Hormonal changes

Fatigue, tiredness and sleep problems in pregnancy are very common, especially in the first trimester and then again towards full-term. There are several reasons for this which will be covered in this article and there will also be some tips to try and help. This review will also cover when you should seek help from your midwife or GP, and when tiredness may mean something more serious.

At the beginning of pregnancy it is mainly the hormonal changes that make you feel more tired, possibly even making you feel exhausted. Your body is working very hard to support the growing baby by making the placenta, and your blood pressure and blood sugar tend to run lower than normal. The main way to help is to rest as much as possible: accept offers of help from family and friends. And remember, being so tired can lead to low mood, so try to keep on top of your physical health by drinking plenty of water and eating a healthy diet.

Although feeling tired is unpleasant, it is not harmful to you or your baby. Despite this, it can feel very difficult, especially in the early weeks of pregnancy when others are not aware you are pregnant.

Towards full-term, carrying the extra weight from the baby can be physically exhausting.  Again, try and get as much rest as you can – this is sometimes more difficult as the shape and size of the bump can make sleeping difficult.  Moreover, during the night you may be up visiting the loo more often than usual!

Pregnancy Insomnia

Not only can people feel more tired in pregnancy, it can also be more difficult to sleep. Even women who don’t suffer insomnia may experience bad dreams or nightmares, either about the baby or about labour. You might actually approach bedtime worrying about the lack of sleep you’ve had, which in itself might keep you awake. This is usually normal and talking it over with your partner or midwife can help. Your midwife or doctor may be able to share relaxation tips or some breathing exercises that can be tried to help you reduce your stress and anxiety.

Because of your bump, sleeping can be uncomfortable. Lying on your back after about 16 weeks can be uncomfortable and we recommend you do not lie on your back after 20 weeks in pregnancy because of the pressure your bump will put on important blood vessels; this can lead to lightheadedness and feelings of faintness but also reduced blood supply to your baby.  Often positioning pillows around your bump and in between your knees can help, and sleeping on your side is sometimes easier. Later, you might find that placing pillows around your back so that you are almost in a sitting position can be comfortable and can help with any heartburn symptom you may also have at this stage.

Tips for tiredness

When suffering from insomnia and sleep problems in pregnancy it is important to remember that it is not harmful to the baby, and so try not to let it get on top of you. Simple things like trying to nap during the day can help. We recommend cutting out caffeine in tea, coffee and fizzy drinks and practicing good sleep hygiene. This refers to what you do in the hour before bed: try relaxing with a shower or a bath, cut out screen time (e.g. TV/phone/laptop) and use relaxation techniques which you might learn at antenatal classes/antenatal yoga or pilates.

Low-level exercise can also help you feel less tired. It may sound counterintuitive but if you are tired in the day, try to fit in some activity such as a brisk walk or swimming which can often make you feel better. If your insomnia is really bothering you, be sure to discuss it with family, your midwife and doctor.

Other causes of tiredness

Occasionally, fatigue and low energy can be symptoms of anaemia (a condition characterised by lower haemoglobin in the blood or fewer red blood cells than normal). This is quite common in pregnancy. Fortunately, you will have blood tests at the beginning of pregnancy and then later on as part of routine care, so your doctor and midwife will be checking for that. Very occasionally, being very tired and having trouble sleeping can also be symptoms of depression. If you feel that you are less interested in things than you used to be, or have more feelings of hopelessness, speak to your doctor or midwife.

In general, and to help counteract sleep problems in pregnancy, it is important to remain active throughout pregnancy and make sure you have a healthy diet. Tiredness and insomnia is very different for every mum-to-be. You may feel tired throughout your entire pregnancy but you may not slow down at all. If things are becoming difficult, do discuss it with your midwife or GP.

Can I take sleeping pills in pregnancy?

When you are exhausted it might feel tempting to take something to ensure a good night’s sleep. However, it’s best to avoid all sleeping remedies in pregnancy as good evidence on the safety of these for the developing baby just isn’t available. Small studies in women who took Zopiclone or Zolpidem showed that they were at increased risk of preterm labour (delivery before 37 weeks).

Women should also try to avoid over-the-counter, natural and herbal remedies since as they are not classified as “medications” they aren’t put through the same rigorous testing and quality standards.

Main Points

• Tiredness, fatigue and sleep difficulties are very common in pregnancy.
• Tiredness in pregnancy is partly caused by the work of your body making the placenta, as well as lower than normal blood pressure and blood sugar levels.
• Rest as much as you feel is necessary and be prepared to accept all offers of help.
• Eat and drink healthily and regularly to keep mood and energy levels up.
• Tiredness is difficult but it is normal and not harmful to your baby.
• From around 16 weeks of pregnancy it can be uncomfortable lying on your back. In fact, doing so can put pressure on important blood vessels, which can lead to lightheadedness and feelings of faintness.

References

• WHO recommendations on antenatal care for a positive pregnancy experience; World Health Organization, 2016
• Antenatal care for uncomplicated pregnancies; NICE Clinical Guideline (March 2008, updated 2017)