Can Insomnia Be an Early Sign of Pregnancy?

People who are pregnant often experience insomnia, or trouble falling or staying asleep. Though it can occur in the first trimester, insomnia is not a reliable indication that you are pregnant. It is most common in the third trimester.

Insomnia in pregnancy is a result of changes in hormone levels and symptoms of pregnancy that can interrupt a good night’s sleep, such as heartburn, leg cramps, or the frequent need to urinate. Insomnia is also the most common sleep disorder, affecting millions of people of all sexes and ages—pregnant or not.

This article explores insomnia during early pregnancy, including why it occurs and how it changes as the weeks pass. It also offers tips for getting a proper night’s rest if you are struggling with sleep during pregnancy.

Sleep Changes in Early Pregnancy

The first trimester of pregnancy involves many changes to a person's body, some of which occur soon after conception. A handful of these changes can interrupt sleep either directly or indirectly, leading to insomnia.

During the first 12 weeks of pregnancy, the hormones progesterone and estrogen skyrocket to prepare the uterus for gestation (the process of carrying the fetus to term). Progesterone in particular can affect sleep in two ways:

• Daytime sleepiness: Progesterone is known to be sleep-inducing, which is why those who are ovulating often feel sleepy. This is problematic because daytime sleepiness and napping can affect your ability to remain asleep at night.
• Fragmented sleep: Progesterone also causes nocturnal sleep fragmentation, meaning that you will wake up repeatedly during the night and feel less refreshed the next morning.

Even if you are exhausted, your inability to have uninterrupted sleep can create a worsening cycle of daytime sleepiness and nighttime awakening. Studies suggest that progesterone-induced daytime sleepiness affects up to 37.5% of pregnant people during the first six to seven weeks of pregnancy.

Other factors can also contribute to sleep problems during the first trimester, including:

• Morning sickness
• Frequent urination
• Back pain
• Breast tenderness
• Increased appetite
• Anxiety

Sleep Changes in Later Pregnancy

Sleep patterns tend to improve during the second trimester as your body adapts to the elevated levels of progesterone. However, they can start to worsen again the closer you get to your delivery date.

One of the reasons for this is an increase in the hormone oxytocin, which helps trigger uterine contractions prior to and during labor. During the third trimester, oxytocin levels will peak at night and may cause sleep fragmentation in the same way as progesterone.

On top of this, the increased pressure placed on the body by the growing fetus can directly and indirectly affect the urinary, digestive, and respiratory tracts, increasing the risk of:

• Acid reflux
• Chronic back pain
• Leg cramps
• Frequent nighttime urination
• Snoring
• Obstructive sleep apnea

All of these can interfere with sleep and contribute to worsening sleep deficit and sleep deprivation.

Managing Insomnia During Pregnancy

If you have insomnia, no matter the reason, you should seek help to sleep better. Poor sleep, over time, can contribute to complications for both you and your fetus.

For temporary relief, you can use over-the-counter or prescription sleep medications, but speak with your healthcare provider first to ensure they are appropriate for you.

You may fare better by making certain changes in your daily lifestyle and habits, including:

• Staying active: Doing appropriate exercise can improve energy levels and feelings of well-being during the day. Taking a long walk or doing gentle exercise before bedtime can promote better sleep.
• Eating and drinking right: Avoiding acidic, spicy, and fatty foods can help reduce the risk of acid reflux. Eating slowly can help do the same. You should also limit the intake of fluids a couple of hours before bedtime, including caffeine which affects sleep and promotes urination.
• Improving your sleep hygiene: This is a daily routine used to correct poor sleep habits. It includes ensuring your bedroom is quiet and dark, room temperature is cool, and electronics are turned off well in advance of bedtime.

Sleep Study

If your trouble sleeping persists, seek an evaluation by a board-certified sleep physician. If needed, your doctor can arrange a sleep study to identify the causes of the disturbance, such as sleep apnea. In addition, they can sort out contributions from stress, anxiety, pain, and other issues. 

Therapy

Since some medications may not be safe to use during pregnancy, you may want to try other solutions. Cognitive behavioral therapy for insomnia (CBTI) is an option to fix the condition without relying on sleeping pills. This education program teaches you a set of skills that will help you to sleep better for the rest of your life, no matter the cause of insomnia.

You can use our Doctor Discussion Guide below to start a conversation with a healthcare professional about the proper treatment approach for you.

Insomnia Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Download PDF

Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.

Email Address

Sign Up

You're in!

Thank you, {{form.email}}, for signing up.

There was an error. Please try again.

Summary

While insomnia is common in early pregnancy, it is not a reliable indicator that you could be pregnant. That's because insomnia can affect anyone for a variety of reasons, pregnant or not.

A Word From Verywell

Although insomnia is not an indicator of pregnancy, it is common and can be a significant issue for some people throughout the pregnancy. I recommend patients try conservative measures and lifestyle changes first to help with sleep. If these don't work, medication options are available, but be mindful that some medications are not recommended during pregnancy.

— CORDELIA NWANKWO, MD, MEDICAL EXPERT BOARD