Sleep often changes from the first trimester through the final weeks before birth. Hormonal shifts can increase sleepiness, while later physical changes such as discomfort, fetal movement, reflux and frequent urination can make sleep more fragmented.

These changes are common, but persistent sleep problems should not simply be accepted as part of pregnancy. Insomnia, restless legs syndrome and sleep-disordered breathing may need specific assessment or treatment. Poor sleep is also associated with lower quality of life during pregnancy.

Pregnancy is closely linked to the body’s circadian system. Maternal hormones such as melatonin follow a 24-hour pattern, and melatonin can cross the placenta, helping provide the developing fetus with information about day and night. Researchers are also studying how sleep timing, sleep regularity and light exposure at night may relate to sleep and health during pregnancy.

Looking across the full 24 hours can help identify realistic ways to support sleep as pregnancy changes.

Pregnancy can change not only how much you sleep but also when you feel sleepy, when you are most alert, and how stable your sleep schedule is from day to day. These changes can begin early in pregnancy and continue to shift as pregnancy progresses.

For some women, increased daytime sleepiness can lead to earlier bedtimes or more napping. Later in pregnancy, repeated nighttime awakenings can break up sleep and may lead to more daytime sleep. Evening or rotating work shifts can make sleep timing less regular, while bright light at night can make it harder for the body to prepare for sleep.

The important point is not whether someone is naturally an “early bird” or a “night owl.” It is whether sleep, light and daily routines are becoming increasingly out of sync as pregnancy changes daily life, and identifying opportunities for support.

Sleep affects more than just how rested you feel. During pregnancy, poor sleep can worsen fatigue and affect mood, concentration, and day-to-day wellbeing. It is also linked to lower quality of life, particularly later in pregnancy.

Sleep and circadian health may also be connected with some pregnancy complications. Research has looked particularly at:

• Gestational diabetes. Short or disrupted sleep, irregular sleep timing and evening shift work have all been linked with higher risk in some studies. 
• Mood and emotional wellbeing. Disturbed sleep and less stable daily rhythms have been associated with more symptoms of depression and anxiety during pregnancy and after birth. 
• Preterm birth and hypertensive disorders. Some studies have found associations with poor sleep or circadian disruption, although the findings are not consistent enough to say that sleep problems directly cause these complications. 

Sleep during pregnancy may also be connected with how a baby sleeps and develops after birth.

Some studies have found that women who had more sleep problems during pregnancy were more likely to have babies with sleep difficulties. Later or more irregular sleep during pregnancy has also been linked to differences in infant behavior. These findings are still preliminary and do not show that a mother’s sleep pattern directly causes these changes. 

The message is not that pregnant women need a perfect sleep schedule. Many factors shape a child’s health and development. Instead, the findings give another reason to take ongoing sleep problems seriously and support good sleep where possible.

Pregnancy can shift sleep and energy across the whole day. Daytime sleepiness, naps, disrupted nights, work schedules and changing routines can all affect when you sleep and how rested you feel.

Looking across the full 24 hours can help you see what may be making sleep easier or harder. The goal is not a perfect routine, but one that works with your pregnancy. A simple sleep or 24-hour diary can help show how naps, work schedules, evening light or changing bedtimes may be affecting your health and your pregnancy experience..

Some sleep disruption is normal during pregnancy, especially later on. Focus on what is making sleep difficult and what can realistically be changed.

Keeping sleep and wake times reasonably consistent can help, while still allowing for naps and changing energy levels. Daytime light and regular physical activity may also support a steadier day-night rhythm.

Focussing on supporting the body during pregnancy can help improve comfort during sleep. Using extra pillows and cushions can make a big difference.

Persistent insomnia does not have to be accepted as part of pregnancy. CBT-I can be used during pregnancy, and sleep disorders such as restless legs syndrome and sleep-disordered breathing may need specific assessment and treatment. Speaking with a doctor if these concerns arise is always appropriate.

Talk with your care team if sleep problems persist, regularly affect daytime function or remain disruptive despite changes to your routine.

It is especially worth discussing symptoms such as loud snoring, choking or gasping during sleep, witnessed breathing pauses, a persistent urge to move the legs, severe daytime sleepiness, or ongoing anxiety, low mood, or other changes in emotional wellbeing.