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Insomnia and Pregnancy: What You Need To Know

This comprehensive guide will take you through all you need to know about experiencing insomnia in pregnancy, and of course, how to tackle it!

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What is insomnia?

Insomnia is the most common sleep disorder, with as many as 35% of adults experiencing its effects. Insomnia can cause problems with falling asleep at the beginning of the night, known as onset insomnia. It can also cause issues staying asleep, meaning you may wake up frequently during the night and find it difficult to get back to sleep: this is known as maintenance insomnia. You might suffer from both onset and maintenance insomnia.

As well as night time symptoms, the disturbed sleep can cause daytime symptoms. This is because sleep is vital for our mind and body to function correctly. Even though we’re resting, there are actually a lot of vital processes going on while we’re sleeping. Therefore, insomnia can result in problems with daytime functioning including fatigue, cognitive problems, and increased risk of physical health issues.

Symptoms and the severity of insomnia can vary depending on the person, and of course, what they do to tackle their sleep issues. For some people, their insomnia might be acute, meaning lasting only a few weeks. For others, their insomnia may be classed as chronic, meaning it continues for over three months and is a long term problem.

What causes insomnia in pregnancy?

Insomnia is a common problem in pregnancy, with over 75% of pregnant women being affected. This can occur even if you’ve never struggled with insomnia in the past and you usually sleep well. Let’s take a look at why it’s so common.

Frequent nighttime disturbance

There’s a good chance that if you’re pregnant, you are being woken up in the night far more often. Whether it’s because you need to urinate more frequently or due to morning sickness, there are many reasons your sleep might be disturbed. Later in pregnancy you might find that twinges of pain in your back or sides, or the baby moving during the night, could be enough to startle you out of sleep.

Hormonal changes

During pregnancy, there are many significant changes in the hormones coursing through your body. These hormonal changes can lead to the other symptoms we’ll discuss which make it difficult to sleep as your body prepares for the baby. However, did you know that the hormonal changes themselves actually change the pattern of your sleep?

Our sleep moves in cycles, shifting between a number of stages within two types of sleep: rapid eye movement (REM) and non-rapid eye movement (NREM). All of these stages of sleep are vital, so when our sleep pattern is disturbed, it can reduce the quality of our slumber. Increased amounts of the hormones progesterone and estrogen during pregnancy change our pattern of sleep, resulting in less REM sleep. So while these hormones might make us feel more tired and in theory help us to sleep, they also change our sleep patterns which can result in reduced quality of sleep overall.

Discomfort

General discomfort can make it difficult to drift off to sleep, as well as making it more likely you might wake up during the night. It can be difficult to get comfortable as your bump gets bigger, especially as you’re encouraged to lie on your side (we’ll discuss this more later) which might not be your natural sleeping position.

Other factors which can cause discomfort at night can include back pain; abdominal pain; round ligament pain (pain in the sides of your lower stomach caused by your expanding womb); leg cramps; and restless leg syndrome (RLS). RLS is more common in pregnancy, causing an uncomfortable feeling in your legs and the uncontrollable urge to keep moving them.

Trapped gas and other digestive changes such as constipation can be very uncomfortable, and this can often make it difficult to get to sleep at night. Your breasts can often become very tender and uncomfortable, as well as larger, which can make it hard to get comfortable.

It’s also common to experience congestion in pregnancy. This article explains that during pregnancy you have, “more blood circulating during pregnancy, which can make the tiny blood vessels inside your nose swell and lead to nasal congestion.” This can cause a runny nose, as well as snoring during the night which may disturb you and your bed partner.

Heartburn

Heartburn is a common complaint in pregnancy. The NHS explains that this is due to, “hormonal changes and the growing baby pressing against your stomach.” You might also hear heartburn referred to as ingestion or acid reflux.

Heartburn can cause a burning sensation or pain in your chest, along with bloating and a feeling of being full. It can also cause nausea, sickness, and excess burping. These symptoms can all be very uncomfortable. Unfortunately, when you lie down it often makes the feeling of heartburn worse, so it can make it very difficult to get comfortable enough to sleep at night.

Increased stress

Being pregnant naturally brings with it a lot of changes and extra responsibilities. It’s completely normal to feel worried about how you are going to cope with the birth and with handling a new baby. It’s a big deal and although it’s usually filled with joy, it can also feel overwhelming.

