Restless nights: Unveiling the possible causes of sleep problems during pregnancy

You’re expecting a baby and there’s nothing you want more than to sleep like a baby.

While there are all these beautiful images of pregnant women smiling in their sleep, most of you who have been pregnant would know that in reality, things are quite different.

It’s ironic how you feel more sleepy than ever, but when you actually try to sleep, you have to deal with all sorts of sleep problems during pregnancy.

They include aches, cramps, a sudden urge to throw up and whatnot. And then when you finally get around to sleeping, there’s the concern of your sleeping position.

Whoever said it was easy being a woman, let alone a pregnant one?

It is inevitable that you will face these sleep problems during pregnancy. But do set your mind at rest, for there are ways to improve the quality of your sleep. Read on to learn more.

Causes of sleep problems during pregnancy

Pregnancy is an incredible journey filled with excitement, but it can also bring its fair share of sleep challenges. Let’s uncover the culprits behind those frustrating sleep problems during pregnancy.

Hormonal changes:

Fluctuating hormone levels can disrupt your sleep patterns and lead to insomnia or frequent awakenings.

Physical discomfort:

As your baby grows, you may experience discomfort from aches, pains and the pressure of your expanding belly, making it hard to find a comfortable position for sleep.

Frequent urination:

The need to urinate more frequently, especially during the later stages of pregnancy, can interrupt your sleep and make it difficult to fall back asleep.

Heartburn and indigestion:

Hormonal changes relax the muscles that prevent stomach acid from flowing back up, leading to heartburn and indigestion that can disrupt sleep.

Restless Legs Syndrome (RLS): 

RLS, characterised by an uncontrollable urge to move your legs, can make it challenging to settle down and find restful sleep.

Anxiety and pregnancy-related stress:

Excitement, anticipation and concerns about upcoming changes can cause anxiety and contribute to sleep difficulties.

Sleep problems in each trimester of pregnancy

As your body goes through remarkable changes to nurture and grow a new life, sleep problems can arise in different trimesters.

Here’s a quick rundown of the sleep issues you might encounter during each stage of pregnancy.

1. First trimester

In this phase, your body adjusts to the presence of a tiny life inside you. Sleep disruptions may manifest in various ways:

• Frequent urination
• Nausea and morning sickness
• Heightened sense of smell
• Hormonal fluctuations

2. Second trimester

Welcome to the mid-pregnancy phase! While you may find some relief from morning sickness, new sleep challenges await:

• Growing belly and discomfort
• Leg cramps
• Heartburn and indigestion
• Restless legs syndrome

3. Third trimester

You’re in the final stretch now! Your baby is getting ready for the grand debut, and your sleep patterns might reflect this excitement.

• Frequent bathroom trips
• Increased backache and discomfort
• Shortness of breath
• Fetal movements and kicks

Remember, these sleep problems are common during pregnancy, but there are strategies to help you get a better night’s rest.

Don’t hesitate to discuss any concerns with your healthcare provider for personalised advice and guidance.

Dr Chee Jing Jye, Medical Director, The Obstetrics & Gynaecology Centre (Paragon), shares the common sleep problems that plague you during pregnancy, what you can do to alleviate the discomfort and what you need to be careful of when it concerns your beauty sleep.

Common sleep problems during pregnancy (and what to do about it)

Dr Chee mentions that your first and third trimesters of pregnancy are generally the hardest times to get uninterrupted sleep.

Here are some of the common sleep problems during pregnancy that you are likely to encounter, coupled with practical tips on how you can alleviate the discomfort.

• Insomnia/interrupted sleep

Of all the sleep problems during pregnancy, the number one problem that women complain of is insomnia. In early pregnancy, many women experience stress, anxiety and blues that keep them up. This is definitely linked to the infamous pregnancy hormones, a known troublemaker.

If you’re expecting, you’ll definitely know what these hormones are capable of.

While the hormones are busy doing what they do, your mind is constantly wandering and coming up with endless possibilities of what could possibly go wrong with your pregnancy. That’s another reason one of the common sleep problems during pregnancy is insomnia!

If that’s not bad enough, in both early and late pregnancy, many women tend to pee frequently and this causes them to have to get out of bed a couple of times every night. If you’re wondering why this happens, blame it on progesterone.

Notice how almost everything goes back to the hormones?

In early pregnancy, the hormones cause blood to flow more quickly through your kidneys. This causes your bladder to be filled more often. Furthermore, during pregnancy, your body has up to 50 per cent more blood and your kidneys have to filter all of it.

This leads to more fluid going through your kidneys and ending up in your bladder – thus frequent urination.

Later in your pregnancy, especially in the third trimester, your growing tummy may place added pressure on your uterus and this once again causes you to pee more frequently.

A word of caution though. Do something about insomnia while you can, for you need your sleep. If the insomnia is left to be, it could worsen and or even become a contributing factor to postnatal depression.

