Many pregnant persons say it’s hard to sleep because they can’t get comfortable, need to run to the bathroom constantly, have leg cramps, and are excited and anxious about their baby’s arrival. They often joke that it is to prepare them for things to come…the arrival of their newborn and more sleepless nights and sleep deprivation to come. Nothing could be further from the truth though as being tired and fatigued through lack of sleep during pregnancy, does not prepare them for labour nor dealing with the demands of a newborn and recovery from childbirth.
From the moment a person becomes pregnant, their body is undergoing numerous physiological and biochemical changes. As a result, the potential for sleep disturbances increases (DiCarlo, 2013). Fluctuating hormone levels cause generalised discomfort and other problems like nausea, vomiting, breast tenderness, increased heart rate, shortness breath, higher body temperature, frequent nighttime urination, leg cramps, back pain, and difficulty in finding a comfortable position to sleep in are some factors that can make it difficult to fall asleep and stay asleep. (Pacheco, 2020)
Anxiety about the upcoming labour, transitioning into parenthood, juggling work and home responsibilities and other worries may also keep a pregnant person’s mind racing at night. In the third trimester, vivid and disturbing dreams also plague many pregnant parents (Pacheco, 2020).
Then there are some common sleep disorders that occur in pregnancy. These include obstructive sleep apnea, restless leg syndrome and gastroesophageal reflux disorder. These conditions need the input of a healthcare provider, a medical doctor as there are therapies that have proven effective in treating them. Continuous positive airway pressure (CPAP) device for OSA, antacids for GERD, or vitamin and mineral supplements for RLS and other conditions. Although there are many theories, the reason for leg cramps and RLS during pregnancy remains unclear. Suggested therapies include vitamin supplementation, heat therapy, and massage but there is no consensus about what is the best treatment (Pacheco, 2020)
Here are some statistics.
- Seventy-eight percent (78%) of women have insomnia or other sleep problems during pregnancy.
- Several sleep disorders can be caused or made worse by pregnancy.
- In a study of over 600 pregnant women, 26% reported symptoms of restless legs syndrome (RLS), a condition characterized by unpleasant feelings in the legs that worsen at night and that are relieved by movement.
- 30-50% of pregnant women experience heartburn (gastroesophagealreflux disease (GERD)) almost constantly during pregnancy, which is worse at night while lying down.
It is important for the pregnant parent and baby to get good quality sleep during pregnancy. Sleepless nights can lead to fatigue and daytime sleepiness. Furthermore, sleep plays a major role in memory, learning, appetite, mood, and decision-making. All are pretty important when preparing to welcome a newborn baby (Pacheco, 2020).
Chronic sleep deprivation can take its toll on the immune system and this may be part of the reason why lack of sleep has such a significant impact on maternal and fetal health. Research has revealed that there is a correlation between the amount of sleep pregnant persons get in pregnancy and the risk of developing hypertension, gestational diabetes mellitus, pre-eclampsia, preterm birth, low birth weight babies, longer and more painful labours and 4.5 times increased risk for caesarean section. (Lee and Gay, 2004). Sleeping less than 6 hours a night increases these risks. Furthermore, there is emerging evidence that also suggests that poor sleep quality during pregnancy may predict sleep problems and crying in babies once they are born (National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, 2016).
So, what can we do as doulas, childbirth educators, and new parent educators?
As a postpartum doula and a maternity sleep consultant, I am in a privileged position to be able to help my clients improve their sleep during pregnancy. I often check in on my clients once a month prior to delivery to check in on their progress and answer any questions they may have. If they are experiencing sleep problems, I can help by offering my support as a sleep consultant- this is not medical advice, but tips on how to optimise sleep, advice on good sleep hygiene and a written sleep plan that I have had further training for and am certified to do. I do not diagnose insomnia or any of the possible sleep disorders and advise my clients to see their medical practitioner. If anxiety is an issue and the client is open to talking to me about this, we work out what is causing the anxiety and try to resolve them which may involve referring out to her medical practitioner, other health care professionals, or resources for local Childbirth Education and New Parent Education classes and working out a postpartum plan together to prepare for the birth and postpartum period.
Here are some helpful tips and sleep hygiene information for doulas, CBEs, and NPEs to share with their clients.
The best sleeping position for pregnancy is sleeping on the left side with legs slightly bent (Pacheco, 2020). This position facilitates blood flow to the heart, kidneys, and uterus and improves the delivery of oxygen to the fetus. Sleeping on the right side is also acceptable if it is uncomfortable to sleep on the left. It may be useful to have some extra pillows to support side sleeping. There are many products on the market that clients can try.
- Keep the bedroom very dark, cool temperature between 68 – 72 °F (20 – 22 °C) and quiet. Use a nightlight to make it easier to get back to sleep after bathroom breaks.
- Establish firm boundaries for bedtime. Make the bedroom a sanctuary for relaxation and sleep. Try not to work, watch tv, or any other activity outside of sleep and sex.
- Reduce EMF’s (electromagnetic field) equipment from the bedroom, as studies have shown prolonged exposure can suppress the immune system and disrupt sleep. (Cirino, 2019)
- Keep a journal and pen handy by the bedside to jot down thoughts that may be racing in the mind and preventing sleep from happening. Or if your clients wake in the night and cannot get back to sleep due to having too many thoughts.