This building anxiety and the high stress levels can make it very difficult to unwind and relax enough to get to sleep at night. When you’re stressed, you’re also on high alert which can make you more likely to wake up during the night in reaction to external noises.

Vivid dreams

The hormonal changes, changes in sleep rhythms, and the anxiety we mentioned can lead to pregnant women having much more vivid dreams. The National Sleep Foundation explains: “Dreams can become more intense and vivid, and some women experience an increase in nightmares and dreams that involve anxiety.” You’re also more likely to remember your dreams. Often these dreams will revolve around fears in relation to giving birth and the changes having a new baby will bring.

These vivid dreams can result in a general sense of restlessness or unease during sleep, which can disturb the quality of your sleep. If your dreams are particularly distressing, you might find that they wake you up. Some people also start to worry about going to sleep if their dreams are very upsetting. This anxiety around sleep can contribute to insomnia.

Coping with pregnancy fatigue during the day

Fatigue during pregnancy is very common, both as a result of the sleep issues we’ve discussed, as well as because of the extra demands being placed on your body. In fact, being pregnant can be frankly exhausting! Yet you still need to function. The question is, how can you cope with pregnancy fatigue during the day? Let’s get some answers.

Take breaks

Try to take more breaks than you usually would. Allow yourself to rest and give your body a break, even if it’s only for a few moments at a time. If you can, put your feet up and relax. You could even practice some relaxation exercises, such as deep breathing, to help yourself really unwind.

Take naps if you need them

While you might not usually nap, it’s time to take a nap during the day if you feel you need it. Your body is doing much more than it usually does and you’re missing out on the sleep quality you usually get. Taking a nap can help you to re-energize and catch up on sleep you’ve missed. Whether it’s after work, or during work depending on your job, make time for a quick nap or even two!

Eat regular meals

It can be hard to keep up with regular meals if you’re experiencing nausea, heartburn, and a whole host of other symptoms. However, it’s important to try and eat regularly to keep your energy levels up. It’s like giving your body the fuel it needs to keep functioning.

Have healthy snacks

If you feel your energy levels dropping, having a healthy snack can be a great way to perk yourself up and keep your blood sugar at a steady level. Ensure you choose healthy snacks rather than junk food, even though it’s tempting! While sugary snacks will boost your energy in the short term, they cause a ‘sugar crash’ before long, leaving you feel even more depleted than before.

Stay hydrated

Dehydration can worsen fatigue, so ensure you are drinking plenty to combat fatigue. Of course, ensuring you’re hydrated becomes even more vital during pregnancy. You should be drinking around 2.3 litres of fluid each day. Your body needs all of this liquid for many vital functions to keep your baby healthy.

Keep moving

Even though it can feel the absolute last thing you want to do, especially when the fatigue is hitting hard, keeping active can really help to boost your energy levels. When you have time during the day, even a short walk around the room can be helpful in waking you up a little bit.

Talk to your workplace

If you feel comfortable with the idea and you’re ready to disclose your pregnancy, talk to your workplace about your pregnancy fatigue. They should do a risk assessment to figure out what they can do to help make you more comfortable at work and to keep you safe during your pregnancy. It’s important you know that you have a right to a safe working environment for you and your baby.

Ask for help

Even if you’re usually a very independent person, try not to take on too much during pregnancy. If ever there is a time to ask for help, it’s right now! Ask loved ones for assistance around the house and with practical tasks. Prioritize rest above housework where you can. If someone offers help, say yes!

Dress for comfort

If you’re feeling increasingly uncomfortable as you get further along in your pregnancy, dress for comfort. Wear what makes you feel at ease, such as loose fitting clothes and things which keep you cool, especially in warm environments. Comfort is key.

Refresh yourself

If you find yourself drifting off or ‘zoning out’ during the day and you really need to stay awake, you can refresh yourself a bit by splashing cold water on your face, using a face wipe, or using a refreshing facial spray.

Be kind to yourself

Perhaps most importantly, be kind to yourself. It doesn’t matter if you can’t keep up with everything you were doing before you got pregnant. Your body is going through one of the biggest changes possible. You’re already working so hard to create a true miracle: that is why you’re so fatigued! So don’t be hard on yourself. Instead, remember how much you and your body are doing, and be kind and gentle with yourself.

