Sun. Oct 2nd, 2022
Insomnia in pregnancy: why can't I sleep?

Tossing and turning in bed without being able to sleep, seeing the night hours go by and not resting, the day coming and spending it tired for not having fallen asleep… These symptoms of insomnia are more likely if you are pregnant. That is why we are going to talk about insomnia during pregnancy and its causes .

And first of all, we have to be clear, when do we talk about insomnia? Is “sleeping poorly” the same as having insomnia? Literally ‘insomnia’ means “lack of sleep at bedtime” (from the Latin, ‘insomnium’), but in practice this term is used with many meanings, which can lead to confusion.

Therefore, if you do not know if you have insomnia or some other sleep disorder, which we are going to try to reveal to you in these lines, it is best that you go to a specialist for an evaluation and diagnosis. Although, with luck, it is more likely that you are simply going through a difficult stage of “sleeping poorly” and we can help you to remedy it through some tips to rest better during pregnancy .

What is almost certain is that, if you are pregnant, you suffer from a sleep disorder. According to studies, more than 85% of pregnant women experience changes in their sleep pattern at some point during pregnancy. The sleep disorder that shows a higher prevalence is the symptomatology of insomnia: sleep latency, nocturnal awakenings and little restful sleep.

Restless legs syndrome, snoring , excessive daytime sleepiness… are other reasons given by pregnant women for this “bad sleep”. But let’s first see what is meant by insomnia .

I have insomnia?

Due to its complex nature, it is difficult to establish a unitary and definitive definition of “insomnia”, which encompasses all its characteristics. In addition, there are several types of insomnia. But it may be that if what you present is a subjective complaint of sleeping poorly and several of the symptoms listed below do not occur, you do not actually have insomnia.

According to the International Classification of Sleep Disorders published in 2014, insomnia is defined as a persistent difficulty in sleep onset, duration, consolidation or quality that occurs despite the existence of adequate circumstances and opportunity for sleep and that is accompanied by a significant level of distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of human functioning.

The Clinical Practice Guideline for the Management of Patients with Insomnia in Primary Care indicates that “insomnia” should not be confused with voluntary or imposed sleep deprivation or lack of sleep, nor with the “complaint of sleeping poorly” in which there is no an impact on performance the next day. In this document insomnia is defined as:

a state of hyperalertness or vigilance disorder that lasts 24 hours a day, so difficulty sleeping during the day is characteristic.

And it is that, although during pregnancy the body undergoes many transformations, our head spins a lot and you will have difficulty sleeping at some point during it (and for more than one night), this does not mean that you have insomnia if they are not fulfilled other symptoms. The nocturnal characteristics of insomnia are the following:

  • Difficulty falling asleep
  • Difficulty staying asleep (frequent awakenings or trouble going back to sleep after waking up)
  • Early final awakening, with inability to go back to sleep
  • unrefreshing sleep
  • The sleep problem occurs at least three nights a week

During the day, features of insomnia include:

  • Fatigue
  • Symptoms of anxiety and depression
  • Dysphoria (emotional disorder or unpleasant or upsetting emotion)
  • Mild attention and concentration deficits
  • In addition, although they are less frequent or determining symptoms, there are memory deficits, deficits in executive functions, excessive sleepiness.

Another characteristic associated with insomnia is worry-prone personality traits. As we can see, insomnia is associated with other disorders that affect quality of life, work capacity…

If you think you meet these characteristics, you are probably suffering from insomnia. And you wonder what you can take and what not to avoid insomnia during pregnancy , which we will explain in a new article. For now, let ‘s see the reasons that lead you to sleep poorly during pregnancy .

Remember: the first thing is to have a specialist confirm your insomnia and advise you in your particular case, since true insomnia requires a personalized approach.

Causes of insomnia in pregnancy

Taking a long time to fall asleep, waking up often during the night and difficulty going back to sleep, waking up earlier… This is what many pregnant women (more than 85%) suffer from, especially in the third trimester (although not exclusively) , has its causes.

The most common causes of insomnia during pregnancy are increased urinary frequency, back pain, gastroesophageal reflux, restless legs syndrome, nausea and vomiting (during the first trimester of pregnancy), and fetal movements (during the third).

  • The problem of nausea and vomiting is much more common in the first trimester than in other stages of pregnancy and affects some women even at night, making it difficult to sleep. To control nausea , remember not to lie down right after meals, eat a small amount of food and eat little fat, eat gingerbread cookies (a natural remedy against nausea) and those foods that do not cause you repulsion…
  • Gastroesophageal reflux affects more than 53% of pregnant women at night, making it difficult to sleep. The hormones of pregnancy and the little space in the stomach cause longer and heavier digestions. Reflux is characterized by a burning sensation in the chest or throat called ‘heartburn’ , and sometimes you can even taste the liquid from your stomach in the back of your mouth, because this liquid ‘goes up’. Some ways to reduce this discomfort is to avoid abundant, spicy, greasy or acidic foods; not eating just before going to bed; wear loose clothing; sleep with the trunk slightly elevated…
  • During pregnancy , you urinate more frequently throughout the day and, of course, this also happens at night. The reasons are mainly the increase in the volume of liquids in the pregnant woman’s body and the increase in the volume of the uterus, which is putting more and more pressure on the bladder. About 70% of pregnant women indicate that this is a reason for insomnia. Even so, do not deprive yourself of drinking water during pregnancy since you need to be well hydrated (and urinating purges toxins from the body), but try not to drink so much at night, before going to bed and go to the bathroom just when you fall asleep .
  • Back pain and other muscular discomfort related to the increase in uterine volume (the body has to find a new balance due to the increase in the abdomen and the curvature of the spine) also influence sleeping difficulties. During pregnancy, especially in the third trimester, pain increases, posture is not found, punctures are suffered, cramps in the feet and legs … Nearly 50% of pregnant women cite these causes of insomnia.
  • Fetal movements also make sleep difficult in 41% of cases. What seemed like an incredible and exciting shock around 18 or 20 weeks pregnant may not be so much fun if the movements of the baby in the womb start to hurt your ribs and this prevents you from sleeping for a few nights in a row. Luckily, the baby also seems to relax during the night hours (provided that the mother also achieves it, which as we see is not easy).
  • Restless legs syndrome , an unpleasant feeling that the legs cannot stand still when at rest. The pregnant woman notices a tingling, burning sensation… and the only way to remedy it is to move her legs, sometimes it is done uncontrollably because it relieves. In extreme cases it can also affect the arms. It is estimated that restless legs syndrome affects 30% of pregnant women and hormonal changes may be behind it (together with possible low iron levels, changes in the structure of the pelvis…). What can be done to avoid this discomfort is to do enough physical activity during the day, so that there is a better rest.
  • Another reason reported by pregnant women for poor sleep in the third trimester is snoring . Be careful if there is a problem of sleep apnea or underlying hypertension or diabetes, you should consult your doctor. What happens is that changes in the airway mucosa due to excessive secretion and increased blood flow predispose to both hoarseness and upper airway obstruction.

In addition, a higher prevalence of insomnia symptoms has been found among multiparous women and women who do not practice physical exercise. The increased heart rate may also play a role in keeping women in a constant state of alertness and less sleepy. Finally, there are studies that indicate that the increase in estrogen and progesterone decreases deep sleep.

insomnia in pregnancy

In short, having trouble sleeping well during pregnancy is normal and if lack of sleep affects your quality of life and during the day your body and mind suffer, you may suffer from insomnia. In any case, we will soon tell you what you can take against insomnia while pregnant and what remedies exist , without risks, to sleep as well as possible. An important advance: do not self-medicate or take anything that they tell you is good for rest .