Will I harm the baby if I don't turn to my left side? Why can't I feel comfortable in any position? What is this feeling in my legs? We've rounded up all the things that disrupt sleep during pregnancy and when they should be taken seriously, with up-to-date evidence.
Sleep during pregnancy is one of the most complained about but least talked about topics. On the one hand, the overwhelming fatigue during the day, on the other hand, the comfortable position that cannot be found at night... Moreover, "will I harm the baby if I do not turn to my left side?" When anxiety is added, sleep can become a source of anxiety rather than something relaxing. In this article, we discuss why sleep is disrupted during pregnancy, the scientific equivalent of the position issue, ways to cope with insomnia, and when restless legs and snoring should be taken seriously.
It is very common for sleep quality to decrease during pregnancy. Sleep is fragmented, especially in recent months: waking up more often after falling asleep, the duration of superficial sleep increases, deep sleep decreases. The main reasons for this are nocturnal urination, increased heartburn at night, anxiety, restless legs and leg cramps, lower back pain, difficulty finding a comfortable position, and — especially in pregnant women with obesity — sleep apnea (UpToDate, "Prenatal care: Patient education, health promotion, and safety of commonly used drugs", August 2026). Two of these causes are particularly common: frequent urination affects 80-95% of pregnant women, while heartburn occurs in 40-85% and increases from the first trimester to the third trimester (UpToDate, "Maternal adaptations to pregnancy: Gastrointestinal tract", August 2026). So most of the time, what interrupts your sleep is not a "sleep problem" but another fixable complaint.
There is also a finding that may alleviate some concern: in a meta-analysis combining data at the patient level, stillbirth was less common in pregnant women with above-average restless sleep. So, turning over frequently at night and waking up frequently is not a bad sign in itself.
The logic behind the recommendation for left side sleeping is as follows: when lying on your back in the last period of pregnancy, the growing uterus can put pressure on the main vein and aorta (aortocaval compression); This can reduce the amount of blood pumped from the heart and blood flow to the uterus. The finding that sleeping on your back was associated with stillbirth in case-control studies made this recommendation widespread. However, these studies are prone to error because they are based on retrospective recollections of people who experienced the event.
Stronger evidence came from a large prospective multicenter study in which sleep position was measured objectively: In pregnant women who spent at least half their sleeping time on their back at 22–30 weeks, the composite adverse outcome (stillbirth, small baby for gestational age, and blood pressure disorders during pregnancy) was not significantly increased (OR 1.24; 95% CI 0.98-1.57). In the same study, the frequency of stillbirth was found to be 5 in 4,667 pregnant women who slept in a position other than on their left side, and 13 in 3,511 pregnant women who slept on the left side. UpToDate interprets this result as reassuring to pregnant women that they can "sleep in the most comfortable position."
The practical equivalent is this: when falling asleep, choose to lie on your side — this not only makes breathing easier, but also helps relieve heartburn and lower back pain. Do not panic when you wake up on your back at night; Just turn on your side and continue sleeping. You cannot control what position you occupy while sleeping, and you are not responsible for that.
A comfortable position is often found by rearranging the pillows. The setup that usually works is this: lying on your side with knees and hips slightly bent; placing a pillow between the knees, a thin pillow under the abdomen and a support behind the back. The pillow under the abdomen carries the weight of the uterus and reduces the load on the waist; The pillow between the knees stabilizes the pelvis. If you have heartburn, raising the head of the bed slightly also improves sleep significantly.
The use of sleeping pills during pregnancy should be avoided as much as possible; Therefore, the first step is behavioral measures. UpToDate's suggested layout is as follows:
If insomnia is chronic, the most effective method is not medication, but cognitive behavioral therapy for insomnia. The decision when medication is required belongs entirely to your physician: benzodiazepine group, known as sleeping pills, and similar drugs are generally not preferred during pregnancy due to concerns about premature birth, low birth weight, and respiratory suppression in the newborn when used close to birth. Although UpToDate recommends melatonin as the first choice for difficulty falling asleep when non-drug methods are inadequate, it emphasizes that melatonin crosses the placenta freely and that data in pregnancy are extremely limited. In short: do not start any sleep support, including herbal products, without asking your doctor.
