Pregnancy discomforts that affect your sleep

AndieM.Ed., RD, LDN, CLC, RYT-200

Unfortunately, physical changes as well as pregnancy hormones can and usually do interfere with your ability to experience extended, deep sleep. Common sleep disrupters include the need to urinate during the night as well as discomforts associated with heartburn, constipation and gas, hemorrhoids, congestion, leg cramps, restless legs syndrome and back pain.

Additionally, many pregnant women find their minds are more active at night than they were pre-pregnancy, so when a full bladder or other physical signals inevitably wake you up, you may have more trouble settling back down to sleep.

Despite these challenges, don’t give up on getting a good night’s sleep – there are ways to manage your discomforts and to put into practice a bedtime routine that invites better sleep.

What to Do

Modify your bedtime routine

A regular, habitual bedtime routine can trigger your body’s natural melatonin to signal sleepiness. A warm bath, calming music, a good book, meditation, or a massage from your partner might do the trick.

To encourage peaceful slumber, try using dark shades or blinds and a white noise or “nature sounds” machine to help you relax. Avoid drinking fluids close to bedtime (especially anything caffeinated!) as a way to diminish the need to urinate in the middle of the night (but do be sure to hydrate adequately during the day). Limit screen time in the hour or even two before bedtime as the blue light emitted by screens seems to suppress melatonin, the hormone key to sleepiness.

Tell your doctor or midwife if you are experiencing restless legs syndrome (RLS) and ask to get your iron levels checked

During pregnancy, RLS most likely occurs in the last trimester. Symptoms include uncomfortable sensations or an irresistible urge to move your legs, usually coming on at night or while resting. The severity can range from mild to intolerable, causing insomnia and resultant hardships from lack of sleep.

While RLS typically resolves itself after delivery, speak with your healthcare provider in the meantime for help.

RLS in pregnancy might be triggered by low levels of folic acid or iron, so supplementation may be recommended. Some evidence also suggests that rising estrogen levels during pregnancy may contribute to RLS.

If you have nighttime leg cramps, try stretching and consider supplementation

Leg cramps feel like a “charley horse” – a sudden, intense muscle spasm in the calf. As soon as you feel the sensation coming on, flex your foot (heel pushes down as your toes reach up toward your leg) and massage your calf. This stretch is easiest while standing up on the effected leg and pushing your heel into the floor while massaging your calf. Avoid pointing your toes, which can bring on or worsen the cramp.

Leg cramps that occur during pregnancy and during sleep are not the same as restless legs syndrome. About 25 – 50% of pregnant women experience leg cramps. The physiologic causes for prenatal leg cramps are unclear and unproven. Theories include hormonal and biochemical effects on calcium, magnesium and phosphorus levels, impaired muscular absorption of calcium, pressure of the enlarged uterus on certain blood vessels and nerves, and electrolyte imbalances.

To help prevent leg cramps, stay well hydrated, stretch before bedtime and get ample exercise during the day. Pregnant women should drink at least 10 cups of fluids daily (and even more if your diet is low in produce which contains lots of water).

Magnesium supplementation of 350 mg at bedtime has shown to be helpful in some studies but not all. Check with your provider before taking supplements.

Take steps to prevent or minimize heartburn and its effects on your sleep

See Strategies for Managing Heartburn for all the details on how to combat heartburn.

Try to avoid hemorrhoids and learn how to relieve pain

Hemorrhoids are varicose veins in the rectum, which can be painful and itchy enough to interfere with sleep. They’re common, harmless, and tend to show up for about 50% of pregnant women late in the second trimester (and are common post vaginal delivery as well).

Common causes include pressure from your growing uterus, increased blood flow to your pelvis and constipation. Constipation can also aggravate hemorrhoids, so constipation prevention is key. Read Hydration to prevent constipation for moms, babies and toddlers for all the info.

For relief at night, apply witch hazel pads to your hemorrhoids and elevate your hips with a towel.

Before bed, a warm bath or a sitz bath can help keep your bottom cleaner while reducing any pain and swelling.

If you have more severe hemorrhoids and need stronger treatment, talk to your healthcare provider.

Use extra pillows to help alleviate back and hip pain during sleep

A pregnant woman can never have too many pillows!

While side sleeping is recommended for pregnant women, this position can sometimes trigger back and hip discomfort. Try using a pillow under your upper arm and one between your knees in addition to placing one “wedge” pillow under your belly and another behind your back.

During the day, practice exercises to promote back health

  • Isometric exercises: Engage the pelvic floor, abdominal, lower back, and gluteus muscles periodically while sitting, and always when lifting, to help strengthen your core and prevent lower back injury.
  • Arm and leg extensions: Start on all-fours, then extend your right arm and left leg as you inhale. Return to starting position as you exhale and repeat with your left arm and right leg. Do 6 sets on each side.
  • Back press: Stand with your back against the wall and feet about one foot away from the wall. Press your lower back into the wall and hold for 10 seconds. Repeat 10 times.
  • Pelvic tilts: Practicing pelvic tilts will help stretch the lower back muscles that may have tightened after performing the above strengthening exercises.
  • Child’s pose: Start on all-fours with your hands under your shoulders and knees wider than your hips. Bring your hips back to your heels and hold for 5 seconds. Come back up to your hands and knees. Repeat 5 times.
  • Sitting twist: Sit with legs crossed. Place your left hand on the floor behind you and your right hand on your left knee as you move into a gentle stretch. Hold for a breath. Do the same on the other side. Repeat the set of twists 5 more times.

When exercising, try to avoid the Valsalva Maneuver, or holding your breath while contracting your muscles. It can create a lot of pressure on the uterus. To avoid this, simply remember to breath out during the exertion and inhale during the release.

Consider products that offer extra support while you sleep

Certain products may help alleviate aches and pains by offering a layer of support against the forces of gravity:

  • Breast pain: The best way to manage enlarged, swollen, painful breasts is to wear a well-fitting bra, even at night. Choose a bra that is comfortable for sleep and has no underwire, such as a sports or shelf bra. Find a maternity store that employs a bra fitter, an expert who can ensure you are matched with the right-sized bra.
  • Sciatica or sciatic nerve discomfort: This condition can be caused by pressure from musculo-skeletal changes involving the lower back and/or pelvis. The uncomfortable and sometimes debilitating sensation often radiates from the lower back all the way down the leg. It can occur while you are resting, sitting, standing or exercising. Prenatal support belts for the lower back and pelvis may help provide some comfort.
  • Carpal tunnel syndrome: Swelling in the wrist area can create pressure on the median nerve, causing a feeling of numbness and tingling in the hand and arm. Carpal tunnel syndrome can occur in expecting women as hormones and weight of pregnancy impair circulation and cause swelling in the extremities. Wearing a carpal tunnel night splint helps deter pooling of fluid and may alleviate symptoms.

Engage in safe prenatal exercise during the day to help you sleep at night

The American College of Obstetricians and Gynecologists recommends a minimum of 30 minutes of exercise a day during pregnancy as long as your healthcare provider says it’s OK. See Go-to exercises during pregnancy and The 4 Ws of exercising during pregnancy: Why, what, when and where for more about exercising.