Sleep in pregnancy: tips for each trimester and when to seek help
Poor sleep is one of the most common complaints throughout pregnancy, and it tends to get harder as the months go on. But the reasons your sleep is disrupted shift from trimester to trimester, so what helps changes too. This article walks through each stage, explains what is driving the problem and offers practical things you can try, including guidance on sleep position from 28 weeks onward and what to discuss with your midwife if sleep becomes a serious issue.
Why pregnancy changes your sleep
Several things conspire against good sleep in pregnancy, and understanding them can make it easier to target the right solution.
Progesterone rises sharply from the moment you conceive. It causes the deep daytime fatigue most people notice in early pregnancy, but it also fragments night-time sleep by altering normal sleep architecture, particularly reducing the quality of deep slow-wave sleep. Progesterone also increases the vividness of dreams and the frequency of waking.
A growing bump makes it progressively harder to find a comfortable position. As the uterus expands it puts pressure on the bladder, which adds to the frequency of night waking for the toilet. Later in pregnancy it can also restrict breathing slightly when lying flat and press on the inferior vena cava, the large vein that returns blood from the lower body to the heart.
Reflux and heartburn become more common as pregnancy hormones relax the valve between the oesophagus and stomach, and as the growing uterus pushes upward against the stomach. Lying down makes reflux worse, which often makes the second half of the night particularly uncomfortable.
Restless legs syndrome (RLS) affects roughly one in five pregnant women and tends to peak in the third trimester. It causes an irresistible urge to move the legs, typically in the evenings and at night, which makes it very difficult to settle.
Anxiety about the pregnancy, the birth, or becoming a parent is extremely common and is one of the most overlooked reasons for pregnancy insomnia. A busy, worrying mind in the small hours is a real and significant cause of sleep disruption, not a sign of weakness.
First trimester: exhaustion by day, disrupted nights
The first trimester can feel like a strange contradiction: you are more tired than you have ever been, yet you may not be sleeping any better. The extreme daytime fatigue is driven largely by rising progesterone and the enormous amount of work your body is doing in the earliest weeks of development. Falling asleep at your desk, on the sofa or at any quiet moment is entirely normal and is not a sign that anything is wrong.
At night, the same progesterone that tires you out also fragments your sleep architecture. You may find yourself waking frequently, sleeping lightly and feeling unrested even after a full night. Vivid, strange or unsettling dreams are also very common in the first trimester and are a well-recognised effect of the hormonal shifts happening in your body.
Frequent urination starts earlier than most people expect. The hormone hCG, which peaks around eight to ten weeks, causes increased blood flow to the kidneys, and the overall increase in blood volume means your kidneys are filtering more fluid. This can mean several trips to the bathroom each night even before the bump is large enough to press on the bladder.
Nausea, which peaks in the first trimester, can also disturb sleep, particularly if it strikes in the night or early morning. Keeping a plain biscuit or cracker by the bed to eat before you get up can help.
The practical advice for the first trimester is relatively simple: rest whenever you can without guilt, go to bed earlier if you need to, and try not to fight the fatigue. This phase passes for most people by around 14 to 16 weeks.
Second trimester: often better, and a good time to build good habits
The second trimester is usually the best sleep window in pregnancy. Progesterone has levelled off a little, the worst of the nausea has often passed, and the bump is not yet large enough to cause significant positional discomfort. Many people find they sleep more soundly in weeks 14 to 28 than at any other point in their pregnancy.
Round ligament pain, a sharp or stretching sensation on one or both sides of the lower abdomen caused by the ligaments supporting the growing uterus, can cause brief night waking but is generally not severe. It tends to ease when you change position slowly rather than quickly.
The second trimester is a genuinely good time to establish the sleep habits that will serve you well in the harder months ahead. A consistent wind-down routine, a cool and dark bedroom, limiting screen time in the hour before bed, and avoiding large meals close to bedtime are all worth building in now. These are the foundations of good sleep hygiene and they become more valuable as the third trimester brings more disruption.
Third trimester: the hardest stage
The third trimester is when sleep tends to become genuinely difficult for most pregnant women. Multiple things are happening at once and any one of them could disrupt a good night; in combination they can make sleep feel like an almost impossible task. It helps to know that this is universal and that each individual problem has something you can try.
Back pain and hip pain
The increased weight of the bump, combined with the softening effect that relaxin has on the joints and ligaments of the pelvis, means many women experience significant low back pain and hip pain in the third trimester. This is often worst at night because you have been on your feet all day and lying still allows the discomfort to become harder to ignore. A pregnancy pillow (see the section below on positioning) is the single most useful thing for most people with pregnancy hip and back pain at night.
Heartburn and reflux
Reflux tends to worsen in the third trimester as the uterus pushes further up toward the diaphragm. Lying flat makes it worse. Eating your evening meal earlier, avoiding large or fatty meals close to bedtime, and propping up the head end of your bed by a few inches (either by raising the bedframe or using extra pillows) can all help. Cold milk can provide short-term relief. If heartburn is persistent or severe, speak to your midwife: antacids such as Gaviscon are generally considered safe in pregnancy, but it is worth getting advice on the right product and dose for your stage of pregnancy rather than self-selecting.
