PREGNANCY & SLEEP: AN IN-DEPTH GUIDE

PregnancySleep

2 Oct

Introduction

Pregnancy is one of the most incredible transformations your body will ever go through. But it’s also no secret that sleep during this time can feel… well, tricky.

Many mummas-to-be are told broken sleep is “just training you for postpartum” (I know I was) AND that’s not particularly helpful when you’re desperate for rest.

The truth is, there are well-documented, physiological reasons why sleep changes so much in pregnancy and when you understand them, you can begin to support your body more effectively.

This guide will walk you through the science behind sleep changes in pregnancy, and more importantly, what you can do to support your body, your nervous system and your rest.

WHY Sleep Changes in Pregnancy

The Hormonal Rollercoaster:

Your endocrine aka hormonal system is working overtime to support both you and your growing baby, here’s how these hormones can influence your sleep:

Progesterone: Levels rise significantly in the first trimester to maintain the uterine lining and support early pregnancy (Umland, 2008). Progesterone has sedative effects at higher levels, which explains daytime sleepiness in early pregnancy. However, as the pregnancy progresses, fluctuating levels may fragment sleep and reduce restorative slow-wave sleep (Baker & Lee, 2018).

Estrogen: Estrogen rises steadily and peaks in the third trimester. It influences temperature regulation (leading to hot flushes and night sweats), can increase nasal congestion, and has been associated with restless legs syndrome by altering dopamine pathways in the brain (Facco et al., 2014).

Cortisol: Cortisol, our “stress hormone,” normally follows a circadian rhythm, peaking in the morning and dipping at night. In pregnancy, basal cortisol levels are higher due to placental production of corticotropin-releasing hormone (CRH), which can flatten the normal rhythm and cause elevated nighttime levels (Mastorakos & Ilias, 2003). This contributes to insomnia and the “wired but tired” feeling.

The Growing Bump:

Physical changes are one of the most obvious reasons sleep feels different:

As the uterus expands, it shifts your centre of gravity forward, altering posture and making certain sleeping positions uncomfortable.
Pressure from the growing uterus on the diaphragm reduces lung capacity, making deep breathing trickier and sometimes waking you short of breath (LoMauro & Aliverti, 2015).
Lying flat on your back can compress the inferior vena cava, reducing circulation and sometimes causing dizziness or palpitations, which is why left-side sleeping is recommended in late pregnancy.

The Waking up to Pee at Night:

Multiple bathroom trips a night, disturbing the deeper stages of your sleep?

By 12 weeks, renal plasma flow and glomerular filtration rate increase by up to 50% (Cheung & Lafayette, 2013). This means your kidneys are filtering more blood and producing more urine.
As your uterus enlarges, it also physically compresses the bladder, reducing capacity.

The Pregnancy Insomnia:

Insomnia affects up to 75% of pregnant women (Sedov et al., 2018).

Hormonal shifts disrupting circadian rhythms (your sleep-wake cycle)
Baby’s nightly dance party: foetal movements, often peaking at night when you’re at rest.
Reflux can become more common due to progesterone relaxing the lower oesophageal sphincter and upward pressure from the uterus (Carbone et al., 2003), this can be made worse at night as you’re laying down flat.
Restless legs syndrome (RLS), is two to three times more common in pregnancy, this is likely linked to iron and folate deficiency plus estrogen’s influence on dopamine pathways (Facco et al., 2014).
Psychological stress, as anticipation and preparation for birth/new parenthood can keep the mind active.

The Nervous System Connection:

Sleep and the nervous system and deeply connected:

Poor sleep alters pain thresholds, making the body more sensitive to discomfort (Haack et al., 2012).
Fatigue reduces prefrontal cortex activity, impairing stress regulation and emotional resilience.
Sleep deprivation also reduces parasympathetic nervous system tone, leaving the body stuck in a heightened “fight or flight” state (Meerlo et al., 2008).

