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Sleep And Pregnancy


How Does Pregnancy Affect Sleep?


Pregnancy is very demanding for any woman and is a time of great sleep disruption. Many factors contribute to this: hormone changes, the growing fetus, bodily discomfort (vomiting, heartburn, cramp, pressure on the bladder), mood changes, and anxiety related to delivery. The postnatal (post-birth) period comes with interrupted sleep pattern in the period when the new baby’s demands take precedence. Some women develop sleep disorders, such as restless legs syndrome and sleep apnea, for the first time.



Do Women Snore More During Pregnancy?


About 30 percent of women will snore during pregnancy, 15-20 percent of them the first time. If this is severe enough, it may be associated with higher blood pressure during pregnancy, and 10 percent of pregnant snorers develop pre-eclampsia (high blood pressure, fluid retention, and protein in urine during pregnancy). Significant snoring during pregnancy should be assessed by a doctor.



Can Women Develop Sleep Apnea During Pregnancy?


Obese women who are pregnant and women who gains excessive weight while pregnant are at a high risk of developing sleep apnea. A drop in blood oxygen levels at night is associated with potential complication for the baby. It is important that any overweight woman or woman who gains a lot of weight during pregnancy should be assessed by a a doctor evidence of sleep apnea.



Do Women Experience Restless Leg Syndrome (RLS) During pregnancy?


The other major sleep disorder that can occur during pregnancy is restless legs syndrome (RLS) and leg cramp. About 15-25 percent of women develop RLS during pregnancy in association with iron deficiency, and women with low folate levels are also at risk. Although RLS will resolve after delivery, it is an additional stressor during pregnancy and can disrupt sleep, so make sure that you have adequate iron and vitamin B12 levels in your blood before and during pregnancy.



How Does Sleep Change After Delivery?


About 35-80 percent of women experience “baby blue” 3 to 5 days after delivery. The blues generally don’t last longer that about 2 weeks, but 20 percent of women develop postnatal depression. Postnatal depression can occur any time within 6 months of delivery and like any mood disorder, it can result in severe sleep disruption.




Sleep Patterns During Pregnancy


Sleep patterns change throughout pregnancy, largely as a result of the enormous physical changes that take place as the fetus grows, but also partly due to hormonal changes that occur.


Sleep During The First Trimester

Sleep_And_PregnancyThe first trimester is the period from conception to 3 months. During this time, there are high levels of progesterone in body, which have a sleep-inducing and sedating effect on the brain.


Progesterone also increases the need to urine due to the effect it has on the smooth muscle in the bladder. Women often experience more sleep difficulty during the night due to an increased need to go to the bathroom.


Many women often experience daytime sleepiness and fatigue during this time. Nausea and vomiting is not just limited to “morning sickness” but can also occur in the evening. There is a greater tendency to sleep longer than prior to pregnancy, but there is less slow wave sleep during this time.



Sleep During The Second Trimester

Sleep_And_PregnancyThe second trimester of pregnancy is the period from the fourth to the sixth month. Progesterone levels continue to rise during this period but more slowly.


Many women experience a great improvement in their sleep quality and quantity during this period and report more daytime energy.


The growing fetus moves above the bladder and the need to urinate decreases. However, many women start to snore at this stage, probably because of the effects of oestrogen on blood vessels, resulting in nasal congestion. During this time, there is an increased risk of developing sleep apnea and also high blood pressure, so you must be carefully monitored by your doctor. There is less slow wave sleep than prior to pregnancy and more time is spent awake during the night.



Sleep During The Third Trimester

Sleep_And_PregnancyThe third trimester is the period from the seventh to the ninth month. Progesterone levels are at their peak during this time. Omen report the most sleep difficulties during this stage of pregnancy.


Sleep disturbances are very common and are caused by a wide variety of factors including leg cramps, heartburn, nasal congestion, and an increased need to urinate. The baby’s movements can also disturb sleep. The baby’s movements can also disturb sleep. In the last few weeks of pregnancy, many women find achieving a comfortable sleeping position difficult.


This can lead to increased daytime fatigue and sleepiness. Breast tenderness, shortness of breath, and irregular uterine contractions can also affect sleep adversely. Overall, more time is spent awake and there is less slow wave sleep.



Improving Sleep During Pregnancy




Ensure a high intake of folate, iron, and vitamin B12 before during pregnancy.


Exercise regularly and control weight.


Keep fluid intake high, but try and cut down before bedtime to ease the stress on your bladder.


If the heartburn is a problem, sleep with the head of your bed elevated, or use a few pillows.


Eating small meals during the day and avoiding spicy or fried meals may reduce reflex and help with nausea, especially during the first trimester.


Schedule naps during the day, to help with daytime fatigue and tiredness.


As your pregnancy progresses, adjust your bedding accordingly. Special pregnancy pillows and support pillows may make sleeping more comfortable.


In the third trimester, try and sleep on your left side (rather than your back to allow for improved blood flow to the fetus, uterus, and kidneys.



Early Stage of Motherhood


Sleep_And_PregnancyWhat sorts of sleep disruption occur after pregnancy?


Unsurprisingly, women experience more awakenings at night after delivery (for feeding of the baby), although this tends to settle after the first month. Many mothers find daytime naps are a good way to compensate for this disruption in sleep during the night. For first time mothers, the first 3-6 weeks after delivery are very tiring and fatigue levels remain high for 3 months (higher than prior to pregnancy). There is a high proportion of slow wave sleep after pregnancy related largely to the production of the hormone prolactin responsible for “letting down milk”.



How Can I Ensure I have Enough Sleep In The Early Stages of Looking After My Baby?


Initially, it will be difficult for you to have unbroken sleep during the night. But the good news is that once your baby has regular sleep wake pattern (by about 6 months) things will start to return to normal. To combat fatigue, make sure you eat well. Iron levels are low after pregnancy and this can make you feel more tired. Scheduling a nap when the baby is napping during the day helps, as does having a partner or family member who can assist with household chores.



Should I Worry if I’m Not Getting Enough Sleep?


Don’t be hard on yourself – pregnancy and the first 6 months with a new baby is extremely demanding physically and emotionally, and just getting through the day is an achievement in itself. If you feel your “baby blues” are not lifting or if feel depressed, seek professional advice. Depression can negatively affect infant mother bonding besides your own state of well being.


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Department of Neurology. Helsinki, Finland