Getting comfortable in bed

One of the best ways you can tackle insomnia in pregnancy is to try and get as comfortable as possible in bed. The more comfortable you are, the more likely you are to drift off to sleep.

Reducing heartburn

As we’ve mentioned, heartburn can be very uncomfortable and can keep you awake. Thankfully, there are a few ways you can reduce heartburn, especially at bedtime. Eating slowly at mealtimes and sitting upright for around an hour after eating can be helpful. It can also be useful to try not to eat in the hour before you to bed, to reduce the risk of heartburn.

You might start to see a pattern in foods or drinks which really aggravate your heartburn. Once you have identified these, avoiding them especially as it gets closer to bedtime can be helpful. Wearing loose, comfortable clothes to bed can also ease symptoms and increase general comfort.

Eating a yogurt or drinking a glass of milk can help to calm the symptoms of heartburn. You might also be able to take over the counter medication for heartburn. Remember it’s always a good idea to check with your doctor or midwife first, to ensure these medications are safe for you and your baby.

When you’re actually in bed, raising your lower body up can be helpful. One of the simplest ways to do this is by simply using pillows to raise yourself up. Research suggests that lying on your left side can help to ease heartburn during the night.

Consider bedroom temperature

If your bedroom is too hot or too cold, it’s likely that you will struggle to get to sleep. Try using fans, opening the window slightly, or using lighter blankets if you are consistently feeling too hot. If you’re cold, try simple things like adding more blankets, wearing something warmer to bed, and putting your heating on.

Block out noise

The last thing you need when you do get to sleep is to be startled awake by external noises. If you’re napping during the day or go to bed before others in the household, talk to them about how important it is for you to get restful sleep. This way they can reduce the amount of noise they are making to ensure you get the sleep you need.

Other practical ways you can reduce external noise include wearing ear plugs or putting on a sound machine. Often steady noises, such as white noise, can mask other harsher noises in the environment and make it easier for you to sleep.

Keep things dark

Our circadian rhythm, which is like our body clock, regulates when we’re awake and when we’re asleep. One of the most important cues it uses is light. Therefore, it’s really important that you keep your bedroom dark to encourage sleep. You could use blackout curtains or wear an eye mask to ensure things are nice and dark.

It’s also worth thinking about using a dimmed light or nightlight if you need to get up to go to the bathroom at night. Turning a harsh bright light can make it so much more difficult to go back to sleep. A softer light can prevent you from fully waking up and make the transition back to bed easier.

Make your bed comfortable

Having a comfortable, supportive bed can significantly improve sleep quality. Ensure that your bed and mattress are good quality. If not and your resources allow, you could invest in a new one. However, if this isn’t practical for you, a mattress topper can be a great alternative. You can even add more blankets and pillows to your bed to increase your sense of comfort.

Wear a sleep bra

We mentioned breast tenderness earlier: this can make it harder to get comfortable at night. Some women may feel more comfortable without a bra at night. However, others may find a sleep bra increases their comfort and decreases tenderness. A sleep bra is a comfortable, wide strapped bra which provides some support while you’re in bed.

Sleep on your left side

During pregnancy, in particular the later stages, it’s important that you sleep on your side. This can be your right or left side, although your left side is preferable. This increases blood flow to your baby and takes the pressure off your liver and kidneys. This 2020 article on the topic explains: “Positioning yourself on the left side of your body allows for optimal blood flow from the inferior vena cava (IVC), which is a large vein that runs parallel to your spine on the right side. It carries blood to your heart and, in turn, to your baby.”

However, research shows that as long as you’re on one side, either left or right, it’s safe for your baby. It’s important that you avoid lying on your back for long periods of time as this can increase the risk of pregnancy complications. If you wake up in the night and you’re on your back, there’s no need to panic: simply roll back over onto your side.

Lying on your side not only ensures that you and your baby are safe, but it also reduces some uncomfortable symptoms such as dizziness, heartburn, back pain, digestive issues, and hemorrhoids. However, if you’re not used to sleeping on your side it can feel a bit uncomfortable.

You can increase your comfort level and help yourself to stay on your side throughout the night by using pillows for support. You could put a pillow between your knees, behind your back, and underneath your growing bump. You can even buy pregnancy pillows which form a u-shape and are very supportive.

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Reducing worry about insomnia in pregnancy

It’s easy to get worried about not being able to sleep during pregnancy. The more tired you get, the more anxiety rises and it can be tough to get your emotions back under control. Often this wound up emotional state only makes insomnia worse. Let’s take a look at how you can reduce these concerns.