You can’t control the hormones or your growing uterus but what you can do is consume as many fluids as you can during the day. However, do reduce your intake about two hours prior to bedtime. If you feel thirsty at night, wet your throat with a few sips of water.

• Reflux problems

The most common acid reflux symptoms experienced by pregnant women are heartburn (burning sensation from the stomach that moves up to the chest or even throat), regurgitation (throwing up) and dyspepsia (indigestion).

If you’re wondering what causes this to happen, no prizes for guessing, the hormones are at work again.

The hormone progesterone, which relaxes the uterus muscles, also relaxes the valve separating the oesophagus from the stomach.

This then allows gastric acids to move back up which in turn causes the burning sensation and other reflux problems.

Among the various sleep problems during pregnancy, reflux is definitely one of the most annoying ones! It makes you feel terrible and can potentially keep you up all night.

Reflux problems definitely have got to do with what you eat but it’s hard to pinpoint the exact food that causes it as people have different reactions to food. The more common triggers are believed to be citrus fruit, spicy food and thick food like chocolate and cheesecake.

Dr Chee wishes to quell the myth that milk helps to alleviate reflux. In fact, milk exacerbates reflux for some. Try to identify what triggers your reflux and think about what you eat. An antacid is a safe type of medication that you can consume to ease the discomfort caused by reflux.

• Leg cramps

Leg cramps, while you are sleeping, are among the barrage of inexplicable things that happen during pregnancy.

Dr Chee talks about how many pregnant women complain of leg cramps while sleeping. And it typically happens around three to four in the morning, just about when you would be falling into a deep sleep.

Dr Chee explains that when you are fast asleep and accidentally move your leg, your calf gets the worst cramps ever. You get hit by a wave of painful spasms.

It’s just one of those things that happen and no one really knows why. Although some people attribute it to the compression of blood vessels in the legs or the fatigue from carrying the extra pregnancy pounds.

Jane Tan, a happy stay-at-home-mum of three boys recalls the cramps she commonly experienced during pregnancy.

“I would get up in the middle of the night and freak out because my leg would suddenly hurt so badly and there seemed to be nothing that I could do about it."

She added that while she had experienced other sleep problems during pregnancy, the leg cramps were her worst experience for they often caused her panic. Especially during her third pregnancy, she had a difficult time getting out of bed to check on her older children.

How to solve this sleep problem during pregnancy?

Ensure that your legs are well covered. Wear long pyjama pants and if need be, stuff the legs of your pyjamas into a pair of socks. This reduces the likeliness of cramps occurring.

• Hot flushes

Another common sleep problem during pregnancy is the hot flushes that bother approximately one in three women.

Dr Chee reports that many of her patients complain that they feel extremely hot, especially towards the end of their pregnancy.

If you haven’t already guessed so, hormones are the reason. Changing hormone levels may increase blood flow to your skin. This makes you feel warm and flushed.

That, coupled with the tropical heat in Singapore is a recipe for disaster, especially if you sleep without the air conditioner.

In addition to her leg cramps, Jane also encountered hot flushes. 

“I had to set the air-conditioner so cold that my husband was freezing," she added, laughing.

In direct opposition to cramps, if you’re having hot flushes at night, you should dress lightly and sleep with either the fan or air-conditioner switched on.

• Foetal movements

Some women complain that their baby’s movements are too strong and that it keeps them up at night.

Dr Chee emphasises that it is important that you feel your baby’s movements and if the movements are strong, if anything, it is supposed to reassure you.

She mentioned that she feels strongly about this matter. Take it positively that you feel constant movement.

For if your baby does not move or kick regularly, it should warrant your concern. Of all the sleep problems during pregnancy, this can be considered a ‘happy problem’.

• Nasal congestion

This is not a serious problem but pregnant women do complain that a perpetually stuffy nose gets in the way of their sleep. And not forgetting the snoring that accompanies nasal congestion.

It is likely to be caused by increased oestrogen levels that increase blood volume in the nose membranes. This causes their nose to swell and thus the congestion.

Possibly the noisiest of the sleep problems during pregnancy, nasal congestion is more of an annoyance than an actual problem to crack your head over.

If your stuffy nose is keeping you up, you can try to elevate your head a little bit. Add an additional pillow or neck support.

Be careful not to overdo it and end up with a stiff neck though. Saline nasal sprays are safe for use during pregnancy as well.

If none of these seems to work for you, you might wish to discuss other options with your doctor.

• Restless Legs Syndrome (RLS)

An estimated 15 to 16 per cent of pregnant women experience this sleep problem during pregnancy. RLS is a strange condition that is likely to occur in your third trimester. It is the uncontrollable urge to move your legs to alleviate burning, tingling or crawling sensations in your leg.

This is a very frustrating problem for the sensations go away when you move your legs but when you stop moving, they return with a vengeance.

This can keep you up all night and if it keeps happening you can only imagine the fatigue that will eventually set in.

Your only consolation – it is a temporary problem. It peaks when you’re seven or eight months into your pregnancy and usually disappears completely upon delivery or soon after.

