The heaviness that settles in during the first weeks, the restless nights of the third trimester, the tiredness that lingers even after a full night in bed. Disrupted sleep is one of the most commonly reported experiences of pregnancy. The reasons shift as your pregnancy progresses, and so do the things that can help.
The first trimester: fatigue, nausea, and night-time wake-ups
In the first trimester, the quality of your sleep often dips.
Nausea affects up to 80% of pregnant women and can arrive at any hour, not just in the morning. When it wakes you at 2am or stops you drifting back off, it chips away at your total sleep time. For most, this eases by the end of the first trimester, with the worst of it typically falling between weeks six and ten.1
The second trimester: a window of better rest
The second trimester often brings a welcome shift. Nausea tends to ease, energy levels settle, and falling and staying asleep usually feels easier. You may notice your dreams becoming more vivid or unusual during this time — this is widely reported in pregnancy and generally nothing to worry about. If vivid dreams are distressing you, it is worth mentioning at your next midwife appointment.
The third trimester: the most disruptive stage for sleep
The third trimester is typically when sleep becomes hardest. Heartburn tends to get worse as your pregnancy progresses and can be particularly uncomfortable when you lie flat.
Restless legs syndrome in pregnancy
That uncomfortable urge to move your legs just as you are settling down to sleep is a recognised condition called restless legs syndrome (RLS), and it affects around 26% of pregnant women, most commonly in the third trimester. The sensations tend to be worse at rest and in the evening, which makes falling asleep particularly difficult. In pregnancy, RLS is thought to be linked to low iron and folate levels, as well as raised oestrogen. If this sounds familiar, speak to your midwife or GP, who can check your levels and talk through your options.2
Obstructive sleep apnoea in pregnancy
If you are snoring loudly, if a partner has noticed pauses in your breathing, or if you are feeling excessively sleepy during the day, raise it with your midwife or GP. OSA in pregnancy needs clinical assessment and is not something to try to manage on your own.
Anxiety, low mood, and sleep
Anxiety and depression affect around 15 to 20% of pregnant women and can disrupt sleep across all three trimesters independently of the physical changes. If you are experiencing persistent low mood, worry that feels hard to sit with, or sleep difficulties you think may be connected to how you are feeling, speak to your midwife or GP. Perinatal mental health support is available through the NHS.3
Practical steps to improve sleep during pregnancy
There are several adjustments that can help improve sleep quality without medication:
- For heartburn, try elevating the head of your bed slightly and avoiding large meals or spicy food in the evening. If heartburn is persistent or severe, speak to your midwife or GP before reaching for antacids, as safety in pregnancy is a clinical decision.4
When sleep problems persist: Cognitive Behavioural Therapy for Insomnia
If your sleep difficulties are ongoing or affecting your day-to-day life, Cognitive Behavioural Therapy for Insomnia (CBT-I) is considered a safe, first-line approach for insomnia in pregnancy. Ask your GP about how to access it. Sedative medications and over-the-counter sleep aids are generally avoided during pregnancy, so it is important not to take anything, whether prescribed elsewhere or bought from a pharmacy, without checking with your GP or midwife first.5
Why it is worth raising sleep concerns with your care team
If you are struggling with your mental health after birth, your GP, midwife, or NHS perinatal mental health services can help.