Frequent urination
As the baby drops lower into the pelvis in preparation for birth, the pressure on the bladder intensifies and night waking for the toilet can become very frequent indeed. There is limited practical help for this beyond avoiding large drinks in the two to three hours before bed and making sure the path to the bathroom is clear and safe in the dark. Cutting fluids too early in the day is not advisable as staying well hydrated throughout pregnancy is important.
Shortness of breath
In the third trimester many women find they become breathless when lying flat as the uterus presses upward against the diaphragm. Sleeping slightly propped up or on your side usually resolves this. If breathlessness is sudden, severe or accompanied by chest pain or a fast heart rate, contact your midwife or maternity unit promptly, as this needs assessing.
Fetal movement at night
Your baby's activity often feels most pronounced at night, partly because you are less distracted and partly because some babies are naturally more active during the hours you are trying to sleep. While reassuring, this can make it hard to drop off or stay asleep. If you are ever worried that you have not felt your baby move in the way you usually would, do not wait until morning. Contact your midwife or maternity unit. The "Count the kicks" guidance from Tommy's recommends getting familiar with your baby's normal pattern of movement from around 24 weeks so you can notice any change.
Sleep position in pregnancy: the guidance from 28 weeks
From around 28 weeks of pregnancy, NHS and Tommy's guidance is to go to sleep on your side rather than on your back. Both the left and right sides are fine. Research carried out as part of the Tommy's Sleep On Side campaign found that going to sleep on your back from 28 weeks was associated with a slightly higher risk of stillbirth, compared with going to sleep on your side. The most likely reason is that the weight of the pregnant uterus can press on the inferior vena cava, a large vein running along the right side of the spine, reducing the return of blood to the heart and therefore to the baby.
This is important information, and it is also worth being clear about the reassuring part: if you wake up during the night and find you are on your back, simply roll onto your side and go back to sleep. The research focuses on the going-to-sleep position, not on every moment of the night. It is perfectly normal to shift positions during sleep and waking on your back occasionally is not something to be frightened about. If you find it helpful, placing a pillow behind your lower back can act as a gentle barrier to rolling fully flat.
Before 28 weeks there is no specific guidance on sleep position, and sleeping in whatever position is most comfortable is the right approach.
Pillows and positioning
The right pillow arrangement can make a significant difference, particularly in the second half of pregnancy. The goal is to support the bump, keep the hips level and take pressure off the lower back.
A full-length pregnancy pillow (sometimes called a body pillow or a U-shaped or C-shaped pregnancy pillow) allows you to support your bump from the front and your back at the same time, and is widely regarded as the most comfortable solution by many pregnant women in the third trimester. They are available from most baby retailers and online.
If you prefer to use ordinary pillows, a common arrangement is: one pillow placed between your knees to keep the hips aligned, and one pillow tucked under the bump to support its weight. A rolled-up towel or small pillow behind your lower back can also help prevent rolling onto your back during sleep.
Experiment with what works for you. The best position is the one you can actually sleep in.
Restless legs syndrome in pregnancy
Restless legs syndrome (RLS) is a neurological condition that causes an uncomfortable, crawling or tingling sensation in the legs and an almost irresistible urge to move them, usually in the evenings or at night. In pregnancy, it affects roughly 20 to 25% of women and tends to be most intense in the third trimester, though it can begin earlier.
The connection to pregnancy is thought to involve both iron and folate. Iron deficiency is one of the best-established risk factors for RLS, and the increased iron demands of pregnancy mean that many women's ferritin levels are lower in the third trimester than they would otherwise be. If you are experiencing RLS, mention it to your midwife or GP so they can check your ferritin level (a measure of stored iron) alongside your haemoglobin. Correcting iron deficiency, if it is present, often reduces or resolves the symptoms. Folate deficiency is also associated with RLS, and ensuring adequate folate intake is worthwhile regardless.
Some women find that magnesium supplements provide relief, though the evidence is mixed. Discuss this with your midwife before starting any supplement in pregnancy. Simple non-drug measures that can help include gentle calf and leg stretches before bed, a warm bath, avoiding caffeine in the afternoon and evening and getting regular moderate exercise during the day.
The reassuring news is that pregnancy-related RLS usually resolves within a few weeks of delivery.
Heartburn and reflux: a closer look
If reflux is a significant problem at night, a slightly more systematic approach can help. The underlying issue is that the muscular valve between the oesophagus and the stomach is relaxed by pregnancy hormones and the upward pressure from the growing uterus means stomach acid can more easily travel back up.