Know it won’t harm your baby

It’s natural to be concerned about your baby’s wellbeing but the most important thing to know, is that insomnia isn’t going to harm your baby! Any sounds, feelings, or physical symptoms you are feeling are very unlikely to affect your baby. Even when you’re wide awake, your baby can still sleep soundly safe inside your womb.

Focus on rest rather than sleep

The more you focus on not being able to sleep, the more stressed you’re likely to get, and the less likely you are to sleep. To help break this cycle, try to stop worrying about not being able to sleep. Instead, focus on relaxation. Take comfort in knowing that if you’re lying in bed and are relaxing, your body is still getting valuable rest. Often when you focus on rest as the goal, you’ll find that you drift off to sleep anyway.

Get up if you’re getting stressed

If you are unable to get to sleep, or you wake up during the night and can’t get back to sleep, don’t panic. If you find you’re getting increasingly restless and frustrated, get up and go into another room. It’s often best to get up after around 20 to 30 minutes, unless you’re feeling very relaxed.

Try to keep the lights dim and the environment relaxed. Rather than doing something stimulating like turning the TV on, try to do something relaxing like reading a book, listening to an audio book, or listening to calming music. When you start to feel tired again, you can head back to bed and see if you can drift off.

Get things off your chest

When we have a lot on our mind and are worrying, it can be difficult to calm our thoughts enough to sleep. If you find that you have recurring worries about pregnancy, birth, your baby, or any other topic that’s on your mind, get them off your chest. Set aside a time during the day to talk to your partner or a trusted loved one about how you are feeling. Sometimes just sharing your worries can be enough to ease them and stop them from playing repeatedly in your mind.

Talk to your doctor if you’re concerned

If you are really worried about your insomnia or you feel as though something just isn’t right, talk to your doctor or midwife. Remember that no question is a stupid question. It’s natural to want to keep your baby as safe as possible and to be a little bit nervous. That’s what the professionals are there for you, so don’t be afraid to reach out.

Sleep hygiene

Sleep hygiene refers to positive habits which can help you to get the rest you need. Often sleep hygiene will be suggested as the first way to try and tackle insomnia. Although some of these things sound simple, they truly can make a big difference.

Implement a bedtime routine

Creating a bedtime routine is really important as it helps your mind to get accustomed to when you are going to be sleeping and when you’re awake. Once you have established a regular routine, your mind and body will start to feel tired as you give the signs that you are heading to bed.

A great first step to establishing a routine is trying to go to bed and get up at around the same time each morning and night. Of course, this can be difficult when you’re struggling with insomnia, but it’s something you can aim for when possible. Try not to worry too much if it varies now and then.

Another wonderful step you can take is making time to wind down before bed. This could involve taking a warm bath (but not hot as this is harmful for baby); reading a book; pampering yourself; listening to calming music; or drinking a nice warm drink. This helps you to release stress and relax, as well as giving your mind definite signals that you are getting ready for bed.

It’s important to try and avoid watching TV or using your phone during the time before bed, as this can actually make you feel more awake. You should also try to avoid stressful conversations or planning for the next day. Instead, focus on really letting yourself unwind.

Keep your bedroom for relaxation

It’s helpful if your mind makes a strong association between your bedroom and relaxation or sleep. This will help to shift you automatically into a relaxed mindset when you head to bed, preparing you to sleep. To do this it’s important that you keep your bedroom for relaxation, sleep, and sex only.

This means that you shouldn’t do stimulating activities in the bedroom, such as working, watching TV, using your computer, or listening to loud upbeat music. While this sanctuary of relaxation probably won’t be practical once your baby is here (sleepless nights are coming for a different reason), during pregnancy it can make a big difference to how easily you get to sleep.

Change drinking habits

We’ve already mentioned that it’s important you’re drinking plenty of fluids, but it’s a good idea to start reducing them in the few hours before you go to bed. While this might not completely eliminate you needing to get up to urinate (this is natural in pregnancy), it can reduce the amount of times you might need to get up during the night. If you’re drinking caffeine during pregnancy, it’s important not to drink it in the evening as it’s a stimulant and can make you feel more awake.

