How unfair that when you need sleep the most, you can't seem to get it. You keep on telling yourself it's the last opportunity for a long, long time (at least until your baby starts sleeping through the night). But you still can't get any. 

Yup, those blissful Zzzs are somehow eluding you and many other expectant mamas. In fact, insomnia, or the inability to fall or stay asleep, can hit especially hard in the third trimester, when it's estimated to affect more than 75 percent of moms-to-be.

Whether your insomnia or disturbed sleep is related to anxiety, crazy pregnancy dreams, frequent trips to the bathroom or your sweet babe kicking you in the ribs, getting enough sleep is crucial for good health. To help you get a better night's sleep, here's more about the causes of insomnia, as well as what you can do to manage and maybe prevent it during pregnancy.

What is insomnia?

Insomnia is a sleep disorder that makes it hard to drift off to sleep or stay asleep at night.[1] This common sleep problem can also cause you to wake up too early and not be able to head back to dreamland, and it may make you feel as if the sleep you did manage to get wasn't refreshing or restorative.

Insomnia, which may affect up to 60 percent of Americans, can impact your mood, energy level, health and work performance.

When does insomnia during pregnancy start?

It's normal to have trouble sleeping at any point during pregnancy, but many expectant women experience insomnia starting in the second to third trimesters, as other pregnancy symptoms increase, and a burgeoning baby belly makes it harder than ever to get comfortable in bed.

Still, first trimester woes can force you from your cozy bed and disturb precious sleep too, including morning sickness, which can happen any time of the day or night, and a constant need to pee. But if you're worried that a case of insomnia may harm your baby, rest assured it won't. So do your best not to fret — and sometimes, just letting go of these feelings is all it takes to help you sleep.

What causes pregnancy insomnia?

Like many annoying pregnancy-related symptoms, insomnia can be pinned, in part, to hormonal changes.[2] But along with this usual suspect there are also a whole host of different factors that may conspire to keep you awake at night, including:

  • Frequent trips to the bathroom
  • Pregnancy heartburnconstipation or morning sickness
  • Aches and pains, including headache, round ligament pain or tender breasts
  • Leg cramps and restless leg syndrome
  • Vivid or disturbing dreams
  • A hopped-up metabolism that keeps the heat on even when it's off
  • Difficulty getting comfortable with your growing belly
  • Kicking, flipping and rolling from your active baby on board
  • Pre-birth anxiety and worries

How long does pregnancy insomnia last?

Since it's possible to experience insomnia and disrupted sleep at any point during pregnancy, you may be faced with a loss of shut-eye for weeks and months with no real end point in sight. But rather than letting this sleep disorder weigh on you, check in with your doctor at your next prenatal appointment for some help and guidance.

Can you take melatonin during pregnancy?

Melatonin, a hormone that the body creates naturally to regulate sleep-wake cycles, might seem like an easy fix for a case of insomnia. But because it's considered a dietary supplement in this country, the regulation of melatonin isn't as carefully overseen by the Food & Drug Administration (FDA) the way other drugs are, and its impact hasn't been well studied in pregnancy.[3] If you're struggling with insomnia, your doctor may approve an occasional and very small dosage (such as 1 mg).

There are also other over-the-counter and prescription sleep aids that are considered safe for occasional use in pregnancy, including Unisom, Tylenol PM, Sominex and Nytol, but always check with your doctor before taking these or any kinds of herbal preparations. You should also try not to take sleep aids every night.

Sometimes, doctors recommended taking a magnesium supplement to combat constipation or leg cramps. If that's the case for you, it makes sense to take it before bed, since magnesium has been touted for its natural muscle-relaxing powers and may help lull you to sleep. Again, always ask your doctor before taking any over-the-counter or herbal sleep aid during pregnancy.

Is insomnia harmful during pregnancy?

