You may sleep well during the first trimester of your pregnancy. You may also need more sleep than usual. Your body is working hard to make a baby. So you may tire easily. But later in your pregnancy, you may have a hard time sleeping well.

Prenatal care - sleeping; Pregnancy care - sleeping

Your baby is growing bigger, which can make it hard to find a good sleeping position. If you have always been a back- or stomach-sleeper, you might have trouble getting used to sleeping on your side (as health care providers recommend). Also, shifting around in bed becomes harder as you get bigger.

Other things that may keep you from sleeping include:

• More trips to the bathroom. Your kidneys are working harder to filter the extra blood your body is making. This results in more urine. Also, as your baby grows, there is more pressure on your bladder. This means a lot more trips to the bathroom.
• Increased heart rate. Your heart rate increases during pregnancy to pump more blood. This may make it harder to sleep.
• Shortness of breath. At first, pregnancy hormones can make you breathe more deeply. This might make you feel like you're working harder to get air. Also, as your baby takes up more space, it can put more pressure on your diaphragm (the muscle just below your lungs).
• Aches and pains.Pains in your legs or back are caused in part by the extra weight you are carrying.
• Heartburn. During pregnancy, the entire digestive system slows down. Food stays in the stomach and bowels longer. This may cause heartburn, which is often worse at night. Constipation may also occur.
• Stress and dreams. Many pregnant women worry about their baby or about becoming a parent, which can make it hard to sleep. Vivid dreams and nightmares are common during pregnancy. Dreaming and worrying more than usual is normal, but try not to let it keep you up at night.
• Increased baby activity at night.

Try sleeping on your side. Lying on your side with your knees bent will likely be the most comfortable position. It makes it easier for your heart to pump because it keeps your baby from putting pressure on the large vein that carries blood back to the heart from your legs.

Many providers tell pregnant women to sleep on their left side. Sleeping on their left side also improves blood flow among the heart, fetus, uterus, and kidneys. It also keeps pressure off your liver. If your left hip becomes too uncomfortable, it is OK to switch to your right side for a while. It is best not to sleep flat on your back.

Try using pillows under your belly or between your legs. Also, using a bunched-up pillow or rolled-up blanket at the small of your back may relieve some pressure. You can also try an egg crate type of mattress on your side of the bed to give some relief for sore hips. It also helps to have extra pillows available to support your body.

These tips will safely improve your chances of getting a good night's sleep.

• Cut out or limit drinks like soda, coffee, and tea. These drinks have caffeine and will make it harder for you to sleep.
• Avoid drinking a lot of fluids or eating a big meal within a few hours of going to bed. Some women find it helpful to eat a big breakfast and lunch, then have a smaller dinner.
• If nausea keeps you up, eat a few crackers before you go to bed.
• Try going to bed and waking up at the same time each day.
• Avoid exercise right before you go to bed.
• Do something to relax before you go to bed. Try soaking in a warm bath for 15 minutes, or having a warm, caffeine-free drink, like milk.
• If a leg cramp wakes you up, press your feet hard against the wall or stand on the leg. You may also ask your provider for a prescription that can help alleviate leg cramps.
• Take short naps during the day to make up for lost sleep at night.

If stress or anxiety about becoming a parent is keeping you from getting a good night's sleep, try:

• Taking a childbirth class to help you prepare for the life changes ahead
• Talking to your provider about techniques to deal with stress

Do not take any sleep aids. This includes over-the-counter medicines and herbal products. They are not recommended for pregnant women. Do not take any medicines for any reason without talking to your provider.

Antony KM, Racusin DA, Aagaard K, Dildy GA. Maternal physiology. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 3.

Balserak BI, O'Brien LM, Bei B. Sleep and sleep disorders associated with pregnancy. In: Kryger M, Roth T, Goldstein CA, Dement WC, eds. Principles and Practice of Sleep Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 186.