Sleep in your most comfortable position
Pregnant women should sleep in the position that they find most comfortable. Pregnancy complications are unlikely to be due to their sleeping position and they should not feel guilty something happened because of their sleeping position.
It is generally difficult to force yourself to sleep in a certain position when you are pregnant. The most recent study published by Silver et al in September 2019 in the journal Obstetrics & Gynecology showed that it's safe to sleep on your back in pregnancy. The authors conclude that: "... Going to sleep in the supine or right lateral position, as self-reported before the development of pregnancy outcome and objectively assessed through 30 weeks of gestation, was not associated with an increased risk of stillbirth, a small-for-gestational-age newborn, or gestational hypertensive disorders." and "..These data should provide reassurance to women regarding sleep position through 30 weeks of gestation."
Previously, pregnant women were advised to sleep on their side. However, this new study confirming the safety of any sleeping position was a better designed study than the one showing that sleeping on the left side (as compared to the back or right side) has been shown to decrease the risk of stillbirths according to a study from New Zealand that was published in 2011.
Though the American College of Obstetricians and Gynecologists, the professional organization of all Obstetricians and Gynecologists does not have a firm recommendation for the sleeping position of pregnant women, the new study confirms thge safety of sleeping on your back during pregnancy.
In a chapter on difficulties of sleeping at night, ACOG suggests that women with sleeping problems should consider sleeping on their side …“ with a pillow under the abdomen and another between the legs”, but that suggestion applies to women with sleeping problems, not necessarily as a precaution to improve pregnancy outcome.
Sleeping during pregnancy is something that is easier said than done. As your pregnancy progresses, you are likely to get less and less sleep due to the baby growing and making things slightly uncomfortable. You will get the most sleep during the first trimester because your body will tire as it works to build the placenta to nourish and protect the baby.
What causes sleep problems?
Several things contribute to problems sleeping during pregnancy.
- You'll find yourself having to urinate more frequently than usual during the first and third trimesters, due to hormones, and the baby pressing on your bladder.
- You’ll also have an increased heart rate and shortness of breath as the pregnancy progresses.
- Leg and back cramps are likely to occur throughout the pregnancy as your body is constantly adjusting to your awkward changing body.
- Heartburn and constipation are also common pregnancy issues that are likely to interfere with your ability to sleep.
- Stress and strange dreams are likely to cause you to have problems sleeping too.
Tips to help you sleep
- Relax: Try not to get worked up about all the nerve-wracking things about pregnancy. While it is normal to become nervous over the labor and delivery, concentrating on these things too much will likely disturb your dreams, and thus your sleep.
- Find a comfortable position: This is most definitely easier said than done, and this position is likely to change throughout your pregnancy. Sleeping on your left side is usually the most comfortable and safest.
- Avoid drinking lots of fluid close to bedtime: This will decrease the likelihood of your bladder waking you up at night.
- Get in a habit of going to bed and waking up at the same time each day: This will get your body into a set schedule, and your biological clock will help regulate your sleeping and waking patterns.
- Cut out caffeine: This is a no-brainer. Soda and coffee are not good for you anyway, so being pregnant and ingesting these things is even worse for you.
- Exercise early in the day, and keep it away from bedtime. Exercising gives you a burst of endorphins, and thus energy. This means that your body will not be ready to relax and sleep for a few hours after you do your routine.
The advice against sleeping on the back has probably its origin from a condition called ‘supine hypotension syndrome’ which is experienced by some women occasionally during pregnancy. The ‘supine hypotension syndrome’ usually occurs in the last trimester of pregnancy, though it can also happen earlier in pregnancy or during post-partum. It is characterized by a feeling of dizziness and nausea in a woman lying on her back, occasionally forcing her to change position from the back to the side. In very rare exceptions, more likely on the operating room table and under anesthesia is it possible for the pregnant woman to lose consciousness.
The supine hypotension syndrome is also known as ‘vena cava syndrome’ because it is likely caused by the pressure of the enlarged uterus and the fetus on a large blood vessel, the inferior vena cava, which flows behind the uterus and through the liver towards the heart. This compression of the vein, in turn, can lead to less blood flowing back to the heart, and an eventual decrease in blood pressure (hypotension).
Compression of this big vein can occur when the woman lies directly on her back, but it can also be observed in other positions such as in the pelvic tilt or sitting positions. The low blood pressure usually improves when you move from your back to your side. Because anesthesia may worsen the condition, pregnant women on the operating table are usually placed for precaution slightly tilted on their side with a wedge under their back.
If you are having problems sleeping during your pregnancy, you are completely normal. Try some of these things to see how they help you, and eventually, you will be able to sleep. Remember that sleep is very important all the time, especially when you are pregnant. If you cannot get a good night’s sleep, talk to your doctor, and do not be afraid to take lots of naps. You are going to have lots of nights without sleep after the baby is born, so you should be resting as much as you can now.
- Balserak BI, Lee KA. Sleep and sleep disorders associated with pregnancy. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 156.