You’re lying awake, unable to get to sleep, and you start to wonder: is insomnia a sign of pregnancy? Could all this tossing and turning be telling you something?
Insomnia, which is defined by the American Academy of Sleep Medicine as "persistent difficulty with sleep initiation, duration, consolidation or quality", is a common complaint in the population at large. According to the American Sleep Association, it is the most common specific sleep disorder in the US, with short-term issues reported by about 30% of adults and chronic insomnia by 10%.
Add pregnancy to the mix and insomnia can be even more of an issue. In one study of pregnant women published in the European Journal of Obstetrics, Gynecology and Reproductive Biology, which tracked nearly 500 women’s sleep patterns at different points during their pregnancy, insomnia rates rose from 6% before pregnancy to 64% in the course of the pregnancy. According to James Wilson, a sleep behavior expert known as The Sleep Geek and co-founder of wellbeing company beingwell, "I have never come across a pregnancy that doesn’t include poor sleep at some point."
Here we look at the science behind insomnia during pregnancy and find out how you can sleep more soundly without causing harm to your unborn child. But above all, we'll answer the question, is insomnia a sign of pregnancy?
How does pregnancy affect sleep?
There are multiple reasons for insomnia during pregnancy, says Leah Hazard, an NHS midwife, author of the memoir Hard Pushed: A Midwife’s Story, and host of the podcast What The Midwife Said. "Sleep can be challenging in pregnancy for any number of reasons: the increasing discomfort of a growing bump, pelvic girdle pain, heartburn, nausea, increased frequency of urination and leg cramps can all play a part."
As the pregnancy progresses, it can be hard to get comfortable, especially if the baby starts kicking in the night or is pressing on your bladder; you may also need to get up to go to the bathroom more often during the night.
According to a study published in the journal, Sleep Science, many women experience sleep disorders during pregnancy, such as obstructive sleep apnea. This is particularly the case, says midwife Leah Hazard, for those who are already at risk (especially women who smoke or have a higher BMI). "Restless legs and leg cramps can also be an issue", she adds. Mental and emotional issues - anxiety about the pregnancy or parenthood or restless dreams - all are additional causes of poor sleep.
Can insomnia be an early sign of pregnancy?
According to research on insomnia in pregnancy published in the Journal of Sleep Research, the rate of insomnia increases as a pregnancy progresses, so you’re more likely to suffer from it in the third trimester (weeks 28-41) than earlier in the pregnancy. One study in the Scientific World Journal suggested that the risk of insomnia was two times higher for those in the third trimester than those in the first and second trimesters. This is hardly surprising given the changes that are taking place in your body and the increased size of the baby that you’re carrying by months seven to nine.
"I wouldn’t particularly say insomnia could be seen as an early indicator of pregnancy," says James Wilson, although he does note that so-called morning sickness - which can last 24 hours a day - can affect your sleep, particularly in early pregnancy.
So if you’re lying awake at night, it’s not necessarily a big red flag letting you know you’re likely to be pregnant. If you do think you might be expecting a baby, a much more reliable way of finding out is to take a pregnancy test, available from pharmacies everywhere.
How to cope with pregnancy insomnia
When you’re considering the sleep aids to help you get a good night’s sleep during your pregnancy, It’s important to make sure you’re not putting your own health or that of your unborn child at risk, so check any medication you’re considering taking with your physician first.
"I would absolutely not recommend melatonin or any other herbal/alternative sleep remedy that has not been rigorously tested and proven to be safe in pregnancy," advises Leah Hazard.
If physical discomfort caused by the size of your bump is stopping you from sleeping, James Wilson has some practical suggestions. "Sleeping on your left side and buying a body or maternity pillow can be priceless, or tuck a pillow between your legs to keep the pelvis in a neutral position."
Reflux and heartburn are common symptoms during pregnancy, so if this is the case for you try leaving a longer gap between eating and going to bed. One study, published in the Journal of Clinical Gastroenterology, showed that the shorter the time between eating, the greater the problem with reflux. Some pregnant women find it helpful to prop themselves up with pillows to achieve a more upright position.
As for leg cramps, there’s no hard and fast cure, says midwife Leah Hazard. "Try not to panic if they wake you up – flex and relax your feet, and the cramp should ease within minutes."
It’s also important to follow general principles of good sleep hygiene, says Leah. "Stop using screens and electronics at least an hour before bedtime for a ‘digital sundown’, ensure that your room’s ambient temperature is pleasantly cool with enough bedcovers to keep your body warm and your head fresh, and keep any bedtime snacks plain but satisfying (i.e toast, banana, chapati, cereal). Avoid overly hot baths at bedtime as they can exacerbate dry/itchy skin in pregnancy."
It can be helpful to talk to someone else about sleep issues, advises James Wilson. "I find many pregnant couples benefit from compassionate conversation around sleep, particularly if sleeping apart might help the person experiencing the pregnancy have more space to sleep in."
Above all, says James, try not to let your insomnia add to your stress. "Like anything that causes us to sleep poorly, it is best to try not to force sleep, make sure you wind down before bed, and try a warm bath to help relax and drop your heart rate."
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Patricia Carswell is a freelance journalist specializing in health and fitness. She has written for a huge variety of national newspapers, magazines and websites, including Healthy, Top Santé, Women's Fitness and fitandwell.com, and writes a monthly column for British Rowing's content hub. She's the founder and host of rowing blog and podcast, Girl on the River, where guests have included Sir Matthew Pinsent and multiple Olympian Frances Houghton MBE. She keeps fit by rowing, walking, and wild swimming, and is at her happiest when on or in the water.