Lack of sleep during pregnancy isn’t just a minor inconvenience that you need to endure. It’s a physiological issue with physiological causes and can often be improved if you understand exactly what happens in your body.
Biomechanics of how pregnancy causes lack of sleep
Your center of gravity shifts forward due to the growing baby inside you. This puts your lumbar spine into a hyperlordoticposition, and your lower back muscles have to work extra hard. Muscles on your thoracolumbar fascia shorten and tighten. Hip flexors are pulled forward. When it’s finally bedtime after a long day of supporting your uterus, your body is already tense.
It’s not helped by a hormone called relaxin. Its primary purpose is loosening the ligaments of your pelvis, making them ready for labor. However, it can affect not only your pelvis. Your sacroiliac joint, pubic symphysis, and hips now have less support, so your muscles have to work harder. The resulting tension doesn’t dissolve automatically with darkness.
Pelvic girdle pain is a natural result of this instability. Sciatica is also a condition that emerges from this instability. Sciatica is a sharp nerve pain that goes from the lumbosacral region to the buttocks and leg. Pregnancy-induced sciatica usually peaks in the second and third trimesters when the uterus grows big enough to press against your sciatic nerve. Both conditions might wake you up in the middle of the night simply when you turn over.
Physiological cost of maternal stress
Stress and sleep form a vicious circle in pregnancy that is hard to break. Cortisol, the main stress hormone in the body, blocks production of melatonin. Melatonin is the hormone that signals your brain it’s time to go to sleep. Thus, when the level of cortisol stays high, your melatonin production lowers, which means sleep delay and interruption.
This is especially important during pregnancy, as cortisol can penetrate the placenta. As a consequence, high levels of it while pregnant can lead to the decrease in blood flow in the uterus and heart rate variability. We say this not to frighten you, but so you understand that stress reduction is an integral part of your prenatal massage and care practice.
Almost 78% of pregnant women report sleep disturbances, which are getting more severe from the first to the third trimesters of pregnancy due to growing discomfort. The percentage is high enough that many people consider sleep disturbance a regular aspect of pregnancy.
Your body clock, which tells you when it’s time to sleep and wake up, can be disturbed by frequent urination during the night. Not only do the interruptions of sleeping cause discomfort but also they interfere with slow-wave and REM sleep stages required for restoration and memory processing.
Somatic mindfulness as nervous system tool
Many pieces of advice about sleeping don’t take into accountthe body’s need to prepare physiologically for sleep. One can’t go from the state of activity and tension to deep sleep. It requires switching gears in the nervous system. It sometimes doesn’t happen during pregnancy and lying down won’t help with that.
Somatic mindfulness is a method of switching the nervous system into a resting mode, bypassing all thoughts and concerns and just focusing on sensations.
How to practice somatic mindfulness in bed:
Start with the jaw. See if it’s tensed and let it relax and open. Back teeth can separate slightly.
Next are shoulders. Focus on them. They are probably raised close to your ears, so just try to bring them down.
Then it’s time for your pelvic floor. It’s often forgotten by expecting mothers. Pelvic floor is constantly bracing during pregnancy, both due to the baby’s weight and stress. Conscious release of this area (not a Kegel exercise) is a signal for your body that it’s time to rest.
Go gradually through these areas giving yourself at least 30 seconds for noticing and relaxing them. No hurry. No effort. Just focus.
Anatomical positioning and pillows’ placement
The way you organize your body during sleeping greatly impacts how much pain you will have during the night and how frequently you will wake up.
Sleeping on the left side is the recommended way during third trimester mainly because of the pressure of baby on the inferior vena cava – the big vessel that carries blood from your lower body to the heart. Right side or supine sleeping compresses this vessel, reducing circulation both in you and the baby.
However, sleeping on the left side with no support creates its own problems. With no pillow between your knees, your top hip internally rotates, twisting sacroiliac joint and causing pelvic girdle pain. You should use the pillow between your knees thick enough to align your hips. If you have sciatica, firm pillow here will be better than soft one, which will get compressed by your leg.
Second pillow underneath your abdomen will support the weight of your uterus and relieve the round ligaments which connect your uterus to your groin. Expecting mothers who skip this pillow wonder later why they wake up with hip and groin pain.
