Sleep Guide For Pregnancy: Challenges and Solutions

Our trimester-by-trimester sleep guide will help you get the rest you need now.


Maybe you think sleep deprivation won't be an issue until after your baby is born. Hah! Depending on how pregnant you are, everything from "morning" sickness to scary dreams to restless leg can take their toll on your nightly shut-eye. Our trimester-by-trimester guide will help you sleep better during pregnancy and even in the the "fourth trimester," when you'll face a brand-new sleep challenge: your baby!

First Trimester: Drowsy All the Time

"Most women don't know what's in store for them [in terms of sleep] during pregnancy," says Kathryn A. Lee, R.N., Ph.D., a professor of nursing at the University of California, San Francisco, who researches the topic. "Women who've had kids know how low-energy they're going to feel during pregnancy and plan for that by sleeping more." Lethargy and overwhelming fatigue are common due to the dramatic rise in progesterone; necessary for maintaining pregnancy, the hormone is also a soporific. Another culprit: the metabolic changes your body is going through. "A lot of calories are going into the gestation process," explains Lee. "The growing fetus is taking every bit of your energy."

First Trimester Sleep Challenges:

Increased Bathroom Visits- Your high progesterone level, along with a growing uterus that's pushing against the bladder, means more frequent urination.

Body Aches- Swollen breasts and pelvic cramping can make it harder to fall and stay asleep.

Nausea- "Morning" sickness can and often does strike during the evening and wee hours of the night.

First Trimester Sleep Solutions:

Schedule Sleep- Plan your snooze time just like you do your meals or your day at the office, and nap as often as possible. "It's best to nap between 2 p.m. and 4 p.m.; otherwise you'll have trouble falling asleep at night," advises Teresa Ann Hoffman, M.D., an OB-GYN at Mercy Medical Center in Baltimore. "And take one or even two 30-minute catnaps rather than one long, two-hour sleep." Nap on the floor of your office or in your car if you need to.

Cut Down On Fluids After 6 p.m.- This will help curtail nocturnal bathroom runs. "If you drink caffeinated beverages, do so only in the morning," says Hoffman.

Stock Saltines On Your Nightstand- Crackers will quell midnight queasiness—and you won't have to trudge to the kitchen to get them.

Exercise Early- Physical activity in the morning, afternoon and early evening will promote sounder sleep. Late-evening workouts, however, tend to encourage insomnia.

Second Trimester: Burning Issues

"Women in their second trimester tend to sleep better," says sleep researcher Meena Khan, M.D., a professor at the Ohio State University Medical School in Columbus. (Your body undergoes its most dramatic metabolic changes in the first trimester.) Still, you might not be sleeping like a baby yet.

Second Trimester Sleep Challenges:

Heartburn- Queasiness usually subsides, but reflux, um, rises. "The growing uterus places pressure on the stomach, forcing acid up into the esophagus," explains Hoffman. Lying down in bed aggravates the burn.

Leg Cramps- Though worse in your third trimester, disquieting cramps (usually in the calf) that can startle you awake and keep you up in the wee hours begin now.

Vivid Dreams- "As the pregnancy progresses, some women get more anxious," says Hoffman. Stressing about the baby's growth, your parenting abilities, finances—or anything else—can produce some disturbing dreams, which will almost certainly interfere with your good night's rest. Forgetting the baby somewhere is a classic one.

Second Trimester Sleep Solutions:

Stay Upright For Four Hours After Eating- The digestive process takes a lot longer during pregnancy, and sitting up will help keep stomach acids where they belong. "Lying down and watching TV after dinner is not a good idea," Hoffman says. You may want to start eating bigger breakfasts and lighter dinners if heartburn is keeping you awake.

Avoid Heartburn-Inducing Foods- These include spicy, fried and acidic foods, including tomatoes, citrus fruits and juices and coffee.

Limit Or Avoid Carbonated Drinks- "A calcium imbalance can lead to leg cramps," Lee says. The phosphorous in bubbly beverages (including soda water) decreases the amount of calcium you're able to metabolize, so stay away from them. In addition, make sure you're getting enough calcium; good food sources include dairy products; dark-green, leafy vegetables; and canned salmon with bones.

