sleep and sleeping position during pregnancy

Why is sleep so important?

If there is one thing any new mother understands, it is the need for sleep. Sleep during pregnancy is essential to the health of both mom and baby. The body undergoes great strain during pregnancy and at least 8 hours of sleep a night helps the body to recover from the effects of the growth of the fetus and the mother's body on the immune system.

How does sleep change during pregnancy?

During the first few weeks of pregnancy, some women may experience nausea and vomiting that can affect the normal sleep pattern. Once this morning sickness is out of the way, the mother to will soon find that sleep is easier until the fetus begins to grow to the point where it is tangible through the abdomen.

After the fetus has begun to grow, mothers who are stomach sleepers will have to adjust the way they sleep every night. Sleeping on the stomach may not affect the baby in any way, but the discomfort of sleeping with a softball under your abdomen is often enough to change your sleeping position.

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.

Do pregnant women sleep a lot?

Pregnant women should sleep and get rest more. However, according to the National Sleep Foundation's poll, 4 in 5 women report more disturbed sleep during pregnancy than at other times, and many report feeling extremely fatigued during pregnancy, especially during the first and third trimesters. Considering the physical and emotional demands of pregnancy and the prevalence of sleep disorders among pregnant women, it’s no wonder that expectant mothers become so tired.

Why do pregnant women have more sleep issues?

One of the reasons for fatigue and sleep problems during pregnancy are changing hormone levels. In addition to the change in hormone levels, gaining normal weight and the increase in belly size can also negatively affect a woman's sleep pattern.

What happens to sleep in late pregnancy?

As the baby continues to grow in the womb, the mother may begin to experience some crowding of the organs located in the abdomen. Many of these organs, including the stomach, lungs, and kidneys will begin to feel the pressure of the fetus during sleep.

The stomach will most often be affected in the most latter months of the pregnancy as the baby positions itself head down. During this time of the gestation period, if the baby kicks at night during sleep, the feet can hit the stomach and force gastric liquid into the throat. This can cause shortness of breath and painful swallowing.

The lungs are also affected as the fetus grows. When a mother lies down for sleep during pregnancy, the lungs may feel pressured by the weight of the fetus. This pressure can also cause shortness of breath.

The kidneys are the most common organ affected by the growing fetus. The larger the fetus becomes the less room the kidneys have to enlarge with urine. This means the mother to be will have to make frequent trips to the bathroom which can affect sleep during pregnancy.

What is the best sleep position?

Most pregnant women receive unsolicited advice all the time about what to do and what not to do. Some of the advice may be correct and of sound background, and some may just be plain common sense that you should follow. Unfortunately, a lot of this advice is not based on sufficient scientific information but on incomplete knowledge and sometimes even on myths. A study has shown that the left side appears safer than the back or right side.

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. Specifically, there is no recommendation that pregnant women must sleep on their left side to improve pregnancy outcome. 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 a precaution to improve pregnancy outcome.

Sleep during pregnancy is often like a pot of gold that is diminishing. The later in the pregnancy the woman is, the less time she has to sleep through the night. Having a newborn can be even harder on the body than the gestational process, so getting the right amount of sleep during pregnancy is the best option for mom.

Sleep during pregnancy may feel just an arm’s reach away, but too far to touch. Insomnia during pregnancy is typical, but that does not mean that you are not frustrated with your new found inability to fall asleep or stay asleep.

What causes insomnia during pregnancy?

Like many other ills during pregnancy, hormones are partially to blame for insomnia during pregnancy, especially during the third trimester. However, hormones alone cause only some of the effect. Anxiety about being a new mom, leg cramps and increased urination are all common during pregnancy and can cause difficulty sleeping or insomnia.

Most women suffer from some sort of insomnia during pregnancy. Back and tummy sleepers soon find it difficult to fall asleep as the uterus grows and prevents them from finding the comfortable sleeping position they are used to. Other women find that heartburn becomes worse at night when they are lying down to sleep and therefore have more difficulty falling asleep.

How is insomnia treated during pregnancy?