This is why sleep challenges can feel like they snowball, poor sleep leads to more stress, which in turn makes sleep even harder.

SUPPORTING Stategies for Better Sleep

Lifestyle & Environment

Pregnancy changes the way you move, breathe, and even how your body regulates temperature. Small environmental and routine adjustments can make a big difference:

Positioning & Pillows: these can be used to support your growing bump, spine, and pelvis and can help to reduce strain on muscles and ligaments, by placing these between the knees and under the bump to avoid over rotating the hips and pelvis all night long. Research shows side-lying (particularly left side) improves circulation to both mother and baby and reduces risk of vena cava compression (O’Brien & Warland, 2014).

Fluid Timing: the kidneys filter ~50% more blood during pregnancy, producing more urine (Cheung & Lafayette, 2013). Hydrate earlier in the day and taper fluids 2–3 hours before bed. This lessens bathroom wake-ups without risking dehydration.

Electrolytes: when you’re feeling like that glass of water “goes straight through you,” it’s often because water lacks electrolytes. Adding sodium, magnesium, and potassium improves absorption. This can reduce frequency of urination and support muscle function.

Lighting: melatonin, your “sleepy hormone,” is suppressed by blue/bright light. Nighttime bathroom trips under full light can disturb your circadian rhythm/sleep wake cycle and re-wake you up . Dim, amber, or red light preserves melatonin secretion and helps you drift back off a little easier (Figueiro & Rea, 2010).

Evening Routine: we put a lot of emphasis on creating a bedtime routine for our littles ones, but what about us? By establishing a wind-down this routine signals the nervous system to shift into parasympathetic (rest and digest) mode. Evidence supports that activities like reading, journaling, light stretching/yoga, mindfulness, and avoiding screens in the hours leading up to bedtime (Bei et al., 2015).

Nutrition & Supplementation:

Nutrition is one of the most powerful (and overlooked) tools in pregnancy sleep.

Blood Sugar Balance: nighttime wake-ups are often linked to dips in blood sugar. A balanced dinner with protein, fibre, and healthy fats slows digestion and stabilises glucose. This reduces 2–3am cortisol spikes (Benedict et al., 2012).

Tryptophan & Serotonin Pathway: foods like turkey, oats, bananas, seeds, and dairy provide tryptophan, a precursor or building block to serotonin and melatonin. Pairing with complex carbs helps tryptophan cross the blood-brain barrier.

Magnesium: supports muscle relaxation, reduces cramps, and promotes deeper slow-wave sleep. Supplementation has shown improvements in insomnia (Abbasi et al., 2012).

Calcium: works synergistically with magnesium. Deficiency is linked to restless legs syndrome (Wali & Hatti, 2017).

Iron & Folate: deficiencies increase restless legs and are common in pregnancy. Correcting these can dramatically improve sleep quality (Manconi et al., 2012).

Omega-3 Fatty Acids: important for foetal brain development and maternal mood regulation. Evidence shows they may reduce inflammation and depressive symptoms that can worsen insomnia (Freeman et al., 2006).

Gentle Botanicals
- Chamomile: Mild sedative, safe in small amounts (Chang & Chen, 2016).
- Passionflower: Supports sleep onset and anxiety (traditional use, some evidence).
- Lemon balm: Mild calming effects.
- Lavender: Aromatherapy shown to reduce anxiety and improve sleep quality (Lee et al., 2011).

Chiropractic Care & Pregnancy Sleep

At House of Healing Chiropractic, we provide pregnancy-adapted techniques designed to support you as your body changes. Our tables and equipment are modified to accommodate a growing bump, and we use approaches that are tailored to your stage of pregnancy and individual needs.

