March 26, 2023

Carrie Madormo, RN, MPH, is a freelance health writer with over a decade of experience working as a registered nurse in a variety of clinical settings.
Monique Rainford, MD, is board-certified in obstetrics-gynecology, and currently serves as an Assistant Clinical Professor at Yale Medicine. She is the former chief of obstetrics-gynecology at Yale Health.
Pregnancy insomnia refers to trouble falling asleep, staying asleep, or both when pregnant. Sleepless nights are a common occurrence during pregnancy. It is estimated that up to 78% of pregnant people experience sleep disturbances throughout pregnancy. 
There are several possible causes of pregnancy insomnia, including hormonal changes, physical discomfort, and mood disorders. It is not recommended to use regular sleep medications while pregnant.
This article will provide an overview of pregnancy insomnia and describe natural remedies to address it. 
Justin Paget / Getty Images
Pregnancy insomnia is a common condition involving trouble falling asleep, staying asleep, or both while pregnant. Most people experience sleep disturbances at some time during their pregnancies. 
One study found that early intervention is important because insomnia may raise the risk of complications during pregnancy and childbirth. It is estimated that women who sleep less than six hours per night during pregnancy are more likely to have long labors. They also are 4.5 times more likely to require a cesarean section (C-section), a surgical procedure to deliver the baby through incisions made in the abdomen and uterus.
A lack of sleep during pregnancy may also raise the risk of preeclampsia (a complication causing high blood pressure and high levels of protein in the urine, which indicate kidney damage) and gestational diabetes (diabetes that develops during pregnancy).
Sleep disturbances in pregnancy may be related to hormonal, physiologic, metabolic, and psychological changes. These changes can raise the risk of conditions that lead to insomnia. These pregnancy-related conditions may include anxiety and mood disorders, breathing-related sleep disorders, and restless legs syndrome (RLS).
The changes throughout pregnancy contribute to sleep disturbances in different ways. During the first trimester, a spike in the hormone progesterone causes:
All of these new symptoms can contribute to sleep disturbances at night. An increased progesterone level can also increase the risk of sleep apnea and snoring. 
It is possible to feel and sleep better during the second trimester. However, by the third trimester, sleep disturbances can return. The growing fetus can lead to heartburn, muscle aches, urinary frequency, and extra pressure on the diaphragm in the third trimester. Estrogen levels increase in the third trimester, leading to rhinitis (nasal congestion, a runny nose, and sneezing) and obstructive sleep apnea (muscles in the back of the throat relax and disrupt breathing). 
Most healthcare providers do not recommend regular sleep medications during pregnancy because of the risk of birth defects and health complications. Most medications for sleep and RLS have risks to a developing fetus. Sleep medications may also raise the risk of preterm labor, low birth weight, C-section, and neonatal abstinence syndrome (withdrawal symptoms experienced by the baby from drugs exposed to when in the womb). 
Because sleep medications are usually not recommended during pregnancy, many pregnant individuals turn to natural remedies for sleep. It’s important to remember that not all natural remedies are considered safe during pregnancy. Talk with your healthcare provider about which methods to try. 
Acupuncture is used for a variety of pregnancy-related concerns. It is generally considered safe during pregnancy for the treatment of:
A study found that acupuncture can significantly improve sleep quality in pregnant women. This may be due to its effect on melatonin in the body. Melatonin is a hormone naturally secreted in the body that helps us relax and fall asleep. Research shows that acupuncture can increase the serum concentration of melatonin in the body. 
In addition to improving sleep quality, increased melatonin levels may also benefit the baby. Melatonin crosses the placenta and plays an important role in fetal brain development.
If you have been experiencing disturbed sleep during pregnancy, consider trying a prenatal yoga class. A review found that starting a regular yoga practice during the second trimester decreased the number of nighttime awakenings and time spent awake in bed for study participants. Individuals who began yoga in their second trimesters experienced more benefits in sleep quality than those who started in their third trimesters.
A regular exercise program may benefit those experiencing pregnancy insomnia. A review found that pregnant people who engaged in regular physical activity experienced significant improvements in their sleep quality. They also experienced a reduction in anxiety symptoms. Regular exercise was especially helpful in treating pregnancy insomnia in the third trimester. 
Massage therapy positively impacts stress, mood, and sleep in pregnant women. A review found that pregnant individuals who took part in a massage and relaxation program reported fewer sleep disruptions. 
Stress reduction is an important way to improve sleep. Cognitive behavioral therapy (CBT) teaches individuals to recognize and change negative thought patterns and behaviors. 
A clinical trial found that CBT led to significant improvements in sleep quality and insomnia symptoms in pregnant individuals. Study participants reported less time lying awake in bed and fewer anxiety symptoms after participating in a CBT program. The participants were also less likely to require sleep medication than those in the control group.
Starting CBT during pregnancy may also reduce the risk of postpartum mood disorders like depression and anxiety.
In addition to prescription sleep aids, over-the-counter medications to avoid during pregnancy include:

While it may not be possible to prevent pregnancy insomnia completely, there are steps that you can take to reduce your risk. Most healthcare providers consider sleep hygiene the first-line treatment of pregnancy insomnia. Sleep hygiene refers to setting up an environment that supports good sleep quality. It can improve pregnant individuals’ quality of life significantly.
Consider trying one or all of the following sleep hygiene techniques:
Pregnancy insomnia is a common condition during pregnancy and refers to trouble falling asleep, staying asleep, or both. Pregnancy insomnia may be caused by the hormonal, physiologic, metabolic, and psychological changes during pregnancy. Regular use of sleep medication is not advised in pregnancy. Five natural remedies that have been proven to improve sleep quality during pregnancy are acupuncture, yoga, exercise, massage, and cognitive behavioral therapy. 
Most new parents expect to give up sleep once their baby is born, but insomnia can cause sleepless nights even before the baby arrives. Pregnancy insomnia may increase the risk of serious complications, and early treatment is essential. Talk with your healthcare provider about your sleep disturbances and ask about your treatment options. Just because pregnancy insomnia is common does not mean you have to live with it. Several natural sleep options may provide relief. 
There is not enough evidence to determine if melatonin is a safe supplement to take during pregnancy. If you have trouble falling or staying asleep while pregnant, talk with your healthcare provider. 

Pregnancy insomnia can start during pregnancy and often begins in the first trimester. 

Pregnancy insomnia usually resolves at the time of childbirth. However, it is common to experience postpartum insomnia after birth due to nighttime feedings, physical discomfort, and mood changes.
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