There are a number of treatments for insomnia during pregnancy, and letting go of the stress in life is often all it takes to return to a normal sleeping pattern.

Treatments for insomnia during pregnancy are often chosen based on the cause of the interrupted sleep. For instance, problems with heartburn and indigestion can be treated by eating more slowly, increasing water intake, and choosing foods that are easy to digest.

If leg pain, headaches, or back pain are the primary cause, over-the-counter acetaminophen and warm compresses can help ease the pain enough to induce sleep.

It is best to look for the root cause of sleep disturbances and work on those problems to counteract insomnia tendencies while pregnant.

Pregnancy can affect a woman’s sleep patterns. Many women who sleep well at other times experience sleep disturbances during pregnancy. In a poll conducted in 1998, 78 percent of women reported more sleep disturbances during pregnancy than at other times. Many women experience fatigue at various stages of pregnancy, but especially during the first and third trimester.

In one study, researchers recruited 198 women between 6 and 20 weeks of gestation and asked them to complete a baseline sleep survey. The scientists then asked these same women to re-take the sleep survey while in the third trimester of pregnancy. Researchers found that, when compared to the baseline assessment, women slept about a half hour less each night, had a greater incidence of restless leg syndrome (RLS), and snored 5 percent more often in the third trimester. Overall poor sleep quality became more common as the women progressed through their pregnancies.

Poor sleep at night can cause sleepiness and fatigue during the day. More than half of women surveyed report a weekday nap while 60 percent of respondents report napping during the day on a weekend.

What are the causes of sleep disturbances during pregnancy?

Hormones play a large role in fatigue and sleep disturbances during pregnancy. The rise progesterone levels may be partly responsible for sleepiness during the day. Other hormonal changes may cause sleep apnea and multiple trips to the bathroom at night, resulting in a significant loss of restful sleep. Nausearestless leg syndrome (RLS)heartburn, and other discomforts associated with pregnancy can also interfere with sleep.

Pregnancy can be psychologically stressful and the mother-to-be may lie awake all night, worrying about labor, the health of her baby, or wondering how the baby might change her relationship with her partner. This is especially true of women expecting their first baby.

Sleep disturbances cause fatigue and daytime sleepiness but sleep disorders during pregnancy can have a negative effect on labor and delivery. One study shows women who sleep 6 hours or less each night during pregnancy had longer labors and were 4.5 times more likely to undergo a cesarean section.

Women should discuss both sleep quantity and sleep quality with their obstetricians as part of basic prenatal care. Doctors can make recommendations about increasing both the quality and quantity of sleep to make pregnancy safer and more enjoyable.

Our 12-step program helps you with sleep issues during pregnancy:

  1. Cut off caffeine. Caffeine is not recommended during pregnancy, but if you must have a cup or two of coffee or soda during your pregnancy, cut off these drinks at least 4 hours before bedtime. The stimulant, caffeine, can prevent the pregnant woman from falling asleep and having a good night's rest.
  2. Take a bath. A warm bath or warm showers are both very relaxing. Combine the warm water with some scented oil, like lavender, and the warm water will help the pregnant woman to fall asleep with ease. The best time to take a warm bath is right before bedtime.
  3. Drink chamomile tea. Chamomile tea is thought to relax the mind and body. Drinking a cup of chamomile tea may offer just enough calm to help ease into sleep at night.
  4. Use props. Propping up the legs, neck, and arms is a great way to keep aches and pains from setting in at night. With pregnancy weight gain and the inability to sleep on the tummy for tummy sleepers, aches and pains can take over by the middle of the night causing an uncomfortable night. Body pillows and extra pillows behind the back may help.
  5. Change bedding often. After a few days, the sheets on a bed can gather balls and a rough texture. Changing the sheets every day can make for a more comfortable sleep and a longer night's rest.
  6. Set up a routine. Following the same routine night after night will mentally help the pregnant woman to get more sleep. These routines allow the body to "know" when sleep time is coming and the internal clock will naturally turn off when the time is right.
  7. Skip the evening snack. Eating late at night will cause digestion and could harbor sleep patterns with dreams. Later in pregnancy, heartburn and indigestion can also cause breaks in the normal sleep rhythm.
  8. Skip the evening beverage. As the baby grows larger, the bladder will have less room to hold urine. Drinking that last cup of tea, water or juice before bed may mean a couple of nighttime trips to the bathroom.
  9. Take the TV out of the bedroom. The bedroom is supposed to be for sleep and sex only. Pregnant moms may want to watch some TV from the bed, but this can decrease the amount of sleep each night. If the pregnant woman falls asleep with the television on, the noise could hinder sleep patterns.
  10. Stop tossing and turning. If you are lying in bed and you cannot fall asleep, staying in bed is not the right idea. Instead, get up and read a book or listen to some calming music and try to fall asleep again later.
  11. Add in some exercise. Exercise, when completed early in the day on a regular basis, improves the ability to fall asleep and the quality of sleep. Make sure all exercise activities are approved by the obstetrician.
  12. Close the curtains. A dark bedroom is a comfortable bedroom. At night, make sure to close the curtains and sleep in a very dark room. This will help the pregnant women to fall asleep faster and stay asleep longer.

