“Sleep while you can. You’re going to miss it once the baby comes.”

If you’ve ever been pregnant (or currently are) this is probably advice you’ve heard time and time again. But for some parents-to-be, a lack of sleep is a real struggle that starts way before there’s a crying newborn waking them up in the middle of the night.

It’s true: Insomnia during pregnancy is pretty common. About 25 percent of pregnant people have trouble sleeping in the first trimester, and this number nearly quadruples by the end of the third trimester, according to the Cleveland Clinic.  This can look like trouble falling or staying asleep, poor sleep quality, and even daytime sleepiness, fogginess, and irritability.

But sleep is an essential part of a healthy pregnancy—you actually need more zzzs than usual (about 8 to 10 hours, according to docs). That’s why it’s important to nip pregnancy insomnia in the bud. In the past, you may have popped a melatonin pill or Tylenol PM to fall asleep, but taking medicine while pregnant is tricky. Not many drugs are tested for safety in pregnant people, which limits what you can and can’t take (more on this later).

Another way to treat insomnia then? Natural remedies. Here, a sleep expert shares tips on how to sleep soundly when you’re expecting, plus what OTC medicines are safe to take on occasion.

What causes insomnia during pregnancy?

Your body goes through many changes when you’re pregnant, and many of these can make it difficult to get comfy at night.

“Hormonal shifts are one of the biggest hurdles to sound sleep during pregnancy,” says Angela Holliday-Bell, MD, a board-certified pediatrician and certified sleep specialist. For example, estrogen and progesterone—two hormones that skyrocket during different stages in pregnancy—can affect your breathing and your sleep cycle, per the Cleveland Clinic.

Soaring estrogen levels in your third trimester can also cause a stuffy nose or swelling of your nasal tissue—called rhinitis. Rhinitis is associated with snoring and obstructive sleep apnea, a breathing disorder that disrupts sleep when air can’t flow into or out of the nose or mouth, according to Johns Hopkins Medicine.

Your growing bump can also be to blame for nightly aches and pains, says Dr. Holliday-Bell. As your baby grows, so does the pressure on your joints, back, and bladder. This can make finding a comfy sleeping position feel impossible, and cause frequent trips to the bathroom in the middle of the night to pee, says Dr. Holliday-Bell.

By your third trimester, “there’s also an increased risk of conditions like acid reflux,” a pesky issue that can lead to heartburn while pregnant,  says Dr. Holliday-Bell. Acid reflux happens when gastric juices from your stomach move up into your esophagus, lighting a fiery feeling in your chest. This tends to get worse as your belly grows larger, because a lot of pressure is put on your stomach. But some people get it in early pregnancy, too.

Acid reflux can “become very uncomfortable and make it even more difficult to get good quality sleep at night,” adds Dr. Holliday-Bell.

Some pregnant people may also lose sleep from restless legs syndrome (RLS)—a condition that causes unpleasant tingling, pulling, or crawling sensations in the legs, per Johns Hopkins Medicine. When these weird sensations strike, you might have an irresistible urge to move your legs to make them stop. RLS usually worsens when you lie down at night, so it can cause a lot of tossing and turning.

Risks of insomnia during pregnancy

Poor sleep during pregnancy isn’t just annoying—it can lead to potential health problems for you and baby. According to Johns Hopkins Medicine, emerging evidence shows pregnant people who don’t log enough zzzs may have higher risks of certain pregnancy complications like the following:

• Preeclampsia, or high blood pressure
• Gestational diabetes
• Longer labors and higher rates of C-sections, particularly among people who get fewer than six hours of sleep over the course of 24 hours

A clinical update from The MGH Center for Women’s Mental Health also suggests a lack of sleep during pregnancy may predispose certain people to perinatal depression or anxiety. But more research is needed to solidify this connection.

Natural remedies for insomnia during pregnancy

When it’s time to hit the hay, try one of these safe strategies to help you get better sleep while pregnant.

Move more often

If you want to sleep sounder, being more active during the day may be the solution. “Exercise has been shown to promote deeper-quality sleep and can be particularly helpful during pregnancy,” says Dr. Holliday-Bell. Not only does physical activity boost your energy and mood, but it also lowers stress levels, which are all key for better sleep.

