--- title: 'How Pregnancy Affects Your Sleep' slug: how-pregnancy-affects-your-sleep-2 lifeStage: pregnancy category: Sleep medicalReviewer: reviewerId: 'https://blog.bloume.com/pregnancy/medical-board.md#' lastUpdated: '2026-06-23' primarySource: 'RCOG – The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum' --- # How Pregnancy Affects Your Sleep Sleep shifts considerably across all three trimesters of pregnancy. Fatigue and nausea in the first trimester, vivid dreams in the second, and back pain, heartburn, and restlessness in the third can all affect how well you rest. This article explains what drives those changes at each stage, what you can do to manage them, and when it is worth speaking to your midwife or GP. **Q: Is it normal to sleep more than usual in early pregnancy?** A: Yes. Progesterone rises sharply in the first trimester, and one of the effects you are likely to notice is a pull toward more sleep than usual. This is a common and expected response to early pregnancy. If your fatigue feels severe or comes with other symptoms that concern you, mention it at your next antenatal appointment. 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. ## 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. ## 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. ## 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. ## 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. ## 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. --- **Q: Is it normal to sleep more than usual in early pregnancy?** Yes. Progesterone rises sharply in the first trimester, and one of the effects you are likely to notice is a pull toward more sleep than usual. This is a common and expected response to early pregnancy. If your fatigue feels severe or comes with other symptoms that concern you, mention it at your next antenatal appointment. **Q: What sleep position is safest after 28 weeks?** After 28 weeks, the guidance is to go to sleep on your side, left or right, rather than on your back. This applies to the position you fall asleep in. If you wake up on your back during the night, just roll onto your side and go back to sleep. For a full explanation of the evidence, visit Tommy's or NHS guidance on sleep position in pregnancy. **Q: Can I take a sleep aid or over-the-counter remedy for insomnia in pregnancy?** Do not take any sleep medication, including anything bought over the counter, without speaking to your GP or midwife first. Sedative medications are generally avoided in pregnancy. If your insomnia is persistent, ask your GP about Cognitive Behavioural Therapy for Insomnia (CBT-I), which is the recommended first-line approach and is considered safe in pregnancy. **Q: What are the signs that snoring or disturbed breathing in pregnancy needs medical attention?** Loud snoring, breathing pauses that a partner has noticed, and excessive daytime sleepiness can all point to obstructive sleep apnoea (OSA). In pregnancy, OSA is associated with serious complications including pre-eclampsia and restricted foetal growth. If you are experiencing any of these, raise them with your midwife or GP as soon as you can, as it needs clinical assessment. **Q: How can restless legs at night be managed during pregnancy?** Restless legs syndrome in pregnancy is thought to be linked to low iron and folate levels. Speak to your midwife or GP, who can check your levels and advise on next steps. Do not start any iron or folate supplement without guidance, as the right dose in pregnancy is a clinical decision. ### Clinical Sources - [RCOG – The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum](https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/the-management-of-nausea-and-vomiting-of-pregnancy-and-hyperemesis-gravidarum-green-top-guideline-no-69/) - [Restless Legs Syndrome in Pregnancy – NHS](https://www.nhs.uk/conditions/restless-legs-syndrome/) - [Antenatal and Postnatal Mental Health – NICE Clinical Guideline CG192](https://www.nice.org.uk/guidance/cg192) - [NHS: Indigestion and heartburn in pregnancy](https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/indigestion-and-heartburn/) - [NICE Guideline on Insomnia – NG215](https://www.nice.org.uk/guidance/ng215)