The September 2013 issue of the journal Psychosomatic Medicine features the results of a study examining how the quality of a woman’s sleep during pregnancy affects delivery and the child she carries. The research team, led by Michele L. Okun, Ph.D., an assistant professor of psychiatry at the University of Pittsburgh School of Medicine, discovered that sleep disturbances, especially in the first trimester, often lead to issues during delivery, including premature birth and low birth weight babies. The findings of the research team suggest sleep is as important to the mother-to-be as it is to her baby.

The Okun research team analyzed previously collected data from 168 pregnant women who participated in a study of antidepressant use and pregnancy, examining the outcomes of women who took antidepressants during pregnancy and those who did not. The research team found sleep disturbances produced similar outcomes regardless of antidepressant use.

Too little or poor sleep quality causes the body’s cytokine levels to spike. A cytokine is a protein required for a healthy immune system but too much of it causes the immune system to fight back, attacking healthy tissue and muscles. It’s this overactivity of the immune system that can lead to complications with pregnancy and childbirth.

If insomnia is keeping you awake, try these steps for better sleep during pregnancy:

  • Cozy up to a pregnancy pillow. Old familiar sleep positions may not work so well as the body changes but a pregnancy pillow can help support the back and belly as the pregnancy progresses.
  • Lull yourself to sleep. If you find yourself still tossing and turning after about 20 minutes, find something boring to read or download a free relaxation podcast and let the sounds of a soothing voice lull you into slumber.
  • Leave the bedroom. Don’t fight sleep in your bed. Bore yourself to sleep in another room and crawl back in bed when drowsiness sets in. Doing so will help your mind associate the bed with sleeping only.
  • Keep lights low. Bright lights are energizing so keep lights low while indulging in boring, late-night activities meant to lull you to sleep.
  • Indulge in Naps. Sleep experts recommend sleeping seven to nine hours each night to allow the body plenty of downtime for mental and physical restoration but sometimes sleep just doesn’t happen that way. If that’s the case, try to get about 90 minutes of sleep during a daytime nap. Anything shorter will interrupt the REM sleep cycle, diminishing the value of the nap.
  • Nap early. Schedule a nap so that you wake before 4:00 PM, allowing plenty of awake time between nap and bedtime. If work schedules mean napping is impossible, schedule time to catch up on sleep during the weekend.

The body is never busier than it is during pregnancy, so it is important to make sure there’s plenty of time for the body to repair and rejuvenate itself on a daily basis. Sound sleep and frequent naps will increase your energy level and brighten your mood, especially when you know your baby benefits from your good night’s sleep as much as you do.

Source: Michele L. Okun et al. "Disturbed Sleep and Inflammatory
Cytokines in Depressed and Nondepressed Pregnant Women: An Exploratory
Analysis of Pregnancy Outcomes." Psychosomatic Medicine. 17 Jul 2013. Web. 16 Sept 2013.