What causes insomnia before labor?

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Insomnia before labor is common. Sleep tends to become steadily more disrupted as the pregnancy progresses. This is due to the physical discomforts of pregnancy and physiological changes in sleep patterns.

In a 2021 review and meta-analysis including data from 8,798 participants, 42.4% reported having insomnia in the third trimester. The rate of insomnia increased with each trimester.

Learn more about insomnia.

Many different factors can contribute to insomnia before labor. They include:

• Physical discomfort: A growing body can make it more difficult to find a comfortable sleeping position, especially if a person experiences pregnancy-related aches and pains. Additionally, some pregnant people wake up more often at night to urinate, which can cause further disruption.
• Hormonal changes: As labor draws near in the final weeks of pregnancy, the body produces more oxytocin. This hormone helps stimulate labor, but it also promotes wakefulness. Thyroid hormone levels may also increase during pregnancy, which can disrupt sleep.
• Stress: As a person’s due date gets closer, they may feel worried about the birth or overwhelmed about becoming a parent. This could affect sleep in the weeks before labor.
• Mental health conditions: Anxiety, depression, and other mental health conditions can affect sleep during pregnancy. This could result from a worsening preexisting condition or a new condition that develops during pregnancy.
• Acid reflux: This can occur during pregnancy and may worsen when lying down. Acid reflux may wake a person at night, leading to insomnia.
• Restless legs syndrome (RLS): According to a 2020 study, 20% of all pregnant people experience RLS. This may occur due to nutritional deficiencies.
• Sleep-disordered breathing: Snoring and obstructive sleep apnea (OSA) can also occur during pregnancy and disturb sleep. In a 2019 study of 267 pregnant people, 30.6% reported snoring.

It is important to note that these symptoms affect some populations more than others.

For example, in the 2019 study, those with obesity before pregnancy who lived in poverty or identified as Black were more likely to have sleep difficulties. This is the result of health inequity.

Learn more about maternal health in Black, Indigenous, and People of Color.

Insomnia tends to increase as pregnancy progresses. Therefore, it can be a sign that birth is getting closer, particularly if insomnia suddenly begins or worsens at the very end of pregnancy.

However, there is no evidence that insomnia always increases before labor or that a lack of insomnia means a person will not go into labor. The sudden appearance of insomnia also does not signal that labor will inevitably begin within a certain time frame.

There is some evidence of a correlation between insomnia and poorer birth outcomes. However, the precise link is uncertain, and research provides conflicting results.

For example, some data suggest that insomnia may correlate with growth restriction, while other data suggest that it may actually accelerate the fetus’ growth.

A 2021 review found associations between sleep disturbances in pregnancy and higher rates of:

• preeclampsia
• gestational diabetes
• gestational hypertension
• preterm birth
• cesarean delivery
• stillbirth

However, the review did not establish the relationship between insomnia and these complications. It is unclear if it directly causes it.

Some of the root causes of insomnia may pose a higher risk than others. For example, OSA has a correlation with an increased risk of stillbirth, the need for cesarean deliveries, and low birth weight.

There is also some evidence that insomnia during pregnancy may affect the parent and baby after birth. A 2021 study found that prenatal insomnia correlated with poorer social and emotional development in the baby at 2 years old.

It is unclear whether insomnia itself, or some other factor that correlates with insomnia, explains this phenomenon. More research is necessary to understand how different types and causes of insomnia influence maternal health.

If a person is having difficulty with insomnia during pregnancy, they should speak with a doctor. Although it is a common issue, it is possible it may affect the health of the fetus.

There is also evidence that pregnancy-related sleeping difficulties are underdiagnosed. In the 2019 study, over half of the 267 participants had clinically significant insomnia, but only nine had received a diagnosis from a doctor.

Speaking with a healthcare professional can mean a person gets access to the necessary advice and therapies. Treatment for pregnancy-related insomnia may involve:

• Sleep hygiene: This means adopting habits that help create the best circumstances for sleep, such as:
  • limiting caffeine
  • going to bed and waking at the same time each day
  • sleeping in a cool and dark room
  • using the bed only for sleep or sex
  • limiting the use of screens and devices close to bedtime
  • adjusting pillows and bedding for comfort
• Lifestyle changes: Measures such as exercising during the day, drinking fluids throughout the day but limiting them at night, managing stress, or avoiding foods that can cause heartburn may help.
• Talk therapies: Psychotherapy can help people with stress, anxiety, or depression. Cognitive-behavioral therapy for insomnia (CBTi) may be especially helpful if insomnia is a persistent issue.
• Treatment for underlying conditions: If a condition such as OSA or RLS is causing insomnia, a doctor may recommend treatments to help.
• Medications: Some sleep medications are not safe during pregnancy. However, diphenhydramine is a low risk drug that may provide short-term relief. Before trying any medication, a person should discuss the risks and benefits with a doctor.

Different people experience different signs that labor is approaching. Some experience numerous signs and still do not go into labor for weeks. Others go into labor without any obvious symptoms appearing first.

Anecdotally, some signs people report as labor becomes closer include:

• diarrhea or more frequent bowel movements
• a sense of fullness, like the fetus has “dropped”
• loss of a mucus plug
• increased vaginal discharge
• change in mood, such as a rush of energy or increased “nesting behavior”

Learn more about the signs of labor.

Insomnia can occur at any time during pregnancy. Some may find it begins or worsens when labor is near. This could be a result of hormonal changes that take place before birth, or it could be the result of other factors, such as stress, sleep apnea, or physical discomfort.

Pregnant people are often eager to find signs that birth is imminent, but no single symptom can reliably predict when this will happen.

Insomnia may affect the health of the birthing parent or fetus. People who are experiencing insomnia should talk with a doctor about how to safely manage their symptoms.