Even gentle forms of movement can make a big difference. For example, research shows that prenatal yoga can improve sleep quality in pregnant people, according to the Mayo Clinic. Hatha yoga and restorative yoga are also safe options to try.

On top of better sleep, exercise has a slew of other benefits during pregnancy including the following, per the American College of Obstetricians and Gynecologists (ACOG):

• Reduces back pain
• Eases constipation
• May decrease your risk of gestational diabetes, preeclampsia, and emergency cesarean birth
• Promotes healthy weight gain during pregnancy
• Improves your overall fitness and strengthens your heart and blood vessels

While physical activity is safe and healthy for most people during pregnancy, it can be unsafe for others with certain conditions or pregnancy complications. For this reason, always check with your OB/GYN or midwife first to see what type of exercise is okay for you.

“Exercise has been shown to promote deeper-quality sleep and can be particularly helpful during pregnancy.” —Angela Holliday-Bell, MD, sleep specialist

Get enough magnesium

“Magnesium is an essential mineral that’s needed for over 300 neurological processes in the body,” says Dr. Holliday-Bell. Among its many benefits, it helps to promote relaxation, she adds. That means it can help you de-stress and get a good night’s sleep.

Getting enough magnesium while pregnant is especially important because some have a higher risk for magnesium deficiency, according to a December 2020 study in Biological Trace Element Research¹.  This reduced amount of magnesium may particularly happen in the second trimester, says Dr. Holliday-Bell.

How much magnesium do you need? “In pregnancy, it’s recommended to take between 350 and 400 milligrams of magnesium daily,” adds Dr. Holliday-Bell. Luckily, there are many foods rich in magnesium including seeds, nuts, green vegetables, and beans. You can also get magnesium through prenatal vitamins or supplements.

If you plan to take a magnesium supplement to help you sleep while you’re pregnant, talk to your doctor beforehand. They can help figure out if it’s the right choice for you.

Use lavender oil

If you’re a fan of essential oils, you’ll be happy to hear that lavender oil is considered generally safe in pregnancy. That’s a major win when it comes to getting better sleep. While there isn’t much research on lavender’s effects, some findings, such as those in a small July 2015 study in the Journal of Alternative and Complementary Medicine², found that inhaling lavender oil along with proper sleep hygiene improved sleep quality.

On top of that, lavender oil has a calming effect, says Dr. Holliday-Bell. “It has been shown to relieve stress and anxiety and promote relaxation,” she adds. All good things for a restful night’s sleep.

If you want to try this out, Dr. Holliday-Bell recommends using an oil diffuser. “This is the safest method of use,” she adds. But keep in mind, pregnancy can make you more sensitive to smell, so you might lavender oil too overwhelming (it might even make your stomach turn). To avoid this, test out the scent by placing a drop of lavender oil on a cotton ball first. If you can tolerate the smell, move to the diffuser.

Sip some tart cherry juice

If you want to head to dreamland, try drinking some tart cherry juice. Tart cherries have two elements that might help you fall asleep, says Dr. Holliday-Bell:

• Tryptophan (an amino acid needed to make serotonin, a hormone that helps balance your mood)
• Melatonin (a hormone in your body that plays a role in sleep)

“Not everyone gets the same response [from drinking tart cherry juice], but some people do find it helps them fall asleep faster and stay asleep longer,” says Dr. Holliday-Bell. And because it’s safe to drink in pregnancy, it’s worth a try. Dr. Holliday-Bell recommends having a small glass 30 minutes to an hour before bedtime, which could help avoid those late-night bathroom breaks.

Relax your pelvic floor before bed

All things pelvic floor health are trending on social media recently, and for good reason. The group of muscles that sit at the bottom of your torso are really important: they help regulate your bladder and bowel movements, support pelvic organs (like your uterus and rectum), and help you achieve orgasm.

But the pelvic floor also bears the brunt of weight during pregnancy—literally. It has to hold up your growing baby and uterus, which can make these muscles pretty tight and tired. The strain can increase your chances of urinary incontinence, or loss of bladder control, according to the Mayo Clinic. This can cause you to leak pee or run to the toilet because your urge to “go” is so strong. Not a good recipe for sleep.

