, so CBT was measured against something that helped. A second trial set a digital version against usual care, and twice as many women reached remission with it¹⁶16 Felder et al., 2020. With two trials pointing the same way, CBT seems well worth asking about if your insomnia has lasted weeks. In the first trial, the women who had CBT got there in a median of about a month¹⁵, and you could start by raising it with your midwife, or with What is CBT for insomnia, and what would it ask of me?

It is, and most pregnant women do: in one large survey, seventy-eight in every hundred napped⁴4 Mindell et al., 2015b. The NHS advises resting as much as you can in early pregnancy, and sitting with your feet up in the day²2 NHS, 2026n. It does suggest skipping afternoon or evening naps if they make it harder to fall asleep at bedtime², so it's worth noticing whether a late nap does that to you, and keeping the ones that don't. People may tell you to get your sleep now, before the baby comes. When you are already trying every night, that can sound like a reproach, so it may help to think of any rest you find as being for the day you're in.

Maybe you've been eyeing the box of sleep aids in the drawer, or a bottle of melatoninmelatonin A hormone your brain releases as darkness falls, telling the rest of your body that night has come. It's also sold as a tablet., and wondering whether you may. Some people reach for a drink instead¹⁰10 Miller et al., 2020, and that one has a plain answer: in pregnancy it's safest not to drink at all⁵5 NHS, 2026k. For the rest, the research is thin, and pregnant women and specialists alike tend to prefer starting without drugs¹⁰.

If the box says diphenhydramine, it's a sleep-aid antihistamineantihistamine A medicine that blocks histamine, a chemical that helps keep you awake. Some older ones make you drowsy and are sold as nighttime sleep aids.. Many women take it in pregnancy, though few studies confirm it's safe¹⁰, and some reports link taking it in the first trimester with birth differences¹⁰. That's why it's one to ask your midwife or doctor about before you take it. An antihistamine your doctor prescribes for sickness is a different matter: that's a separate, supervised use⁷¹⁰7 NHS, 2026m.

Melatonin has had little research in pregnancy, and nobody yet knows whether it helps insomnia there¹⁰¹⁷17 NCCIH, 2024. What researchers have seen, mostly in animals, suggests it crosses the placenta, which raises a theoretical concern for the baby's developing body clock¹⁰¹⁷. With that still open, it's worth a word with your midwife or doctor first. Valerian and chamomile sound harmless, yet little is known about whether they're safe in pregnancy, and herbs can interact with medicines¹⁸¹⁹18 NCCIH, 202519 NCCIH, 2024b, so they belong in that conversation too, especially if you take anything else.

Specialists treat prescription sleeping pills as a decision for you and your doctor to make together¹⁰. For zolpidem, one large study found more babies born small or early, though no more birth differences¹⁰, and a newborn can have withdrawal from many drugs taken late in pregnancy¹⁰. Still, specialists say some medicines may be justified when treatment without drugs hasn't worked¹⁰, because an untreated condition can be riskier for you and the baby than a medicine is¹⁰. If you already take a prescribed medicine for sleep or mood, please don't stop it suddenly without talking to your doctor first, as stopping without advice isn't recommended¹⁰²⁰20 National Institute of Mental Health, 2023.

The sleeplessness itself is something you can bring to your midwife as a problem in its own right, and the CBT from the section above is still there to try.

From your side of the bed, it can seem as though she barely sleeps at all. She gets up in the dark, comes back, and turns over slowly with the bump, a pillow at a time. What you're watching is the bladder, the heartburn and the sheer size from the sections above, each taking its turn. You could take over the evening tasks so dinner comes earlier and she can sit up afterward. You could help build the wall of pillows at bedtime, and when she wakes from a strange dream, talk it through together²2 NHS, 2026n.

You may also see something before she does. Partners and family may be the first to notice signs of depression, and can help by encouraging a talk with a health professional²⁰20 National Institute of Mental Health, 2023. And if you hear her snoring heavily with pauses or gasps, you could tell her, so she can mention it to her midwife.

So when you lie down again tonight, you could pick whichever side your hip prefers, with the pillows where you want them. That's the whole of what the position research asks. If you wake later on your back, you can turn onto your side and go back to sleep.