How chiropractic care may support sleep in pregnancy:

Pelvic and spinal balance: as hormones influence ligament flexibility, the spine and pelvis may adapt in different ways. Chiropractic care aims to support balance and movement through these changes.
Reducing mechanical stress: addressing areas of tension in the spine or pelvis can help improve mobility and comfort.
Nervous system function: chiropractic adjustments influence the spine, which is closely connected to the nervous system. Supporting this connection may help the body adapt more effectively to stressors.
Adapting to change: pregnancy is dynamic. Chiropractic care is tailored to help your body manage the ongoing physical changes that can contribute to disrupted sleep.

Here is some of the things you can expect us to adapt during a pregnancy consult:
Pregnancy pillows (cushion on the outside and a big hole in the middle for your growing belly to drop into) and modified tables to allow for comfortable positioning.
Techniques chosen with consideration for pregnancy stage, your health history and preferences.

Research has explored chiropractic care in pregnancy, particularly in relation to spinal and pelvic function and musculoskeletal discomfort (Browning et al., 2010; Stuber & Smith, 2008).

Nervous System & Stress Support:

Sleep is a dialogue between your environment and your nervous system, so here are some proven strategies to help our body and mind to move from our stressed out sympathetic or fight/flight nervous system and into that beautiful calm parasympathetic or rest/digest mode.

Breathwork: slow, diaphragmatic breathing activates the vagus nerve and parasympathetic system. Even 5 minutes can lower heart rate and cortisol (Jerath et al., 2015).

Circadian Rhythm Reset: natural light exposure (especially morning light) regulates melatonin and cortisol cycles. This is particularly helpful when pregnancy disrupts your normal rhythms.

Mind-body Practices: prenatal yoga, meditation, and guided relaxation reduce anxiety and improve subjective sleep quality (Beddoe & Lee, 2008).

Final Thoughts

So yes, while poor sleep in pregnancy is common, let’s focus on doing the best we can, it doesn’t have to feel hopeless. By supporting your body form the inside out, you can find greater ease, rest, resilience and a better, deeper, more restorative sleep.

You’ve got this Mumma!

References

Abbasi, B., Kimiagar, M., Sadeghniiat, K., Shirazi, M. M., Hedayati, M., & Rashidkhani, B. (2012). The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. Journal of Research in Medical Sciences, 17(12), 1161–1169.

Benedict, C., Hallschmid, M., Schultes, B., Born, J., & Kern, W. (2012). Intranasal insulin improves memory in humans. Psychoneuroendocrinology, 33(8), 1326–1330.

Beddoe, A. E., & Lee, K. A. (2008). Mind–body interventions during pregnancy. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37(2), 165–175.

Browning, R., Miller, J., & Sims, J. (2010). Spinal manipulation in the treatment of pregnancy-related back pain: A systematic review. Chiropractic & Manual Therapies, 18(1), 7. https://doi.org/10.1186/1746-1340-18-7

Carbone, F., et al. (2003). Gastroesophageal reflux and pregnancy. Journal of Clinical Gastroenterology, 36(2), 108–112.

Chang, S. M., & Chen, C. H. (2016). Effects of an intervention with drinking chamomile tea on sleep quality and depression in postpartum women: A randomized controlled trial. Journal of Advanced Nursing, 72(2), 306–315. https://doi.org/10.1111/jan.12836

Cheung, K. L., & Lafayette, R. A. (2013). Renal physiology of pregnancy. Advances in Chronic Kidney Disease, 20(3), 209–214. https://doi.org/10.1053/j.ackd.2013.01.012

Facco, F. L., Kramer, J., Ho, K. H., Zee, P. C., & Grobman, W. A. (2010). Sleep disturbances in pregnancy. Obstetrics and Gynecology Clinics of North America, 41(2), 229–240.

Figueiro, M. G., & Rea, M. S. (2010). The effects of red and blue lights on circadian variations in cortisol and melatonin in humans. Journal of Circadian Rhythms, 8(1), 1–9. https://doi.org/10.1186/1740-3391-8-8

Freeman, M. P., Hibbeln, J. R., Wisner, K. L., Davis, J. M., Mischoulon, D., Peet, M., … & Stoll, A. L. (2006). Omega-3 fatty acids: Evidence basis for treatment and future research in psychiatry. Journal of Clinical Psychiatry, 67(12), 1954–1967.