Restless legs syndrome (RLS) is an uncomfortable feeling that causes the desire to move the legs while resting and goes away when you move. It is very common in pregnancy: in a meta-analysis covering 27 studies and more than 50,000 pregnant women, the pooled prevalence for all three trimesters was 21%; It increases to 8%, 16% and 22% by quarter and 7-8 months respectively. It peaks per month. The frequency of its occurrence for the first time during pregnancy is 18% (UpToDate, "Restless legs syndrome during pregnancy and lactation", October 2025). RLS is the third most common cause of insomnia in pregnancy, after nighttime urination and position-related discomfort.
The good news: in approximately 70% of affected pregnant women shortly after birth, the complaint disappears completely, in most of the remaining it decreases markedly.
Cramps or restless legs? The distinction is easy to make: a night cramp is a sudden, painful contraction in which the muscle feels stiff in the hand; Movement initially increases the pain. In restless legs, there is an "unbearable need to move" rather than pain, and movement provides relief.
Iron connection: Known risk factors of RLS include low ferritin level and iron deficiency anemia. For this reason, iron status is evaluated in everyone who complains of restless legs during pregnancy, even if they do not have anemia. UpToDate recommends oral iron supplementation in pregnant women with ferritin levels below 75 mcg/L (Grade 2C); If it is above 75 mcg/L, iron supplementation has no place. So, the correct approach is not "I have restless legs, let's get iron", but "let's get my ferritin checked".
Non-drug approaches come first: regular and moderate exercise (such as brisk walking, water aerobics), regular and adequate sleep, pain control, avoidance of caffeine and nicotine. Also know: some medications used for nausea and vomiting (such as doxylamine, prochlorperazine, promethazine, metoclopramide) may worsen restless leg; Ondansetron does not appear to have such an effect. If your restless legs increase while using nausea medication, be sure to tell your doctor.
Swelling of the nasal mucosa, narrowing of the throat area and weight gain during pregnancy make snoring easier. Some snoring is harmless; However, some of them are a sign of obstructive sleep apnea (repeated blockage of the airway during sleep). The frequency of sleep apnea detected by objective methods during pregnancy varies between 3-27% depending on the group examined; This rate is 0.7-6.5% in non-pregnant women of reproductive age. In the largest study involving more than 3,300 pregnant women, the frequency was found to be 3.6% in early pregnancy and 8.3% in mid-pregnancy, and most cases were mild.
This issue is important because sleep apnea has been associated with serious problems in pregnancy. In a meta-analysis combining 120 observational studies, preeclampsia (OR 2.36; 95% CI 2.00-2.79), gestational hypertension (OR 1.93; 95% CI 1.51-2.46), gestational diabetes (OR 1.88; 95% CI 1.47-2.40) and preterm birth (OR 1.38; 95% CI 1.26–1.51) were found to be increased in pregnant women with objectively diagnosed sleep apnea. There is also data on the treatment side: in a meta-analysis of 809 pregnant women combining four randomized trials and two cohorts, gestational hypertension (RR 0.65; 95% CI 0.47-0.89) and preeclampsia (RR 0.70; 95% CI 0.50-0.98) were less common in those receiving CPAP (positive airway pressure during sleep) therapy.
Tell your physician if you have these symptoms: loud snoring more than three days a week; your partner notices that you stop breathing at night; waking up feeling like you are choking or struggling to breathe; Being too sleepy to drive during the day. If these complaints are present, the evaluation is made by referring you to a sleep physician; A sleep test is required for diagnosis. Note: screening questionnaires commonly used during pregnancy (such as STOP-Bang, Berlin) have poor predictive power in this group, so it would not be correct to say "I passed the questionnaire, I don't have it".
A remarkable data: in a study, only 5% of pregnant women were asked about snoring during prenatal check-ups; 32% of those asked reported snoring. So, if you do not bring up this issue, it is very likely that it will be overlooked.
Napping during the day is extremely common during pregnancy, especially in the first trimester. A short nap relaxes you; However, long naps late in the day disrupt night sleep. Keeping naps short and close to noon is one of the easiest ways to save the night.
Sleep disruption during pregnancy is often a period of adaptation, not a disease; But there are also real problems hiding behind the phrase "insomnia is normal during pregnancy." Don't beat yourself up about the position: the most recent data says you can sleep in the position you're comfortable with. On the other hand, loud snoring, stopping breathing at night and restless legs that disrupt sleep are conditions that need to be addressed and treated. Bring up your sleep patterns at follow-up exams — often a few simple changes and a blood test if necessary can dramatically transform your nights.
Last updated: . This content has undergone scientific verification and is not a substitute for a medical examination.