Insomnia during Pregnancy

Pregnancy is a time when you require long hours of sleep more than ever, but at the same time, getting a good night’s sleep may seem harder than ever during these nine months. However, that does not mean you are obliged to spend sleepless nights day after day, as there are plenty of tips and measures to help you get the much-needed rest.

Is insomnia common in pregnancy

A poll carried out by the National Sleep Foundation found that 78% of women experienced more sleeping problems during pregnancy than when they were not pregnant ^[1].

Is insomnia an early pregnancy sign

Although it is completely normal to have sleeping disruptions in the first trimester, insomnia is not considered an early pregnancy symptom as it more commonly hits during the third trimester ^[2].

How much sleep does a pregnant woman need

An average adult person needs 7 to 9 hours of sleep at night and pregnant women usually need several more hours of sleep per day ^[3]. You may compensate with a few daytime naps if it is difficult get that much sleep in straight hours ^[4].

Once you conceive, all your major organs have to work harder to provide for both you and your baby. Your heart pumps 30%-50% more blood for better circulation so your baby can get enough nutrients while the kidneys work harder to get rid of the extra waste materials ^[5]. At the same time, the higher estrogen levels speeding up your metabolism causes severe fatigue ^[6]. All these factors contribute to your requiring more sleep during these nine months ^[7].

What causes trouble sleeping and insomnia in pregnancy

Apart from the usual suspects, the pregnancy hormones, there are various other factors that may keep you awake night after night.

Frequent urination

The extra blood filtered by the kidneys increases the urine production, forcing you to use the bathroom frequently, even in the middle of the night. Additionally, when you lie down at night, the fluid retained in your lower extremities all day finally travels to the heart, as your legs are at the same level with the body, resulting in even higher production of urine. It is more likely to occur if you are experiencing swelling of the legs and feet ^[8].

In the later stages of pregnancy, the growing uterus puts considerable pressure on the bladder, making you feel the urge to urinate even more often, especially at night if your baby is more active during nighttime ^[9].

Anxiety and depression

All the common worries and anxieties related to your baby’s wellbeing, your upcoming labor, childbirth and the kind of parent you would make are enough to keep you awake at nights ^[10].

Gas, acid reflux and heartburn

The pregnancy hormones relax the digestive tract, slowing down the digestion process, leading to gas and acid reflux. It may not be so easy to fall asleep with severe heartburn and bloating ^[11].

Restless leg syndrome and Leg cramps

Leg cramps is another typical problem among pregnant women that may make it difficult to sleep at night, usually in the second and third trimesters. The problem often intensifies at night, which may be because of the uterus putting pressure on the nerves leading to your legs and the blood vessels returning blood from the legs to the heart ^[12].

Restless leg syndrome, characterized by crawling, tingling and sometimes painful sensations in the legs, is one of the most common factors for sleeplessness in pregnancy, especially in the third trimester ^[13].

Your growing belly

By the middle of the third trimester, it becomes almost impossible to lie comfortably in your bed with your bulging belly in the way. So, it is quite normal for you to end up tossing and turning all night instead of getting some sleep.

Pregnancy related pain and discomfort

The pregnancy hormones gradually relax the muscles and ligaments in your abdominal area in preparation for labor and birth. This often leads to common yet painful symptoms of pelvic, tailbone and round ligament pain, in addition to the considerable back pain resulting from your shifting center of gravity ^[9]. All these aches and pains are enough to make you too uncomfortable to sleep.

Shortness of breath

Your growing baby putting pressure on your ribcage and lungs can lead to shortness of breath, usually in the third trimester ^[14]. It can be worse in a twin pregnancy due to the extra pressure ^[15]. The pregnancy hormones cause the mucus membrane in your nose to swell up, leading to a stuffy nose and breathing difficulties.

Vivid dreams

Intense, vivid dreams during this time may wake you up, making it difficult to go back to sleep. However, experts are not yet sure about the causes responsible for this pregnancy issue ^[11].

Your baby kicking

During the day, your baby is rocked to sleep as you move and walk around in your daytime activities. But once you lie down in your bed at night, and the rocking movement stops, your baby is more likely to wake up, starting to kick and punch in your uterus ^[16].