RLS has been associated with iron deficiency and your doctor might run a test to check your iron levels.

If your iron levels are low you might be given additional supplements (as you usually would already have iron supplements) or be advised to consume food that is rich in iron.

Exercise and abstinence from caffeine may also help if you have RLS.

Lifestyle remedies for better sleep

These are general recommendations for better sleep, pregnant or not.

Now that you need your sleep more than ever and you have to deal with sleep problems during pregnancy, you might want to make a more conscious effort to try to incorporate some of these lifestyle changes.

• Stay hydrated

The importance of water can never quite be emphasised enough. Ensure that you get a minimum of eight glasses of water every day.

Other fluids work well too but of course, you don’t want to end up loading up on carbonated sweet drinks. And remember to reduce your fluid intake as bedtime approaches.

• Exercise 

Exercise is undoubtedly beneficial for you during pregnancy but remember to get your doctor’s clearance before you try anything new.

Whatever you do, don’t exercise or do any strenuous activity close to bedtime as it is likely to keep you up.

• Watch what you consume

As Dr Chee mentioned, identify food that triggers discomfort and reflux and make a conscious effort to avoid those.

Do also remember that caffeine and sugar are known to keep you up at night so reduce your intake.

Some of you are especially sensitive to caffeine so please avoid it like the plague if you wish to have any hope of a good night’s sleep.

• Wind down

Try to incorporate a daily bedtime routine that begins with a warm shower. Some relaxing music and a cup of warm milk can help too.

Chamomile and lavender tea work wonders as well, so long as there’s no caffeine. A routine like this is sure to calm those nerves and soothe you into slumber.

Dr Chee wishes for all pregnant to know that after the 20th week of pregnancy, you should not lie flat on your back.

The reason is by the fifth month of pregnancy, the uterus would have reached a substantial size and weight.

The weight of the uterus would then weigh down on the vena cava (the main vein that carries blood from your lower body back to the heart).

Compressing the vena cava would interfere with blood circulation which definitely isn’t ideal when you’re pregnant.

This could cause you to feel dizzy and may even disrupt the flow of blood and nutrients to the placenta and your baby.

The problem gets more serious if you already have a condition like high blood pressure or diabetes which affects the amount of nutrition your baby is getting.

The other thing Dr Chee wants you to know is that as the pregnancy progresses, your tummy is growing and this causes your back to arch such that lordosis (excessive inward curvature of the spine) occurs.

Lordosis causes many women to suffer from backaches and sleeping flat makes lordosis more pronounced.

And of course, pregnant women should not be lying on their tummies.

Sleeping positions during pregnancy

So how then should you sleep? Here are some of Dr Chee’s suggestions:

• Left lateral position

Dr Chee usually advises mums to be to sleep in a left lateral position, with their torso slightly tilted to the left.

She cautions that many people misunderstand this and turn 90 degrees and sleep on their shoulders. It is not necessary to do that.

In fact, if you keep sleeping on your shoulder, your left shoulder will soon be screaming out loud.

• Pillows galore

When trying to sleep in a left lateral position, Dr Chee suggests tucking a small pillow under the right side of your back so that your tummy shifts and points to the left. You can also place some pillows under your knees to bend them and flatten out your back. This is to prevent lordosis from occurring.

To combat the infamous reflux problem, you may wish to add a few pillows to prop your head up to avoid lying flat. Lying flat may worsen the reflux issue.

Dr Chee jokes that towards the end of your pregnancy, there is usually no space left for your husband as your bed will have pillows everywhere!

• Seated position

Though not considered the most comfortable or ideal position, some women may prefer to just fall asleep seated, at least for some parts of the night.

This is, of course, up to the individual but there is nothing to worry about and it is considered perfectly safe for you to sleep in this position if you please.

Well, ladies, the sleep problems during pregnancy are beyond any doubt not something to look forward to. You would have expected the eyebags and lack of sleep after the arrival of your bundle of joy.

Sorry to be the bearer of bad news but it’s almost as, if not more, difficult to get the sandman to come by when you are pregnant.

Don’t feel bad about it though, it’s all part and parcel of the roller-coaster ride that goes on for nine good months.

Dr Chee has provided you with all the necessary information as well as some useful tips. So do give those tips a try and perhaps, for all you know, you may be out like a light!

When do you seek help when you can’t sleep?

It’s common for sleep problems to arise during pregnancy, but there are instances when seeking help becomes necessary.

If you find that your sleep difficulties persist and significantly impact your daily functioning and overall well-being, it’s important to reach out to your healthcare provider.

Additionally, if your sleep problems are accompanied by severe symptoms such as intense anxiety, depression, or persistent insomnia, professional assistance should be sought.

Your healthcare provider can provide personalised guidance, offer solutions tailored to your specific needs, and ensure the well-being of both you and your growing baby.

ALSO READ: Sleeping on the back during pregnancy third trimester linked to low birth weight: Study

This article was first published in theAsianparent.