Pregnant insomnia is common: a meta-analysis of 24 studies with 11,002 women found 45.7% reported poor sleep quality, and sleep got worse from the second to the third trimester. In an Italian and Swiss cohort of 439 women, poor sleep quality was reported by 34% in the first trimester, 46% in the third and 71% in the first month after birth. Daytime sleepiness peaked early, in the first trimester, while restless legs peaked in the third. None of this makes it harmless: sleep disturbance in pregnancy can worsen quality of life and may be a risk factor for adverse outcomes, and snoring, restless legs and low mood are worth raising at an appointment. A European position paper names cognitive behavioural therapy for insomnia as the preferred first treatment in the perinatal period. Insomnia on its own is not a dependable early sign of pregnancy.
Insomnia when pregnant has a particular texture. In the first weeks you are flattened by tiredness and still awake at 3 a.m. By the end there is a body that will not settle, a bladder that will not allow it, and a brain that has started rehearsing the delivery. Almost everybody around you says "that's normal", which is true and also not quite the point.
This page goes through pregnant insomnia trimester by trimester, with the numbers from large studies, a section on what is worth mentioning to a midwife or doctor, and what a few recorded nights can add. It does not recommend any treatment. That belongs with the person who knows your history.
Pregnant insomnia: how common it is, and why "normal" is not the whole answer
The cleanest overview of insomnia in pregnant women comes from sleep quality studies, which are not identical to an insomnia diagnosis but run alongside it. A meta-analysis pooled 24 studies and 11,002 women who had answered the Pittsburgh Sleep Quality Index. 45.7% (95% confidence interval 36.5% to 55.2%) fell into the poor sleep quality range. In the studies that followed the same women over time, scores worsened from the second trimester (5.31) to the third (7.03), a difference of 1.68 points. Gestational age moderated the results, with older samples reporting worse scores. The authors conclude that some reduction in sleep quality is expected, but that very poor sleep quality could require intervention.
The largest study with sleep recordings, the Italian and Swiss Life-ON study, followed 439 women from the 10th to 15th week and again in the 23rd to 25th week, with home polysomnography at the second visit and questionnaires throughout pregnancy and after birth. Poor sleep quality was reported by 34% of women in the first trimester, 46% in the third trimester and 71% in the first month after delivery. The authors report a similar trend for insomnia, without giving a separate number in the abstract.
A 2022 review in Obstetrics and Gynecology adds the point that gets lost: sleep disturbances affect more than half of pregnancies and increase as gestation progresses, and because they are so widespread, people assume they are normal, which can prevent accurate diagnosis. Obstructive sleep apnea, insomnia and restless legs syndrome are the most common sleep disorders in pregnancy, and sleep disruption can substantially worsen quality of life and may be a risk factor for adverse pregnancy outcomes.
Insomnia 1st trimester: sleepy by day, awake by night
Insomnia 1st trimester is the least discussed version, because the cliché of pregnancy sleep is a large third-trimester bump. The Life-ON data tell a different story for the early weeks. Excessive daytime sleepiness peaked in the first trimester, when 30% of women reported it, and fell to 22% in the third, while 34% already reported poor sleep quality. Pregnancy insomnia early on therefore often means two things at once: heavy daytime sleepiness and a night that does not deliver.
The usual explanations, hormonal changes, nausea and needing the bathroom more often, are the ones clinicians commonly give. None of the studies cited here tests them, so treat them as plausible and not as proven. What the data do support is the pattern. 1st trimester insomnia is not a sign that something is wrong with you in particular, and it is not rare.
Is insomnia an early sign of pregnancy?
Sleep changes are so noticeable in early pregnancy that many women wonder whether poor sleep announced it. The cited data do not support using it as a sign. They show that sleepiness and poor sleep are common in the first trimester, but they say nothing about how common they are before a test would be positive or how they compare with women who are not pregnant. As an early sign of pregnancy, insomnia is therefore a weak clue at best, and a pregnancy test answers the pregnancy question, where sleep does not.
Second trimester insomnia: the middle of the curve
The second trimester is the stretch with the least to say. In the pooled longitudinal studies, sleep quality scores worsened from the second trimester to the third, which suggests the second is where many women have their best nights. Second trimester insomnia exists and is not unusual, but if you had a bad first trimester, a better middle is a reasonable expectation and a worse end is a reasonable thing to prepare for.
Third trimester insomnia: why the last stretch is the hardest
Third trimester insomnia is where several of the measured problems pile up. Insomnia in third trimester is usually blamed on the bump alone, and the data suggest a longer list. Poor sleep quality reached 46% of women in Life-ON. Restless legs syndrome, with a prevalence of 25% in that cohort, peaked in the third trimester. A later analysis of the same cohort found that 26.03% met the diagnostic criteria for restless legs syndrome at least once during pregnancy, that a previous history of restless legs was present in half of those women, and that about 20% of women with it reported severe or very severe symptoms. Severity was similar across trimesters, which suggests it does not simply fade after the first symptoms. If an urge to move your legs is what keeps you up at night, what causes restless legs is the place to start and your care team is the place to follow.
Insomnia third trimester: breathing and sleepiness
Breathing belongs on that list. In the polysomnography part of Life-ON, performed around the 23rd to 25th week, sleep-disordered breathing (a respiratory disturbance index of 5 or more) had a prevalence of 4.2% and correlated with body mass index. In a separate Portuguese study of 289 pregnant women, the number of symptoms suggesting breathing problems in sleep, and sleepiness scores, tended to increase with gestational age, particularly in the third trimester, and snoring was associated with older age and higher body mass index. Fatigue (65.4%), problems with memory or concentration (52.2%) and non-restorative sleep (50.5%) were the most common complaints there. None of these studies splits insomnia in the third trimester into causes, so nobody can say how much of it is a breathing problem and how much is a bump, a bladder and a busy mind. What they do support is simpler: snoring and sleepiness rise as pregnancy goes on, and both are worth mentioning. Snoring while pregnant has the details.