A way to help this? Pelvic floor relaxation exercises, says Dr. Holliday-Bell. These include deep belly breathing, happy baby pose in yoga, and deep squatting. All can help relax, lengthen, and stretch your muscles through their full range of motion (versus always being flexed).

If you’re unsure about the best pelvic floor exercises to do while pregnant, enlist the help of a pelvic floor therapist for some guidance.

Get a rubdown

There’s no better time to pamper yourself with a good massage than during pregnancy. “Massage can help to ease stress and decrease muscle aches and pains that can interfere with sleep,” says Dr. Holliday-Bell. Case in point: a September 2013 systematic review in the Journal of the Canadian Chiropractic Association³ found that prenatal massage therapy was associated with decreased stress hormones and improved sleep (and mood).

But be careful: Massage is generally safe during pregnancy, but certain massage techniques and trigger points on the body can bring on contractions and premature labor, according to UT Southwestern Medical Center. That’s why you should only see a massage therapist who has a prenatal massage certification. They have special training in safe techniques for pregnant people.

It’s also best to check in with your OB/GYN or midwife before you schedule a massage because it might not be safe if you have certain medical conditions. Or, they may advise you to save your massage until the second trimester—just to ensure optimal health for you and baby.

See an acupuncturist

Not a fan of needles (even minuscule ones)? You might change your tune once you learn that acupuncture—a healing treatment based on traditional Chinese medicine—may help prevent pregnancy insomnia.

A small May 2020 study in Nature and Science of Sleep⁴ found that acupuncture treatments were associated with improved sleep quality in pregnant people. While researchers still aren’t totally sure why, they hypothesize that acupuncture may increase the amount of melatonin your body produces, a hormone which we’ve learned helps us relax and sleep.

And if your pregnancy-related back pain is keeping you up at night, there’s even more good news. A 2022 systematic review and meta-analysis in BMJ Open⁵ found that acupuncture was associated with significantly improved lower back (and/or pelvic pain) and quality of life in pregnant people.

Acupuncture is generally considered safe during pregnancy, says Dr. Holliday-Bell, and according to the BMJ Open study, has no negative effect on newborns. Still, like with prenatal massage, there are certain trigger points that are unsafe to activate during pregnancy. For this reason, acupuncture should only be performed by a licensed professional with experience treating pregnant people. And of course, make sure you get the okay from your OB/GYN or midwife, says Dr. Holliday-Bell.

Try cognitive behavioral therapy

While pregnancy can be a happy time, sometimes it can also be one of anticipation and worry. You may have stressful thoughts swirling around in your head as you lie down for the night, which can keep you from drifting off to sleep.

“Managing stress is huge for promoting better quality sleep,” and cognitive behavioral therapy for insomnia (CBT-I) is one way to do this, says Dr. Holliday-Bell. Like traditional cognitive behavioral therapy, CBT-I involves working with a therapist to address any thoughts and behaviors that interfere with sleep.

While it can be helpful for anyone dealing with insomnia, it’s especially beneficial for pregnant people stressing about new parenthood. Indeed, a January 2020 study in JAMA Psychiatry⁶ found that digital CBT-I greatly improved sleep quality and decreased symptoms of depression and anxiety in expectant parents.

Other natural sleep remedies

Whether you’re pregnant or not, practicing healthy sleep habits (also known as sleep hygiene) is always a good idea. Here are some tried-and-true tips for better zzzs, per the Centers for Disease Control and Prevention:

• Go to bed and wake up around the same time every night, including the weekends
• Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature
• Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom
• Avoid large meals, caffeine, and alcohol before bedtime (to reduce your risk of heartburn)

Sleeping on your left side (with one pillow in between your legs and one supporting your belly) can also make you comfier. Not only does it keep your body in proper alignment, but it also promotes blood flow, according to the Cleveland Clinic.

Are OTC sleep aids safe to take during pregnancy?

If you’ve tried all these methods and are still struggling to get even a wink of sleep, you might wonder whether over-the-counter (OTC) sleep aids are okay to take on occasion. Here’s a breakdown of the most common ones, and if they’re safe to take in pregnancy.

Tylenol PM

Tylenol PM (a combination of acetaminophen, a mild pain-relieving drug, and Benadryl, an antihistamine) is considered generally safe to use during pregnancy, says Dr. Holliday-Bell. But there’s some growing concern that acetaminophen could potentially harm your baby’s development, she says.