Consider eating habits

It’s important not to go to bed too full, as this can make you uncomfortable. Try not to eat heavy meals close to bedtime, so schedule dinner time for earlier on in the evening if your schedule allows. Ensure you take the time to chew slowly to reduce the risk of heartburn and avoid foods which you know might aggravate it.

Conversely, it’s important you don’t go to bed hungry. Hunger tends to increase during pregnancy and this can leave you feeling nauseous with a grumbling stomach. If you find you’re regularly hungry in bed, having a light, healthy snack closer to bedtime is a good idea to stave off hunger pangs.

Exercise

It might feel like the last thing you want to do, but doing some light exercise during the day can help you to sleep better at night. Exercise also reduces stress, increases relaxation, and helps to keep you and your baby healthy during pregnancy. It doesn’t have to be a lot, but some light walking or yoga can be very helpful. Make sure you check with your doctor or midwife that you’re cleared for any new exercise you are going to try.

Utilize relaxation techniques

Relaxation techniques can be very useful, especially when carried out in the evening as part of your bedtime routine, or even in bed to help you drift off to sleep. These techniques are often based in mindfulness, which we’ll discuss further soon. Techniques might include meditation, visualization, or breathing exercises.

Some of these techniques might be taught in your antenatal classes or be recommended by your midwife. Listening to guided mindfulness sessions can be incredibly helpful, especially while lying in bed, as they guide you step by step and the accompanying voice and sounds enhance feelings of relaxation. You can access these online or as part of an online insomnia treatment programme.

Insomnia treatment options

If you’re struggling with insomnia, you can choose to seek professional treatment. Treatment for insomnia during pregnancy focuses on psychological therapies. You can access these by talking to your doctor and asking for a referral, or you may be able to self-refer depending on where you live. You could choose to seek private therapy, although this can be a costly option. You could also treat insomnia naturally at home via online sleep therapy.

Cognitive behavioural therapy for insomnia (CBT-i)

CBT-i is the primary treatment for insomnia. While some women take comfort in knowing that their pregnancy insomnia is temporary and try to cope at home, others prefer to seek treatment to help them tackle their insomnia. CBT-i is an appropriate, safe, and effective method for pregnant women who wish to seek treatment for their insomnia, and it’s easily accessible.

CBT-i works to change negative thoughts patterns and the behaviours which stem from them, targeting those which are causing your insomnia. Instead, you are taught to replace them with positive thoughts and behaviours which will help you to get the restful sleep you need. CBT-i will involve a range of methods to help you improve your sleep. The National Sleep Foundation states: “CBT is aimed at changing sleep habits and scheduling factors, as well as misconceptions about sleep and insomnia, that perpetuate sleep difficulties.”

Mindfulness

Mindfulness focuses on helping you to be present in the moment in a non-judgemental way. Rather than worrying about the past or present, or over analyzing your thoughts, you’ll learn to let all of that float by you as you stay grounded in the here and now. Mindfulness encourages a state of complete relaxation and is fantastic for reducing stress and anxiety. It’s easy to see how this can be useful for pregnant women in easing worries and helping them to unwind. Mindfulness is also proven to help improve sleep.

Mindfulness techniques might involve meditation, guided visualization, and breathing techniques. You can be taught these through mindfulness therapy or they may be integrated into CBT-i to bring optimum results. You can also access lots of mindfulness resources online from your own home.

Once you learn the skills of mindfulness, you can practice it any time you are struggling to sleep or need to relax. It can even be useful to carry out a mindfulness exercise in bed, to help you drift off to sleep. Take your time to figure out what works for you and remember to focus on rest and relaxation.

References

American Academy of Sleep Medicine, (2020), “Insomnia – Overview and Facts”. Sleep Education.

Amy O’Connor, (2019), “Insomnia During Pregnancy”. What To Expect.

Darienne Hosley Stewart, (2020), “Stuffy nose during pregnancy”. Baby Center.

NHS, (2017), “Indigestion and heartburn in pregnancy”.

National Sleep Foundation, (2020), “How Pregnancy Can Affect Your Dreams”.

Paula Kashtan, (2017), “How to Stay Hydrated During Pregnancy”. The Bump.

Ashley Marcin, (2020), “What Are the Best Sleeping Positions When You’re Pregnant?”. Healthline Parenthood.

National Sleep Foundation, (2020), “Cognitive Behavioral Therapy for Insomnia (CBT-I)”.

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