Growing a human is exhausting. So why is sleep so hard to come by? From the right sleeping position to restless legs, snoring, heartburn, and 3am overthinking.
You are not imagining it, and you are not alone. Research consistently shows that the vast majority of pregnant women experience meaningful sleep disruption at some point, and for many, it starts earlier than they expect and lingers longer than they’d like.
What’s actually happening to your sleep
Pregnancy changes how comfortable it is to lie down, but also fundamentally alters your sleep architecture; the structure of how you cycle through light sleep, deep sleep, and REM sleep across the night.
In the first trimester, rising progesterone levels cause excessive daytime sleepiness, but paradoxically also fragment night-time sleep, meaning you might feel exhausted and still not sleep well. By the third trimester, sleep fragmentation tends to increase significantly, driven by physical discomfort, frequent urination, foetal movement, and heightened anxiety as birth approaches.
There’s also a strong connection between sleep and mood that runs in both directions: poor sleep increases the risk of prenatal anxiety and depression. Disrupted sleep during pregnancy has also been linked to a higher risk of gestational diabetes, preeclampsia, preterm birth, and longer labour, which is not meant to alarm you, but is a good reason to treat sleep as a genuine health priority rather than a luxury.
Sleep positions: what the research actually says
This is probably the question pregnant women ask most, as well as the one that generates the most anxiety. The short version: position matters more as pregnancy progresses, and the research has evolved in the last few years in ways worth knowing about.
Left side
Sleeping on your left side with knees slightly bent is widely recommended by midwives and obstetricians, particularly from the second trimester onwards. It promotes optimal blood flow to the placenta and reduces pressure on the inferior vena cava (the major vein that returns blood to your heart). It also helps with heartburn.
Right side
Here’s an update that may take some pressure off: a 2025 study in the Canadian Medical Association Journal found that sleeping on your right side is considered equally safe after 28 weeks. This is a meaningful shift from earlier guidance that strongly preferred the left. Switching sides throughout the night to relieve pressure on your hips is totally fine.
Back sleeping
After around 20 weeks, the growing uterus can press on the inferior vena cava when you lie flat, potentially reducing circulation and causing dizziness or shortness of breath. Research across six separate trials has shown that going to sleep on your back in the third trimester is associated with an increased risk of stillbirth. Which is why the guidance from 28 weeks onwards is clear: go to sleep on your side. If you wake up on your back, don’t panic, simply roll back onto your side.
Stomach sleeping
Safe in the very early weeks, but most women find this naturally becomes impossible as the bump grows.
>> On pillows: A good pregnancy pillow is not a gimmick. C-shaped and U-shaped maternity pillows support your back, belly, and knees simultaneously, reduce the likelihood of rolling onto your back, and make side sleeping more comfortable. If a full body pillow feels excessive, a wedge pillow under the bump and a regular pillow between the knees covers most of the same ground at lower cost.
The most common sleep disruptors — and what to do about them
Frequent urination
The kidneys work harder during pregnancy, and the growing uterus puts increasing pressure on the bladder. Multiple nighttime bathroom trips are almost universal by the third trimester.
Reduce fluid intake in the 1–2 hours before bed, but make sure you’re well hydrated through the day so you’re not playing catch-up at night. Always do a bathroom trip immediately before getting into bed. Sleeping on your left side can also slightly reduce the pressure on the bladder.
Heartburn and reflux
Progesterone relaxes the valve between the oesophagus and stomach, allowing acid to move upward, which gets significantly worse as the uterus grows and pushes against the stomach. Lying down makes it considerably worse, which is why it tends to be a nighttime problem.
Eat smaller, more frequent meals rather than large ones. Avoid spicy, fatty, or acidic foods in the evening. Don’t lie down within two hours of eating. Sleeping on your left side also helps keep acid down. Speak to your midwife or GP about safe antacids if symptoms are severe.
Restless legs syndrome (RLS)
An overwhelming urge to move your legs, often accompanied by crawling, tingling, or aching sensations, that gets worse when you’re still and typically peaks in the evening and at night. RLS affects a significant proportion of pregnant women, particularly in the third trimester, and is one of the most frustrating sleep disruptors because lying down is exactly what triggers it. It’s closely linked to iron deficiency, which is common in pregnancy.
Talk to your midwife or doctor about checking your iron and folate levels, and supplementing if these are low. Gentle stretching before bed, a warm bath, and light massage can help in the moment. Walking or moving the legs when symptoms strike provides temporary relief.
Leg cramps
Sudden, sharp muscle cramps, that jolt you awake. More common in the second and third trimesters, and often worse at night.
Gentle calf stretches before bed. Ask your midwife about calcium and magnesium supplementation. When a cramp strikes, flex your foot upward (toes toward your shin) and push your heel away — this straightens the calf muscle and usually eases the cramp quickly.
