Written by:

Dr Aynsley Cresswell

BA (Oxon), BMBCh, DRCOG, DFSRH, MRCGP

Dr Cresswell is a general practitioner in the North East having recently moved to Yorkshire from Oxford. Aynsley has a special interest in women's and sexual health, and she has gained diplomas in both of these specialist areas. She has a keen interest in teaching and also enjoys caring for patients with long-term health conditions in her day-today practice.

Tiredness and Sleep Problems in Pregnancy

In this article:

  • Pregnancy Insomnia
  • Tips for tiredness
  • Other causes of tiredness
  • Main Points
  • References

Tiredness and Sleep Problems in Pregnancy

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 addressed 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 form family and friends. 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 at the loo more often!

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. This is usually normal and talking it over with your partner or midwife can help. Your midwife or doctor may have relaxation tips or some breathing exercises that can be tried to help with 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 later in pregnancy because of the pressure your bump will put on important blood vessels; this can lead to light headedness and feelings of faintness.  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 practising 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 (eg. 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.

Main Points

  • Tiredness, fatigue and sleep difficulties are very common in pregnancy.
  • Tiredness in pregnancy is partly caused 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 light headedness and feelings of faintness.
  • It is often best to sleep on your sides and to use multiple pillows to make yourself comfortable.
  • Cut caffeinated drinks from your diet to increase your chances of sleeping well.
  • Practice good ‘sleep hygiene’: this means eliminating screen time in the hours before bed and developing calming bedtime habits.
  • Tiredness or fatigue can be symptoms of anaemia or depression. Talk to your GP or midwife about these possibilities.

References