Haack, M., Scott-Sutherland, J., Santangelo, G., & Mullington, J. M. (2012). Sleep deficiency and chronic pain: Potential underlying mechanisms and clinical implications. Neuropsychopharmacology, 37(1), 272–284.

Jerath, R., Crawford, M. W., Barnes, V. A., & Harden, K. (2015). Self-regulation of breathing as a primary treatment for anxiety. Applied Psychophysiology and Biofeedback, 40(2), 107–115. https://doi.org/10.1007/s10484-015-9279-8

Lee, M. S., Choi, J., Posadzki, P., & Ernst, E. (2011). Aromatherapy for health care: An overview of systematic reviews. Maturitas, 71(3), 257–260. https://doi.org/10.1016/j.maturitas.2011.02.011

LoMauro, A., & Aliverti, A. (2015). Respiratory physiology of pregnancy. Breathe, 11(4), 297–301. https://doi.org/10.1183/20734735.008615

Manconi, M., Govoni, V., De Vito, A., Economou, N. T., Cesnik, E., Casetta, I., & Granieri, E. (2012). Restless legs syndrome and pregnancy. Sleep Medicine, 13(5), 591–594. https://doi.org/10.1016/j.sleep.2011.10.018

Mastorakos, G., & Ilias, I. (2003). Maternal and fetal hypothalamic–pituitary–adrenal axes during pregnancy and postpartum. Annals of the New York Academy of Sciences, 997(1), 136–149. https://doi.org/10.1196/annals.1290.016

Meerlo, P., Sgoifo, A., & Suchecki, D. (2008). Restricted and disrupted sleep: Effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Medicine Reviews, 12(3), 197–210. https://doi.org/10.1016/j.smrv.2007.07.007

Miners, A. L. (2010). Chiropractic treatment and the effect on heart rate variability: A review. Journal of the Canadian Chiropractic Association, 54(4), 260–267.

O’Brien, L. M., & Warland, J. (2014). Sleep and stillbirth: What we know and what we need to know. BMC Pregnancy and Childbirth, 14(1), 1–8. https://doi.org/10.1186/1471-2393-14-1

Sedov, I. D., Cameron, E. E., Madigan, S., & Tomfohr-Madsen, L. M. (2018). Insomnia symptoms during pregnancy: A meta-analysis. Journal of Sleep Research, 27(3), e12635. https://doi.org/10.1111/jsr.12635

Silber, B. Y., & Schmitt, J. A. (2010). Effects of tryptophan loading on human cognition, mood, and sleep. Neuroscience & Biobehavioral Reviews, 34(3), 387–407. https://doi.org/10.1016/j.neubiorev.2009.08.005

Stuber, K. J., & Smith, D. L. (2008). Chiropractic treatment of pregnancy-related low back pain: A systematic review of the evidence. Journal of Manipulative and Physiological Therapeutics, 31(6), 447–454. https://doi.org/10.1016/j.jmpt.2008.06.005

Umland, E. M. (2008). Treatment options for insomnia in pregnancy. Pharmacotherapy, 28(2), 235–245. https://doi.org/10.1592/phco.28.2.235

Wali, S. O., & Hatti, S. (2017). Restless legs syndrome: Association with low serum calcium and response to calcium supplementation. Sleep Medicine, 34, 223–226. https://doi.org/10.1016/j.sleep.2017.02.027

Zhang, J., Dean, D., Nosco, D., Strathopulos, D., & Floros, M. (2006). Effect of chiropractic care on heart rate variability and pain in a multisite clinical study. Journal of Manipulative and Physiological Therapeutics, 29(4), 267–274. https://doi.org/10.1016/j.jmpt.2006.03.012