What helps is a question for your care team
Nothing on this page is a treatment recommendation, and no herbal tea, supplement or sleep aid is recommended. What can be said comes from a joint position paper of European insomnia and perinatal mental health groups, which reviewed evaluation and treatment of insomnia in the peripartum period. It says that insomnia symptoms are frequent in the peripartum and are risk factors for peripartum psychopathology, that assessing and treating them should be a priority in clinical practice, that cognitive behavioural therapy for insomnia should be the preferred treatment choice, and that pharmacological treatment may be considered when severe insomnia does not respond to non-drug therapy. Who provides that, and what else is right for you, is for your midwife, obstetrician or doctor to decide with you.
The practical, low-risk part is information: when you wake, what wakes you, how the days feel. For the general habits, sleep hygiene tips and the page on sleeping positions are a reasonable read, and a doctor can tell you what is safe for your pregnancy.
What a recorded night can add
A recording will not tell you why you are awake. It can tell you when, how often, and what the room did around it. Three things are useful to a clinician. Whether the wake-ups cluster at a similar hour. Whether snoring has started or has become louder, which is worth an early mention because of the breathing and sleepiness figures above. And how the weeks compare: a bad stretch that lasts one week looks different on a timeline from one that has deepened over a month.
If you want to try it, put the phone on the nightstand with the screen down, and read how to record yourself sleeping first. If you are alone at night and unsure whether you snore, how to know if you snore is the short version.
Tell your midwife or doctor soon if you snore loudly or somebody has seen you stop breathing in your sleep, if restless legs or leg pain keep you awake most nights, if low mood or anxiety will not lift or you have thoughts of harming yourself (in the United States, call or text 988; elsewhere, use your local emergency number), or if you feel unusually sleepy through the day. As always in pregnancy, a severe headache, changes in vision or sudden swelling of the face or hands go straight to your care team. A recording or an app cannot rule any of this out.
What to mention, and how soon: a three-step guide
- At your next routine appointment: waking more often than before, trouble getting comfortable, daytime sleepiness, legs that are restless now and then, snoring that is new but quiet.
- Call the practice in the coming days: loud snoring, pauses someone has witnessed, restless legs or leg pain that keep you up most nights, low mood or anxiety that will not lift, unusual sleepiness through the day.
- Straight away: severe headache, changes in vision, sudden swelling of the face or hands, or thoughts of harming yourself.
The sorting is ours and deliberately cautious. It is not a triage tool, and your midwife or doctor may draw the lines elsewhere for you.
We have not validated SleepTrace in pregnancy, and a pregnant body may change the sounds and movements the app listens to. Treat its stage figures lightly. The audio timeline is the part worth having: snoring and other sounds marked with timestamps, and weeks of nights side by side. It cannot diagnose sleep apnea, restless legs or insomnia, and it is not a medical device. What it can do is turn "I sleep terribly" into evidence you can show somebody. For the breathing question, snoring while pregnant has the details, and waking at 3am covers the hour that people in every trimester complain about.
Frequently asked questions
Yes, in the sense that it is common. A meta-analysis of 24 studies covering 11,002 women found that 45.7% reported poor sleep quality, and a review of common sleep disorders in pregnancy says sleep disturbances affect more than half of pregnancies and increase as gestation goes on. The same review warns that treating this as always normal can stop real problems, such as sleep apnea or restless legs, from being picked up.
There is no fixed week. In the Life-ON cohort of 439 women, 34% reported poor sleep quality already in the first trimester, 46% in the third, and the authors saw a similar trend for insomnia itself. Daytime sleepiness was highest in the first trimester, which is why early pregnancy can feel like being exhausted and awake at the same time.
Nobody can say from the sources used here. A 2022 review states that sleep disruption in pregnancy can substantially worsen the mother's quality of life and may be a risk factor for adverse pregnancy outcomes. That is an association and a reason to raise it with a midwife or doctor, not evidence that a bad week of sleep harms a baby.
That decision belongs to your own clinician, and this page does not recommend any medicine or supplement. A European position paper on insomnia in the perinatal period says cognitive behavioural therapy for insomnia should be the preferred treatment choice and that pharmacological treatment may be considered when severe insomnia does not respond to non-drug therapy.
References
- Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: A meta-analysis. Sleep Med Rev (2018). Europe PMC
- Manconi M, van der Gaag LC, Mangili F, et al. Sleep and sleep disorders during pregnancy and postpartum: The Life-ON study. Sleep Med (2024). Europe PMC
- Hackethal S, Esteves AM, Riccardi S, Garbazza C, Manconi M. Restless legs syndrome during pregnancy and puerperium. Sleep (2026). Europe PMC
- Montês J, Grafino M, Ângelo-Dias M, Lima J, Furtado ST. Sleep-Related Breathing Disorders and Pregnancy: Where We Stand and Where to Go. Medicina (Kaunas) (2026). Europe PMC
- Facco FL, Chan M, Patel SR. Common Sleep Disorders in Pregnancy. Obstet Gynecol (2022). Europe PMC
- Palagini L, Bramante A, Baglioni C, et al. Insomnia evaluation and treatment during peripartum: a joint position paper from the European Insomnia Network task force "Sleep and Women," the Italian Marcè Society and international experts task force for perinatal mental health. Arch Womens Ment Health (2022). Europe PMC
SleepTrace is a wellness app, not a medical device. This article is general information, not medical advice. If your symptoms are frequent, severe or worrying, please talk to a doctor.
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