Start with position
From the second trimester, sleep on your side — the left is often recommended as it optimises blood flow through the vena cava, though either side is acceptable and far better than flat on your back. Use a pillow between the knees to keep the pelvis level, one supporting the bump, and one behind your back so you do not roll. A full-length pregnancy pillow does all three. If you wake on your back, simply turn over; it is not something to feel anxious about.
Cannot fall asleep
Keep a fixed wake time, get morning daylight, and stop screens an hour before bed. If you are awake for more than twenty minutes, get up, sit somewhere dim and do a body scan or slow breathing, then return. Lying in bed anxious about not sleeping trains your brain to associate the bed with wakefulness. Avoid daytime naps longer than thirty minutes, and none after 4 pm.
Reflux and heartburn
Progesterone relaxes the valve at the top of the stomach and the uterus pushes upward. Eat dinner two to three hours before lying down, keep it small and low in fried food and chilli, and prop your upper body on an extra pillow or wedge — flat is the worst position for reflux. A glass of cold milk helps some people. Ask your doctor before taking any antacid regularly.
Restless legs
An irresistible urge to move the legs, worse in the evening. It affects up to a third of pregnancies and is strongly associated with iron and folate deficiency — ask for a ferritin test, not just haemoglobin. Moderate daytime exercise, a warm shower, calf stretches and reducing caffeine all help. Most cases resolve within days of delivery.
Leg cramps
Usually calf cramps in the second half of the night. Stretch the calves before bed — face a wall, step one foot back, heel down, lean in for 30 seconds each side. Stay well hydrated, and include magnesium-rich foods: nuts, seeds, bananas, ragi, green leafy vegetables. When a cramp hits, pull the toes towards you with the leg straight.
Frequent urination
Drink most of your fluid before evening, lean forward slightly when emptying your bladder to empty it fully, and keep a night light rather than turning on the main light. Do not restrict fluids overall — dehydration causes cramps, constipation and contractions. Burning, urgency or fever means a urine test.
Breathlessness
Common in the third trimester as the diaphragm is pushed up. Sleep more upright, propped on pillows. Sudden severe breathlessness, chest pain, or breathlessness at rest that is new needs urgent assessment.
Snoring and possible sleep apnoea
Nasal congestion and weight gain make snoring common. But loud snoring with witnessed pauses in breathing, gasping, morning headaches and heavy daytime sleepiness suggests obstructive sleep apnoea, which is linked to high blood pressure, pre-eclampsia and gestational diabetes. Tell your doctor — it is treatable and worth identifying.
Vivid dreams and anxiety dreams
Frequent waking means you remember more dreams, and pregnancy anxiety supplies the content. Vivid, unsettling dreams about birth or the baby are extremely common and not predictive of anything. A wind-down routine and talking about the underlying worry help more than trying to control the dreams.
Itching that wakes you
Mild itching responds to emollients and cool cotton. Intense itching on the palms and soles that is worst at night, with no rash, needs a bile acid and liver function test for cholestasis of pregnancy — this week, not at your next visit.
When to raise it with your doctor
- Snoring with pauses or gasping.
- Severe restless legs, or cramps not responding to the basics.
- Insomnia with low mood, hopelessness or anxiety.
- Intense night-time itching.
- Any breathlessness at rest, chest pain, or one-sided calf pain and swelling.