- Invite downtime. Make sure your client has downtime on a daily basis where time can be spent relaxing and destressing. Activities include nature walks, yoga, journaling, massage, deep breathing, meditation etc.
- Prioritise sleep and establish a bedtime routine close to 10pm. At 10pm, the body begins repairing itself and being awake slows this process.
- Dim all lights, computer screen, smart phones at least an hour or two before bed. Install dimmer switches on lights where possible. Candlelight may be an option, having these illuminate the house during the hours of bedtime can be very relaxing. However, practice good fire safety and blow the candles out when going to bed.
- Sleeping aid eye pillows, sleep pillows, and mattress toppers can aid comfort and support in bed. Experiment with them to find the best one that will suit your clients’ changing body and posture.
- Eat light meals before bed, or foods that are easily digested. Recognise which foods are anti-sleep and pro-sleep in order to encourage deep sleep and avoid sleep disruption. Avoid caffeine, spicy foods, and heavy meals too close to bedtime to reduce the risk of GERD.
- Eliminate as many stimulants from the diet as possible. This includes caffeine, chocolate, and spices of all kinds. Try limiting grains, beans, and diary later in the day which can be irritating and stimulating to the digestive system. Take vitamin supplements in the morning, as some may have a stimulating effect and disturb sleep if taken in the evening.
- Drink plenty of water throughout the day but reduce liquid intake before bed to reduce nighttime bathroom breaks.
- If sleep is elusive, recommend getting out of bed and doing something else until your client feels sleepy.
- Write down thoughts in a journal.
- Seek help from a partner (if they have one), friends, a doctor, or childbirth classes if they are feeling stressed.
- Get natural unfiltered sunlight. Expose eyes to natural sunlight first thing in the morning for at least 15 minutes if possible. Getting some sunlight on exposed skin is also useful. This will send a strong message to the pineal gland and their internal clock.
Sleep is vital for us to function at our optimum, more so in pregnancy. Sleep helps balance stress hormones. Excessive stress hormones can affect the labour process – delaying or extending labor. Getting at least 6-7 hours of sleep a night will help pregnant persons feel more rested. This may help reduce the risks of some complications in pregnancy, labour and in the postpartum period. Adequate rest in turn will enable them to be more physically and mentally prepared for labour and parenthood. Babies too will benefit, as pregnancy is the perfect time to prepare and establish new sleep habits and for healthy sleep to continue long after baby arrives (Di Carlo, 2013)
*Spelling in the article reflects Canadian/UK version of certain English words.
- Mar Di Carlo, 2013. Getting Stronger for Labor with Sleep – http://maternityinstitute.com/getting-stronger-for-labor-with-sleep/
- Erica Cirino, 2019. Should You Be Worried About EMF Exposure? – https://www.healthline.com/health/emf
- Lee and Gay, 2004. Sleep in late pregnancy predicts length of labour and type of delivery – https://pubmed.ncbi.nlm.nih.gov/15592289/
- Breus, Michael J Ph.D. Poor Sleep Can Lead to Complications at Birth – https://www.psychologytoday.com/us/blog/sleep-newzzz/201308/poor-sleep-in-pregnancy-can-lead-complications-birth
- Pacheco, 2020. Pregnancy and Sleep – https://www.sleepfoundation.org/pregnancy
- National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. (2016, July 15). Tips for Better Sleep. Centers for Disease Control and Prevention. Retrieved October 28, 2020, from https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html
- Carie Nierenberg, 2017. Live Science contributor – https://www.livescience.com/50713-pregnancy-sleep.html
- Ruby P. M. (2011). Experimental research on dreaming: state of the art and neuropsychoanalytic perspectives. Frontiers in psychology, 2, 286. https://doi.org/10.3389/fpsyg.2011.00286
- Lee and Gay , 2004. Sleep in late pregnancy predicts length of labour and type of delivery – https://pubmed.ncbi.nlm.nih.gov/15592289/
- Aurora, R. N., Zak, R. S., Auerbach, S. H., Casey, K. R., Chowdhuri, S., Karippot, A., Maganti, R. K., Ramar, K., Kristo, D. A., Bista, S. R., Lamm, C. I., Morgenthaler, T. I., Standards of Practice Committee, & American Academy of Sleep Medicine (2010). Best practice guide for the treatment of nightmare disorder in adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 6(4), 389–401. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919672/
- A.D.A.M. Medical Encyclopedia. (2018, March 26). Nightmares. Retrieved October 14, 2020, from https://medlineplus.gov/ency/article/003209.htm
- Edwards, S. (Summer 2014). Remembering Dreams. On The Brain (Vol. 20, No. 2). The Harvard Mahoney Neuroscience Institute. Retrieved from
About the Author
Suyin Jordan RGN, RM, CPD, believes in a strong and supportive organization that promotes the view of Doulas as professionals in the Doula field. Her background is evidence-based and her aim is to encourage Doulas to reach their potential, support Doulas who want to achieve certification and engage in continual professional development (CPD), helping them set and achieve their goals.
Suyin speaks several languages including English, Malay, Hokkien, Cantonese and some Mandarin. Her hobbies include Knitting & crochet, scrabble on-line, cooking and healthy eating, yoga, fitness and looking after the family pets. Her mission is to feed the world and make everyone happy (her doula work and her devotion to her family help her achieve this in some small part!). If SuYin could have her life over again she would be a farmer; growing all kinds of produce while looking after the farm and all the farm animals.