Authored by Dr. Laurel Charlesworth and reviewed by the First Exposure Medical Review Team.
Dr. Laurel Charlesworth MD FRCPC is a neurologist and sleep medicine physician at The Ottawa Hospital, and an assistant professor of medicine at the University of Ottawa.
This health topic is an expert opinion about insomnia during pregnancy.
* The information provided is the expert opinion of the First Exposure Medical Advisors. It is for informational purposes only and does not replace medical care and advice from a healthcare provider. Please contact your healthcare provider if you have any concerns or to discuss any questions that you believe may be relevant to you or your baby. In case of emergency, please go to the emergency room or call 911.
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Clinical Scenario
I am 7 months pregnant. I am having trouble falling asleep and I keep waking up during the night. Is there anything I can do to help me sleep better?
Q. What is insomnia?
A. Insomnia is when someone has trouble falling asleep, staying asleep, getting back to sleep after awakening, or waking up too early. Insomnia can cause tiredness and sleepiness during the day and add to stress.
Q. Who is at higher risk for insomnia during pregnancy?
A. People with a history of anxiety, trauma, irregular sleep habits (such as shift work or poor sleep hygiene), or socioeconomic factors such as crowded living environment with noisy or shared bedrooms, are at a higher risk to develop insomnia.
Q. Does insomnia get worse in pregnancy?
A. There are many changes and stressors during pregnancy that can cause or worsen insomnia. Expectant parents may have insomnia due to planning, anticipating, and worrying. Anxiety and intrusive thoughts can be worse at night. Physical and hormonal changes in pregnancy may lead to sleep disruption, which can cause or worsen insomnia. Please see the Sleep during Pregnancy health topic for an overview.
Q. Does insomnia increase the risk of any harmful effects on pregnancy?
A. Insomnia itself does not have direct impact on the pregnancy, although having enough restful sleep in pregnancy is very important. Insomnia may affect both sleep duration and quality. Poor sleep has been shown to be associated with a higher risk of adverse affects on the pregnancy. Please see the Sleep during Pregnancy health topic for an overview.
Q. How can insomnia be managed during pregnancy?
A. Insomnia is best managed by addressing the underlying cause. In addition, trying to keep to a sleep schedule and a wind down routine (sleep hygiene), as much as possible, can be helpful. Please see the Sleep during Pregnancy health topic for tips on how to improve sleep. Talk to your healthcare provider if you have any concerns about your sleep.
If insomnia is persistent, a specific type of cognitive behavioral therapy (CBT) for insomnia (CBT-I) may be helpful. CBT-I is offered by sleep therapist who are trained in providing this therapy. The sleep psychologist needs to be made aware of the pregnancy as adjustments to the therapy may be necessary.
Sleep medications may not provide the same quality of sleep as non-pharmacologic interventions (non-medication treatments). However, if sleep hygiene and /or CBT-I are not working, medications may be considered. Discuss whether medication is needed and its safety in pregnancy with a healthcare provider.
Q. Where to get more information?
Resources for Patients
Key References
Rajagopal A, Sigua NL. Women and Sleep. Am J Respir Crit Care Med. 2018;197(11):P19-P20. [PMID: 29856255].
Sedov ID, Anderson NJ, Dhillon AK, Tomfohr-Madsen LM. Insomnia symptoms during pregnancy: A meta-analysis. J Sleep Res. 2021;30(1):e13207. [PMID: 33140514].
Tomfohr-Madsen LM, Clayborne ZM, Rouleau CR, Campbell TS. Sleeping for Two: An Open-Pilot Study of Cognitive Behavioral Therapy for Insomnia in Pregnancy. Behav Sleep Med. 2017;15(5):377-93. [PMID: 27124405].
Disclaimer
First Exposure does not offer health care treatment. If you have an urgent question about your pregnancy or your baby’s health, you should contact your health care provider directly. If you don’t have a health care provider and you live in Ontario, you have a variety of health care options. In the case of an emergency, visit a hospital emergency room or call 911.