A third pillow behind your back serves two purposes. First of all, it provides you with something to lean on, which can reduce the feeling of being unsupported from behind and help you relax. Second, it can prevent you from unconsciously rolling to the supine position during sleep.
Full-length body pillow can replace all of these pillows if they constantly shift during the night.
Targeted bodywork and professional support
Self-massage techniques such as glutes massage with thumbs, hip flexors massage with tennis ball and gentle circular massage around the sacrum can give you some short-term relief. They are the things that you’ll want to use regularly, especially when you feel sore and achy at the end of the day.
However, professional intervention will go much further than this. Prenatal massage done by a certified therapist can address myofascial restrictions which can’t be reached during self-massage, especially thoracolumbar fascia and deep hip rotators. What’s more, there are many studies which prove that therapeutic massage lowers your cortisol and raises the levels of serotonin and dopamine. It makes your body produce more melatonin, which makes your short and restless nights easier to cope with.
There is also a circulatory aspect that directly affects comfort. Lymphatic drainage is slowing during pregnancy and fluid retention occurs in your lower extremities – these are the swollen ankles and feet that most expectant mothers have todeal with since second trimester. Pregnancy safe massage techniques which stimulate lymphatic return will reduce this edema, thus making walking, resting and sleeping more comfortable.
Prenatal massage is performed with specific bolstering and positioning, reflecting each stage of pregnancy. Prenatally trained therapists are also aware of pressure points that shouldn’t be touched and they never put their patients on the back after first trimester. If you are suffering from physical discomfort that interferes with sleep, booking consistent sessions (not just one), will have cumulative effect.
Optimizing your sleeping environment
During pregnancy, your body temperature is naturally elevated, especially in first and third trimesters. Hormonal and metabolic changes increase your core temperature and night sweats are common. They are not only uncomfortable, butalso cause frequent awakenings that fragment your sleep the same way nocturia does.
A room temperature of 60-67°F promotes sleep onset in most people and is cooler than pregnant women think they need. Breathable and moisture-wicking sheets allow managing increased body temperature without the need to cool the room to uncomfortable temperature. A fan circulating the air and not blowing on you can do wonders.
Heavy blackout curtains will help you in two ways. First of all, they keep the light out, protecting your melatonin levels and second, they serve as an insulator for the temperature variations during the night.
Evening nutrition and hydration
In third trimester, it’s crucial to manage your fluid intake if you have sleep-disrupting nocturia. Solution here is not to dehydrate yourself but to front-load fluids. Consume most of liquids until 6 PM and then drink very little in the last two hours before sleeping. You’ll urinate during the night, but the total volume will be lower and awakenings during the night may be shorter, making it easier to fall back asleep.
As regards your evening snacks, magnesium rich ones such as pumpkin seeds, almonds or leafy greens help with muscle relaxation and have a slight sedative effect on your nervous system. The general rule is to skip big meals at least two-three hours before sleeping in order to avoid developing acid reflux which is quite likely during third trimester due to the pressure of your uterus on stomach.
Managing the 3 AM wake-up
It’s practically an instinct to grab your phone when you wake up in the middle of the night and are unable to go to sleep. Try to refrain from it. Blue light between 460-490 nanometersrange actually blocks the production of melatonin and wakes up your brain. Even briefly looking at your screen will keep you awake for an additional hour.
Instead of using phone, keep small notebook beside your bed. If you are going over birth details, a list of things to pack for the hospital and your childcare plans, write it down. Just writing these things out of your head will ease the mental load and will be sufficient for falling asleep in many cases. It’s not really a diary, just a tool to clear your mind.
If you are concerned about labor at 3 AM, somatic scan (from jaw to pelvic floor) will be more effective than reasoning about it. You are not going to solve anything at 3 AM. Redirecting your attention from abstract thoughts to physical sensations is a more reliable path to sleep than any reassurances.
Lack of sleep during pregnancy is common, but common is not inevitable. Most sleep-disrupting factors – pain, heat, anxiety, positioning – can be managed. The unpleasant part is that several changes may need to be made at once in order to achieve an effect.