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I’m sending you this question at 2:45 a.m. because I can’t sleep. I haven’t been able to get a good night’s sleep since week four of my pregnancy. Why does this happen to pregnant people? Don’t we go through enough? What is an actually effective way to manage pregnancy insomnia?
—The Struggle Is REAL
First, you are not alone. Pregnancy insomnia is real, and it’s more common than when not pregnant.
A recent meta-analysis looking at 24 studies with over 15,000 pregnant people found that about 38% experience insomnia symptoms during pregnancy. This gets worse as the pregnancy progresses: The prevalence jumps from around 25% in the first trimester to nearly 40% in the third trimester. By comparison, an estimated 12% of the overall population has chronic insomnia.
This happens for a few reasons. One is bladder capacity — you need to pee more, so you wake up more. A second issue is physical changes in body temperature and weight distribution, which can make it more difficult to get comfortable.
There is also a stress component. Basically, people who are vulnerable to insomnia are more likely to develop it during stressful periods. Pregnancy, even when it is deeply wanted and going well, is stressful. Birth can be scary, and parenting is hard (and also can be scary). One study found that people with high “stress-related sleep reactivity” were more likely to report both insomnia and anxiety during pregnancy.
The third trimester is the worst because you’re getting hit from all sides: maximum physical discomfort, maximum pregnancy-related anxiety, and your body is working harder than it ever has.
In terms of solutions, the research is frustratingly limited.
There are sleep aids that are safe during pregnancy — Unisom is widely understood by medical providers to be safe and effective — but many pregnant people are nervous about taking it. You shouldn’t be! If this helps, go for it. Melatonin is another option, but we have less concrete safety evidence (although no proactive reason for concern).
In terms of non-medication therapy, the most promising option is Cognitive Behavioral Therapy for Insomnia (CBT-I). This has been proven effective in the general population, and there’s data indicating it works in pregnancy, too. CBT-I typically involves things like: sleep restriction (only being in bed when you’re actually sleeping), stimulus control (getting out of bed if you can’t sleep), and addressing anxious thoughts about sleep.
CBT-I can take some time as a fix, but especially if you are prone to insomnia outside of pregnancy, this is worth exploring (there are books, or you could ask your doctor).
Some practical things that might help in the meantime: Try to avoid catastrophizing about the sleep loss. Research on dysfunctional beliefs about sleep suggests that worrying about the consequences of poor sleep can actually perpetuate insomnia. If you wake up and can’t fall back asleep, get out of bed rather than lying there anxious.
The good news: for most people, the insomnia of pregnancy improves post-birth. So hang in there.
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