Jun 01, 2026

Insomnia During Pregnancy: Causes & Safe Relief

Quick answer: Insomnia during pregnancy is very common — affecting up to 78% of pregnant people by the third trimester — and is caused by hormonal shifts, physical discomfort, anxiety, and frequent urination. Safe first-line approaches include sleep positioning, CBT-I techniques, and sleep hygiene changes; most sleep medications are not recommended in pregnancy without medical supervision.

Poor sleep in pregnancy isn't just exhausting — research links it to longer labor and other complications. Here's why it happens and what you can safely do about it.

Key takeaways

Pregnancy insomnia is extremely common, especially in the first and third trimesters.
Main causes: progesterone surges, physical discomfort, nocturia, anxiety, and heartburn.
CBT-I techniques (stimulus control, relaxation) are safe and effective in pregnancy.
Most sleep medications carry pregnancy risks — always consult your OB before taking anything, including supplements like melatonin.
Left-side sleeping is the recommended position in the third trimester.

Why insomnia is so common during pregnancy

Multiple overlapping factors disrupt sleep across each trimester:

First trimester: rising progesterone causes fatigue but also lighter, more fragmented sleep; frequent urination begins.
Second trimester: symptoms often ease, but restless legs syndrome (RLS) can emerge.
Third trimester: fetal movement, back pain, heartburn, shortness of breath, and anxiety about birth converge to create the worst sleep of the pregnancy.

A large meta-analysis found insomnia symptoms in 38% of pregnant women in the first trimester, rising to 60% by the third (Sedov et al., Sleep Medicine Reviews, 2018).

Safe sleep hygiene strategies during pregnancy

Sleep on your left side: left lateral positioning improves blood flow to the placenta in the third trimester. A pregnancy pillow between the knees and under the belly reduces hip and back pain.
Elevate the head of the bed: a 15–30° elevation can reduce nighttime heartburn and shortness of breath.
Keep a consistent sleep schedule: go to bed and wake at the same times each day.
Limit fluids 2 hours before bed: reduces nighttime urination frequency.
Light pre-bed movement: gentle yoga, stretching, or a short walk can reduce RLS symptoms and lower cortisol.

CBT-I for pregnancy insomnia

A randomized controlled trial found that a brief CBT-I intervention significantly improved sleep efficiency and total sleep time in pregnant women without any side effects (Manber et al., Obstetrics & Gynecology, 2019). This makes CBT-I techniques the preferred treatment approach — they address the behavioral and cognitive maintenance of insomnia without any risk to the pregnancy.

What to avoid

OTC sleep aids: diphenhydramine (Benadryl, Unisom SleepTabs) is widely used but its safety in pregnancy is not well established; consult your provider.
Melatonin: not studied enough in pregnancy to recommend routinely — ask your OB.
Prescription sleep medications: most carry risks; use only if prescribed and closely supervised.
Alcohol: never appropriate in pregnancy.

When to talk to your provider

If insomnia is severe, persistent, or accompanied by snoring, gasping, or excessive daytime sleepiness, mention it at your next prenatal appointment. Sleep apnea can develop or worsen in pregnancy and requires evaluation. Depression and anxiety are also common contributors to pregnancy insomnia and are very treatable.

For behavioral sleep support during pregnancy, Circady's sleep assessment can identify which CBT-I-based strategies fit your situation best.

Frequently asked questions

Is insomnia normal during pregnancy?

Yes. Up to 60–78% of pregnant people experience insomnia at some point, making it one of the most common pregnancy complaints — especially in the first and third trimesters.

What can I take for insomnia during pregnancy?

Behavioral approaches (CBT-I, sleep hygiene, positioning) are safest and most effective. For medications or supplements including melatonin, always consult your OB or midwife first.

Why can't I sleep while pregnant?

Hormonal changes, physical discomfort (back pain, heartburn, fetal movement), frequent urination, restless legs, and anxiety all disrupt sleep during pregnancy, often compounding each other.

What is the safest sleep position in pregnancy?

Left-side sleeping is recommended, especially in the third trimester, as it optimizes blood flow to the placenta and kidneys. A pregnancy pillow can make this position more comfortable.

Can pregnancy insomnia harm the baby?

Severe, chronic sleep deprivation in pregnancy has been associated with longer labor and other complications, which is why addressing insomnia with safe behavioral methods is important. Talk to your provider if insomnia is significantly affecting your daily function.

References

Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: a meta-analysis. Sleep Medicine Reviews, 2018. pubmed.ncbi.nlm.nih.gov/28866020
Manber R, Bei B, Simpson N, et al. Cognitive behavioral therapy for prenatal insomnia: a randomized controlled trial. Obstetrics & Gynecology, 2019. pubmed.ncbi.nlm.nih.gov/30399116
American Academy of Sleep Medicine. Sleep-disordered breathing in pregnancy. aasm.org

Medically reviewed by Dr. Alf Fischbein, MD — June 1, 2026.

This article is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider before taking any medication or supplement during pregnancy.