Nip A Cramp In The Bud- If you do get a painful leg cramp, flex your foot (extend your heel and point your toes toward your head; do not point your toes).

Make Relaxation a Priority- Easier said than done, but a quieter mind will ensure a better night's sleep. Experts suggest meditation, prenatal yoga or other relaxation techniques; soaking in warm baths; eating tryptophan-rich foods such as turkey, milk and bananas (this amino acid turns into mood-soothing serotonin in the brain); enrolling in a parenting class now so that you feel better able to care for a newborn; and seeing a counselor if you're losing sleep due to anxiety-riddled dreams.

Third Trimester: Sleepus Interruptus

By the end of pregnancy, a large percentage of expectant women report waking up at least three times per night. Two-thirds are awakened five or more times. But it's vital to make sleep a priority now: Research has shown that pregnant women who average less than six hours of sleep a night have significantly longer labors and are 4.5 times more likely to have Cesarean sections than those who get seven hours or more nightly.

Third Trimester Challenges:

Back Pain- A Yale University study found that nearly 60 percent of pregnant women say that lower-back pain causes sleep disruptions.

Frequent Urination—Again- Just like in the first trimester, the urge to go at night increases, as your uterus grows larger and the baby drops lower in your pelvis.

Disordered Breathing- Vascular congestion in the nasal passages and abdominal weight gain can partially close your airways, leading to snoring. In 6 percent of women, snoring can progress to obstructive sleep apnea, a condition in which breathing stops for at least 10 seconds. This is more common in women who were overweight or obese prepregnancy and can be very serious: Sleep-disordered breathing is linked with an increased risk for preeclampsia and low-birth weight babies.

Restless Leg Syndrome (RLS)- About 20 percent of pregnant women experience the truly weird sensation of what feels like ants crawling inside their legs. Studies have shown that women who have lower levels of iron and folate are at higher risk for sleepless nights due to RLS.

Third Trimester Solutions:

Baby Your Back- Sleep on your left side; this will take stress off your lower back, help prevent snoring and increase circulation to your baby. Put pillows between your knees, behind your back and under your belly or use a pregnancy pillow. Stretch and do abdominal exercises frequently.

Cut Back On Liquids In The Evening- And don't drink for two hours before you go to bed. Whenever you urinate, lift your belly to allow your bladder to empty completely.

See a Certified Sleep Specalist- If snoring and apnea become severe, you'll need to have your airflow monitored. A CPAP (continuous positive airway pressure) machine may be prescribed to keep your airways open and ensure that you and your baby are getting enough oxygen. "It will also help you sleep through the night," adds Khan. Find a specialist at

Have A Pre-Bedtime Light Leg Massage And Warm Bath- Evening walks also help foil RLS.

Eat More Fortified Grains And Leafy Greens- "Eating foods rich in iron and folate can reduce the severity of restless leg syndrome," says sleep researcher Meena Khan. Avoid caffeine, too, because it inhibits absorption of iron and folate.

The "Fourth Trimester"

Sleep issues get turned on their head after your baby is born. Instead of the nightly disturbances and insomnia you experienced during pregnancy, you'll be so tired at the end of the day that you'll find it more difficult to stay awake! "I always warn women, 'Your baby is going to be awake every few hours, maybe even every hour,' " says Baltimore OB-GYN Teresa Ann Hoffman, M.D., who sees many pregnant women with sleep problems. Here are some tips for more—and better—slumber after delivery:

Sleep Close To Baby- Running down the hall in the wee hours to attend to your crying baby is much too arousing. So use a bedside bassinet that attaches to your own bed or put the baby's crib in your room.

Breastfeed- Prolactin, the hormone that promotes lactation, is also a soporific.

Sleep When Baby Sleeps- Don't do chores or return phone calls, texts or e-mails. Stay off Facebook.

Share Nightime Duty- If you're nursing, prepare bottles of pumped breast milk so your partner can feed the baby.