High-quality sleep during pregnancy is far easier said than done for a multitude of reasons, starting with hormonal changes. Progesterone, which is required to maintain pregnancy, also happens to promote daytime sleepiness and nighttime sleep fragmentation. (1) Oxytocin is also a factor in late pregnancy. Responsible for uterine contractions, this hormone peaks at night and also may contribute to sleep fragmentation. (1) Other factors impacting sleep during pregnancy include:

  • Nausea, heartburn, and back pain
  • Increased risk for sleep disorders such as Restless Leg Syndrome (RLS), (2) snoring, (3) and Obstructive Sleep Apnea (OSA) (4)
  • Pre-existing asthma, which can be exacerbated by physiologic changes during pregnancy (5)
  • Stress

Another consideration is changing sleep positions. After 20 weeks, pregnant women are told to begin sleeping on their left side (which is best because it allows for optimal blood flow from the inferior vena cava, which brings blood to the baby), explains Dana Bender, MS, NBC-HWC, one of Proper’s national board-certified coaches. However, having to adjust to a new position can be disruptive for many who are typically on team back or stomach.

Sleep struggles often differ based on what stage of pregnancy you’re in: (6)

  • First trimester
    The first trimester is marked by a significant need for sleep as the placenta grows…don’t be surprised by the urge to nap or go to bed earlier. ”I would feel my sleep drive kick in sometimes one to one and a half hours earlier than my normal bedtime,” explains Dana.

  • Second trimester
    The hours of sleep that some need normalizes during the second trimester—a “honeymoon phase before the third trimester comes,” explains Dana. But for others, this time can be marked by more frequent sleep disturbances.

  • Third trimester
    Late pregnancy is characterized by poor quality sleep due to more frequent urination needs, back pain from weight gain, congestion, baby kicks, and leg cramps. Indigestion from late meals is also a common culprit.

Although it’s impossible to completely rid yourself of the culprits of poor sleep during pregnancy, there are certain lifestyle changes, tips, dos, and don’ts that can help you get higher quality (and quantity) sleep at night.

​​Excitement or stress prior to bedtime causes an increase in the body’s sympathetic nervous system activation. When this occurs, the autonomic nervous system (ANS) releases stress hormones such as adrenaline and cortisol that circulate blood to vital organs and muscles.

Your heart rate increases, your breath quickens, your muscles tense, and beads of sweat form as your “fight or flight” response, which evolved as a survival mechanism to enable people to quickly react to life-threatening situations.

When this occurs before bedtime, it can run interference with sleep onset (the ability to fall asleep) and sleep maintenance (the ability to stay asleep) by interfering with melatonin and disrupting our sleep-wake cycle. That’s why a wind-down nighttime routine with less stimulating activities is so important for quality, restful sleep.

Taking a warm bath may be the first thing that comes to mind, but we’ve got six additional suggestions for activities to add to your evening, pre-bedtime routine >>

“Prior to expecting my first child, I had a regular exercise routine in the mornings,” explains Dana, “and would often wake up early to get things done. Since I experienced more fragmented sleep due to indigestion in my third trimester, I realized I needed to give myself permission to be more flexible with my morning routine while pregnant and allow for enough sleep time in the morning. I made sure my self-talk was adaptive and reframed any thoughts that might lead to feeling guilty, especially since I made sure to move and exercise later on in the day.”

It is recommended to eat more frequently during pregnancy with 5-6 smaller meals rather than three large meals. The goal? Help ease indigestion, which can impact sleep.

“Digestion is a lot slower in pregnancy due to progesterone, so eating 3-4 hours before bed becomes even more important,” explains Dana. “Otherwise, you might be waking up between 2-4am with bad heartburn.”

The quality of the food matters as well since high-carb, fried, and/or spicy foods will engage the digestive system to work on processing the meal (and increase the risk for indigestion), while sugary foods with a high glycemic index will cause a blood sugar spike.

Occasionally, even after eating early and prioritizing the right foods, indigestion can occur, in which case Dana recommends elevating your head as you sleep. “I prop myself up with a second pillow to help minimize some of the sleep problems from heartburn,” she explains. “Lying flat makes it worse even during the daytime!”

Learn more about the best and worst foods for your sleep >>

As mentioned above, pregnant women are advised to sleep on their left side to facilitate optimal blood flow after the 20-week mark. In order to make this an optimally comfortable sleeping position, some women turn to pregnancy pillows to help support the weight of the baby, especially in mid-late second and third trimester.

“I am a side sleeper, so I am using the Boppy Side Sleeper pillow,” says Dana. “I used to sleep on my right side more pre-pregnancy, but the left side started to feel more comfortable the further along I went. My body wisdom almost knew it needed to adjust! The pillow helps make sure I don’t roll onto my back, which isn’t good after you get to the second trimester.”

Ultimately, the choice of pillow is up to personal preference. Some women prefer a full-body pillow, which looks like a big U, while others opt for more support under the belly or low back/pelvis. There are also pillows that can sit comfortably between the legs.

Hydration is incredibly important during pregnancy for several reasons. For one, it’s needed to help the baby grow and help with the amniotic fluid/sac—the recommended amount is 8-10 glasses per day (7) and more if someone exercises daily. Hydration also has the added benefit of helping to reduce leg cramping, which can cause trouble sleeping. But it’s important not to drink too close to bedtime, otherwise it can add more frequent bathroom trips to your already more frequent bathroom trips.

That said, it’s important to remember that the increased weight gain of a growing belly in the third trimester typically increases the need to urinate versus water intake alone, meaning that even if someone has water earlier in the day, the pressure on the bladder (and less space in general) might still trigger awakenings.

“I do wake up to use the restroom during my third trimester,” explains Dana, “but most of my pregnancy I drank water earlier in the day (ensuring I had enough) and did not feel like my sleep got disrupted.”

When middle-of-the-night sleep disruptions do happen, Dana recommends avoiding clock watching and bright lights, which can indicate wakefulness by triggering the light receptors in the eyes.

Deep breathing and meditation are great relaxation techniques to incorporate in an evening wind-down routine; however, there are some breathing exercises that pregnant women should avoid. Below, Dana—who is also an experienced, registered yoga teacher, explains more.

“You should avoid internal and external breath retention (holding breath in after an inhale and/or holding breath out after an exhale). Also, you should avoid active breathing like Kapalabhati and breathing that requires a deep abdominal scoop like pranayama (Nauli Kriya).

Instead, it’s best to focus on deep breathing and meditation/mindfulness exercises (#6 on this list of the best breathing exercises for better sleep).

Studies on the impact of exercise on sleep for the general population are promising. They have shown (8) that it reduces sleep latency (amount of time it takes to fall asleep) and increases the quantity of slow-wave sleep (SWS), also known as deep sleep.

In addition to promoting sleep quality and quantity, movement and regular exercise can minimize swelling and inflammation that occurs in the third trimester as the due date approaches—and also help with labor and delivery. (9-10)

Read more about the best time to exercise for quality sleep >>

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