Insomnia symptoms during pregnancy

Difficulty falling asleep
Waking up in the middle of the night ^[17]
Difficulty going back to sleep once awake
Feeling tired or unrefreshed when you wake up in the morning ^[18]
Feeling sleepy throughout the day

Does the lack of sleep affect your baby

Your baby’s sleep patterns are independent of yours ^[19]. So if you are unable to fall asleep, it does not mean that your baby is not getting enough sleep either. In fact, your having insomnia does not affect your baby at all as he can sleep during the day ^[18], even when you are awake.

However, if you remain sleep deprived day after day, it may have an effect on your pregnancy, as a research done by the University of California shows women who had less than six hours of sleep per night in pregnancy had longer labor while having 4.5 times higher chances of needing a cesarean delivery ^[10].

How to deal with insomnia while pregnant

Drinking lots of water helps to keep the mucus thin, preventing nasal congestion ^[11]. However, make sure to fulfil most of your daily fluid requirement before the evening to reduce the number of bathroom visits at night ^[2].
Lying on your left side, using lots of pillows to support your belly, back and legs; try sleeping with a pillow between your legs, or you may opt for a pregnancy body pillow ^[20].
Avoiding all caffeinated drinks, especially if you have restless legs, as caffeine further interferes with your sleep, worsening the RLS symptoms ^[21].
If you are suffering from anxiety and depression, writing down your worries can help you leave them in the pages of your diary when you go to bed ^[22].
Trying not to worry about each passing minute when you are unable to fall asleep at night as becoming anxious will only make things worse ^[23]. Instead, get out of your bed, go to the next room and listen to some relaxing music or read a book until you finally feel sleepy.
Wearing nasal strips may help to keep your nasal passages open, making it easier for you to breathe while sleeping ^[11].
Eating small meals throughout the day, and having your dinner at least a couple of hours before bedtime to avoid heartburn ^[24]. You may have a light snack of some whole grain crackers and cheese if you are hungry.
Having a high-protein (yet light) snack before bed can be of help if symptoms like headache, vivid dreams and body sweats are keeping you awake as these often result from low blood sugar ^[25]. A few options of high-protein foods include a small piece of turkey, an egg or some peanut butter.
Going to bed and waking up at the same time every day ^[6]
Drinking some warm milk before you go to bed as according to experts, milk contains the L-tryptophan amino acid that boosts the serotonin levels in the brain, making your eyelids feel heavy and contributing to better sleep ^[25].
Joining a prenatal yoga class or following a light exercise routine as working out can help you get a good night’s sleep. However, make sure not to exercise within at least four hours of going to bed or you may find it even more difficult to fall asleep ^[15].
Practicing some relaxation techniques to fight stress and anxiety
Stretching your legs before going to bed to reduce the symptoms of restless leg syndrome.

Using sleep aids to treat insomnia during pregnancy

Prescription pills and other sleep aids are never recommended in pregnancy. Certain over-the-counter ones, including Nytol, Sominex as well as Benadryl, all having diphenhydramine as the active ingredient, may be considered safe ^[11]. Unisom (doxylamine) is another medication that may be safe for occasional use ^[28]. However, many experts recommend avoiding all OTC aids and home remedies as well ^[9]. Make sure to consult your physician before considering using any drugs or herbal sleeping aids.

Alternative treatments including acupuncture and homeopathy are some other options you may consider; but make sure you contact a licensed practitioner to avoid any risk to your baby ^[29].

When to call the doctor

Loud snoring with or without severe nasal congestion and breathing problem while sleeping, as it may indicate a sleeping disorder named sleep apnea ^[11]. In addition to waking you up frequently at night, this condition may even be harmful for the baby as it causes the airways to close many times while you are sleeping, causing a lack of oxygen supply to the fetus. Studies have associated sleep apnea in pregnant women with a higher risk of preeclampsia ^[26].

Severe restless leg syndrome that interferes with your sleep on a regular basis should also be brought to our doctor’s notice ^[27]

Insomnia ICD-9 and ICD-10 codes

ICD-9: 307.42 ^[30], 307.41 ^[31], 327.0 ^[32], 780.51 ^[33], 780.52 ^[34]

ICD-10: F51.0 ^[35], G47.0 ^[36]

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