Practical steps that help many people include: eating your last meal of the day at least two to three hours before going to bed; keeping portions smaller and avoiding rich, fatty or spicy foods in the evening; elevating the head of the bed by about 10 to 15 cm by placing blocks or books under the feet of the bedframe, or by using a wedge pillow under the mattress; and drinking cold milk for short-term symptom relief.
If these measures are not enough, speak to your midwife about antacids. Alginate-based antacids (such as Gaviscon) are widely used in pregnancy and considered safe, but the guidance on which preparation to use can depend on your stage of pregnancy, so it is worth asking rather than choosing off the shelf.
Anxiety and sleeplessness
Anxiety is one of the most common but least-acknowledged causes of poor sleep in pregnancy. Worry about the health of the baby, about the birth, about finances, about becoming a parent, or simply the free-floating anxiety that can accompany any major life change is entirely understandable and extremely common.
When anxiety is driving your sleeplessness, the usual sleep hygiene advice can feel insufficient because the problem is not really about the bedroom environment, it is about a mind that will not stop. Cognitive behavioural therapy for insomnia (CBT-I) is the most evidence-based approach available and works by identifying and gently challenging the thought patterns and behaviours that maintain insomnia, rather than simply sedating them. CBT-I is considered safe and appropriate during pregnancy and is often available through your GP, through the NHS IAPT (Improving Access to Psychological Therapies) service, or through evidence-based apps and self-help guides.
Simple practices that can help in the short term include writing down worries before bed rather than letting them circle in your mind, keeping a consistent wake time regardless of how the night went (this helps regulate the body clock), and using relaxation or breathing exercises when you wake in the night. If anxiety feels severe, persistent or is significantly affecting your quality of life, please tell your midwife. Antenatal anxiety is treatable and your care team is there to help.
When to speak to your midwife or GP
Most sleep disruption in pregnancy is a normal part of the experience and does not need urgent medical attention. But there are situations where you should reach out to your midwife or GP rather than waiting for a routine appointment.
- You are not sleeping at all for several consecutive nights and are finding it impossible to function. This level of sleep deprivation needs assessment.
- Restless legs is severe and stopping you from sleeping at all, or is present throughout the day as well as at night. A ferritin check and further support are warranted.
- Your partner tells you that you snore loudly, gasp for breath or have pauses in your breathing during sleep. These are signs of obstructive sleep apnoea (OSA), which is more common in pregnancy and is associated with an increased risk of pre-eclampsia and gestational diabetes. It should be assessed by your midwife or GP promptly.
- You have not felt your baby move in the way you would normally expect. Reduced or changed fetal movement is always worth reporting to your maternity unit, day or night, regardless of what time it is.
- Anxiety about sleep or about the pregnancy is feeling unmanageable. This is exactly what your midwife is there to help with.
Over-the-counter sleeping tablets and sedating antihistamines are generally not recommended in pregnancy and should not be taken without discussing them with your GP first. If sleep deprivation is severe enough to need medication, your doctor can advise on whether there is anything appropriate and what the risks and benefits are at your stage of pregnancy.
Frequently asked questions
Is it safe to sleep on my back in pregnancy?
From around 28 weeks, it is recommended to go to sleep on your side rather than on your back. Research from Tommy's found that going to sleep on your back from 28 weeks was associated with a slightly higher risk of stillbirth, likely because the weight of the uterus can press on a large vein and reduce blood flow. If you wake up on your back, simply roll onto your side and go back to sleep. There is no need to be alarmed if this happens; the guidance is about your going-to-sleep position.
Which side is better to sleep on in pregnancy?
Both the left and right sides are fine. The NHS and Tommy's both confirm that either side is a good choice. The important thing is going to sleep on your side from 28 weeks rather than on your back, not which particular side you choose.
Why can't I sleep in the first trimester?
Progesterone rises sharply in early pregnancy and disrupts sleep architecture, causing vivid dreams and frequent waking. On top of that, hCG increases blood flow to the kidneys and causes frequent urination even before the bump is large. Nausea and anxiety about the pregnancy add to the picture. This tends to improve by the second trimester for most people.
What helps with restless legs in pregnancy?
Mention it to your midwife or GP so they can check your ferritin level and folate status, as iron deficiency is a common cause. Gentle calf stretches before bed, a warm bath and avoiding caffeine in the afternoon and evening can all help. Magnesium may offer some relief but check with your midwife first. RLS usually resolves after delivery.
Can I take sleeping tablets in pregnancy?
Most over-the-counter sleeping aids are not recommended in pregnancy. If poor sleep is significantly affecting you, speak to your GP or midwife rather than self-medicating. Cognitive behavioural therapy for insomnia (CBT-I) is an effective, evidence-based and pregnancy-safe alternative that your GP can refer you to.
What should I do if I wake up on my back in pregnancy?
Simply roll onto your side and go back to sleep. The guidance about side sleeping from 28 weeks is about the position you go to sleep in, not about every moment of the night. Shifting position during sleep is normal and waking on your back occasionally is not something to worry about. A pillow placed behind your back can help prevent rolling fully flat if you find that reassuring.
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