A lost night of sleep during pregnancy here and there isn't usually a big concern, but continued or chronic inadequate sleep has been linked to gestational diabetes, stress and depression. Insomnia and frequent snoring also have been linked to an increased risk of giving birth to a baby that's too large or too small for its age, and sleep issues late in pregnancy have been linked to a longer labor and a greater need for a cesarean section.

How to manage pregnancy insomnia

You're probably getting more shut-eye than you think, but it might not feel that way if your sleep is interrupted, if you're tossing and turning trying to find a comfortable position, or if you're awake at night feeling anxious about the baby's birth. To help, here are a couple of ways to manage sleeplessness.

  • Get out of bed. If you're not asleep after 20 to 30 minutes, get up and find a small, boring task to accomplish. (Think bill paying for 15 minutes, not scrubbing the toilet.) Then try to go to sleep again. You may just be tired enough by that point to get the rest you need.
  • Don't count the hours. Though most people do best on about eight hours of sleep, some feel fine on less and some need more. Do some quick math and check how you're feeling on the hours you're getting. If you're not chronically tired, you may be sleeping the right amount. 

How to prevent pregnancy insomnia

You don't have to take insomnia lying down! Instead, consider a few of the many ways you can try and beat back sleeplessness and finally summon the sandman:

  • Clear the emotional decks. If you have persistent worries that are keeping you up at night, talk about them with a friend or your partner so you can sort them out during daylight hours. You can also try meditation or writing your thoughts on paper.
  • Avoid caffeine and chocolate. Especially in the late afternoon or evening, since they can keep you awake. 
  • Eat small and early. A big meal, eaten late in the evening, can keep you from falling and staying asleep, so try to eat a lighter, earlier dinner.
  • Take your time. Don't wolf your food down at your evening meal. A leisurely pace can help keep symptoms of heartburn at bay.
  • Top it off. A light snack before you turn in will tide you over until breakfast, but choose a healthy carb-protein pair to keep your blood sugar stable, such as a whole grain muffin and a glass of warm milk, or a cheese stick and a few dried apricots.
  • Slow the flow. Fill your daily requirement of fluids earlier in the day and cut back on what you're drinking after 6 p.m. This may help to cut down on bathroom runs after you've hit the hay.
  • Work it out. Getting some daily pregnancy exercise can make you sleepier at night. Just avoid hitting the gym too close to bedtime, since a post-workout buzz can keep you awake.
  • Make a bedtime routine. Try to go to sleep and get up at the same time every day. Craft a routine that includes activities such as: light reading, soothing music, gentle yoga poses or relaxation exercises, a warm bath, prenatal massage and sex.
  • Download sleep. There are plenty of apps that promise to help you sleep, so download some of the better-rated ones that rely on self-guided meditation, nature sounds or other white noise.
  • Try nasal strips. If you're having trouble sleeping due to a pregnancy runny nose, nasal strips may help you breathe more easily at night.
  • Try white noise and black-out shades. Consider a machine that emits a quiet sound and room-darkening curtains to block light that might be keeping you up.
  • Wean off the screen. Using your phone, tablet, e-reader, TV or laptop before bed can mess with your Zzzs. The screen's blue light alters sleepiness and alertness and suppresses levels of melatonin. Power off at least an hour before bed.
  • Air it out. Is your bedroom too cold? Is it a sauna? Check the temperature, and make sure you're using a mattress and pillows that provide solid support without feeling like bricks. Open a window to keep the room from getting stuffy — you're sure to heat up during the night.
  • Get comfy. There is no such thing as too many pillows during pregnancy. Use them to prop you up, support you where you need it or just cozy up to (or better yet, invest in a good pregnancy pillow). After the first trimester, you can also try snoozing upright in a recliner, which will allow you to stay on your back without lying flat and ease heartburn.
  • Save your bed for sex and sleep. If you're doing daytime activities in bed, you might be unwittingly associating that part of your home with being awake — and with stress. Pay your bills in the kitchen, and save the bed for two purposes only — sex and sleeping.
  • Smell your way to sleep. A lavender-scented pillow or sachet tucked into your pillowcase can help you relax and bring on sleep faster.