Back pain and hip pain
The ligaments soften and the centre of gravity shifts as the bump grows, putting significant strain on the lower back and hips. This can make it very hard to find a comfortable position, and the pain tends to worsen after lying still for a while.
A pillow between the knees reduces strain on the hips when side sleeping. A pillow under the bump adds support. A pregnancy support belt worn during the day can reduce pelvic girdle pain that affects nighttime comfort. Prenatal yoga and gentle stretching help maintain the muscles that support the pelvis. If pain is severe, a referral to a physiotherapist who specialises in pregnancy is worth asking for.
Snoring and sleep apnea
Nasal congestion is common in pregnancy due to hormonal changes that cause the nasal tissue to swell, and this, combined with the weight changes and positional shifts of pregnancy, means snoring becomes significantly more likely. In some cases, this tips into obstructive sleep apnea (OSA), where breathing is repeatedly interrupted during sleep.
Nasal strips or a saline rinse can help with congestion. If you’re told you snore loudly, wake gasping, or feel extremely fatigued despite sleeping, mention it to your midwife or GP.
Vivid dreams and nightmares
Many pregnant women report intense, sometimes disturbing dreams, often about the baby, the birth, or becoming a parent. This is thought to be related to hormonal changes and the increased time spent in REM sleep, combined with the emotional processing of a major life transition.
These are normal and don’t indicate anything is wrong. Talking about anxieties and fears during the day with a partner, a midwife, or a counsellor, rather than pushing them down can reduce the intensity. A grounding pre-sleep routine helps signal safety to the nervous system before bed.
Anxiety and a racing mind
Pregnancy is one of the biggest transitions a person can go through, and the mind tends to do its worrying at night when there are no distractions. Concerns about the birth, the baby’s health, finances, relationships, and what parenthood will mean are all entirely normal, but they can make switching off genuinely difficult.
Cognitive Behavioural Therapy for Insomnia (CBT-I) has strong evidence and is the preferred treatment for pregnancy-related insomnia. Ask your GP for a referral or look for a therapist who specialises in it. A consistent wind-down routine, limiting news and screens in the hour before bed, and writing worries down (to mentally “park” them until morning) all help. If anxiety feels unmanageable, please speak to your midwife or GP. Prenatal anxiety is common and very treatable.
Building a sleep environment and routine that actually works
Evidence-based sleep hygiene for pregnancy
- Keep your room cool and dark. Body temperature rises during pregnancy; a cooler room (around 18–20°C) significantly improves sleep quality. Blackout curtains or a sleep mask help.
- Establish a consistent wind-down routine. A warm shower or bath, gentle stretching, and a consistent sequence of pre-sleep activities trains your nervous system to associate them with sleep.
- Limit screens for an hour before bed. Blue light suppresses melatonin production. This matters more during pregnancy when melatonin is already fluctuating.
- Don’t lie in bed awake for long periods. If you can’t sleep after 20 minutes, get up and do something calm in dim light until you feel sleepy, lying awake in bed trains the brain to associate the bed with wakefulness.
- Limit caffeine after midday. Caffeine has a longer half-life than most people realise and pregnancy slows its metabolism further. A 3pm coffee may still be affecting your sleep at 11pm.
- Nap strategically. Short naps (20–30 minutes) before 3pm can address daytime fatigue without interfering significantly with nighttime sleep. Longer naps later in the day tend to make nighttime insomnia worse.
- Stay gently active. Regular walking or prenatal yoga has been shown in a 2025 meta-analysis to meaningfully improve self-reported sleep quality during pregnancy. Even a 20-minute walk during the day helps.
- Eat a small, balanced snack before bed if needed. Low blood sugar can cause nighttime waking. A small protein-rich snack like Greek yoghurt, a banana with nut butter, can help stabilise blood sugar through the night.
When to talk to your midwife or GP about sleep
- Sleep problems that persist for more than a few weeks despite trying lifestyle changes
- Daytime functioning is significantly impaired, you’re struggling to concentrate, drive safely, or manage daily life
- You or your partner have noticed loud snoring, gasping, or periods where your breathing stops during sleep
- Restless legs or leg cramps are severe and happening every night
- Sleep problems are accompanied by low mood, hopelessness, or significant anxiety
- You’re considering taking any medication or supplement — prescription, OTC, or herbal — to help you sleep
Share this page
BUMP&baby
BUMP & baby is New Zealand’s only magazine for pregnancy and early babyhood. Our team of mums and mums-to-be understand what it’s like to be pregnant in this connected age, and that’s why BUMP & Baby online is geared toward what pregnant women and new mums really want to know.
Other articles of interest
How we learned to detect pregnancy
Pregnancy tests today feel almost ordinary. A tiny stick, a few quiet minutes, and an answer. But […]