Some research in animals found that acetaminophen may act as an endocrine disruptor—possibly affecting important hormones and altering how a baby’s nervous and reproductive system develops, according to UT Southwestern Medical Center. Only a few human epidemiologic studies (which look at patterns of diseases and other health-related conditions in certain groups of people) found a potential link between acetaminophen exposure in utero and reproductive or nervous system abnormalities in babies. But many other studies have found no association.

All this to say, more research is needed to determine whether there’s a direct relationship between acetaminophen and irregular fetal development.

For the time being, ACOG’s guidance remains the same: It’s fine to take acetaminophen during pregnancy as long as your OB/GYN or midwife says it’s okay, per UT Southwestern Medical Center. The safest way to take it? The smallest dose for the shortest time, and only when absolutely necessary.

And if you’re not comfortable taking it? Don’t. There are plenty of other safe options (both OTC medicines and natural remedies) to help you sleep.

Unisom

Unisom (doxylamine) is an antihistamine that treats insomnia. It’s often prescribed along with pyridoxine (vitamin B6) to treat nausea and vomiting in pregnancy. But doxylamine is also safe for occasional sleep issues during pregnancy, says Dr. Holliday-Bell. When used as prescribed, it’s not known to cause any fetal abnormalities, according to the National Library of Medicine (NLM).

Still, it’s best to talk with your doctor before trying it, and try not to take it every day. According to the NLM, taking Unisom long term or in higher doses when nursing can affect your milk supply and possibly make your baby drowsy.

Melatonin

Because we naturally produce melatonin, you might assume it’s no biggie to take a little extra to sleep when pregnant, right? Unfortunately, it’s not that simple. For one, melatonin supplements aren’t monitored by the FDA. That means you can’t be sure that every advertised product is safe and effective.

Plus, the typical amount of melatonin available in supplements (1 to 3 milligrams) can raise your blood melatonin levels up to 20 times higher than what your body normally produces, which may be too much for you and baby, according to the MGH Center for Women’s Mental Health.

While animal studies suggest that melatonin is probably safe for a developing fetus, we don’t know how these high levels could affect a human baby in the womb. And because there’s not enough research, it’s generally not recommended to take melatonin during pregnancy, says Dr. Holliday-Bell.

L-theanine

L-theanine is an amino acid that’s naturally found in tea leaves (like green tea and loose-leaf tea), but it’s also used as a supplement to help reduce anxiety and promote sleep. It makes you feel relaxed by elevating certain neurotransmitters (or chemical messengers) in your body including the following, per the Cleveland Clinic:

• GABA, or gamma-aminobutyric acid (produces a calming effect)
• Dopamine (known as the “feel-good” hormone because it gives you a sense of pleasure)
• Serotonin (often called your body’s natural “feel good” chemical, it plays a pivotal role in your sleep quality)

Though L-theanine is considered generally safe for most healthy adults, like melatonin, the FDA doesn’t review or regulate L-theanine products. So you can never be certain the supplement you’re taking is dosed accurately or contains the ingredients listed. There’s also limited research on its safety in pregnant people.

For these reasons, Dr. Holliday-Bell is very clear: People who are pregnant (or lactating) should not use L-theanine because it might be unsafe for your baby.

When to see a doctor about pregnancy insomnia

Being uncomfortable while pregnant is par for the course, but it shouldn’t have to affect your sleep. There are plenty of ways to get quality zzzs while pregnant, be it natural remedies, lifestyle changes, or OTC meds as needed.

If you’ve tried these methods and pregnancy insomnia starts affecting your waking hours (causing brain fog, depression, anxiety, illness, etc.), bring it up to your doctor, says Dr. Holliday-Bell. Long term, this lack of sleep can also increase your risk of complications like preeclampsia, gestational diabetes, longer labor, and higher risk of C-section, says Dr. Holliday-Bell. “Good quality sleep is not only helpful for you, but also your unborn child,” she adds.

So don’t wait until you’re totally wiped out to talk to your OB/GYN or midwife. “It’s best to address sleep issues as soon as they arise,” says Dr. Holliday-Bell. The sooner you get sleep, the better it’ll be for you and your baby.

—medically reviewed by Andrea Braden, MD, OB/GYN