Why Sleep Gets So Hard During Pregnancy
Many women expect to feel tired during pregnancy-but not that tired. By the third trimester, nearly 1 in 10 pregnant women develop obstructive sleep apnea (OSA), and the number jumps to nearly 1 in 4 for those with obesity. It’s not just about waking up tired. It’s about waking up gasping, choking, or with a burning throat. It’s about lying down and feeling like your body won’t let you breathe properly. And it’s not just you-your baby’s health is tied to how well you sleep.
During pregnancy, your body changes in ways that directly interfere with breathing. Hormones relax the muscles in your airway. Your neck gets thicker. Your nose swells. Your growing uterus pushes up on your diaphragm. These aren’t minor inconveniences. They’re physiological shifts that can turn a good night’s sleep into a series of interruptions, low oxygen levels, and high blood pressure.
What Is Sleep Apnea in Pregnancy-and Why It Matters
Sleep apnea isn’t just snoring. It’s when your airway closes off repeatedly during sleep, stopping your breathing for 10 seconds or more. Each time this happens, your brain jolts you awake just enough to restart breathing-so you never truly rest. In pregnancy, this isn’t just about feeling exhausted. Studies show that untreated sleep apnea raises your risk of preeclampsia by more than double, gestational diabetes by 70%, and cesarean delivery by more than twice.
The good news? Treating it works. A 2023 study in JAMA Network Open found that using CPAP therapy starting between 24 and 28 weeks reduced the risk of preeclampsia by 30% and gestational hypertension by 35%. That’s not a small benefit-it’s life-changing for both mother and baby.
How to Know If You Have Sleep Apnea
Snoring alone doesn’t mean you have sleep apnea. But if you snore loudly, wake up gasping, feel exhausted even after 8 hours of sleep, or your partner says you stop breathing at night, it’s time to talk to your provider. The American College of Obstetricians and Gynecologists now recommends screening all pregnant women using the STOP-Bang questionnaire at 28 weeks. It’s simple: Do you snore? Are you tired during the day? Has anyone noticed you stop breathing? Do you have high blood pressure? Are you overweight? Are you over 35? Are you male? (Yes, they include this-because the tool was designed for general use, but it still works well in pregnancy.)
If your score is high, you’ll likely be referred for a sleep study. The gold standard is an overnight polysomnography in a lab, but home sleep tests are now accepted for low-risk women. Don’t wait for symptoms to get worse. If you’re in your second trimester and already feeling like you’re suffocating at night, get tested. Early intervention makes all the difference.
CPAP Therapy: The Most Effective Treatment
Continuous Positive Airway Pressure (CPAP) is the first-line treatment for moderate to severe sleep apnea in pregnancy. It works by delivering a steady stream of air through a mask to keep your airway open. Sounds simple-but many women struggle with it.
Here’s what actually helps:
- Use nasal pillows instead of full-face masks. Your face swells during pregnancy, and a tight mask causes pressure sores and leaks.
- Turn on humidification set to 37°C. Pregnancy causes nasal congestion-humid air helps you breathe easier.
- Start between 20 and 28 weeks. The earlier you begin, the better the outcomes. Each week of use before 28 weeks reduces preeclampsia risk by nearly 5%.
- Use a pregnancy-specific CPAP pillow like the Boppy Noggin or Leachco Full Body Pillow Pro. These are designed to support your belly and keep you on your side without crushing the mask.
Adherence is the biggest hurdle. Only about 62% of pregnant women stick with CPAP beyond four weeks. But clinics that offer a 30-minute orientation, follow-up calls at 3 and 7 days, and free mask replacements see adherence jump to 82%. Don’t go it alone-ask your sleep clinic for support.
Positioning: The Simple Fix That Works
If you have mild sleep apnea (AHI under 15), changing your sleep position can cut your apnea episodes by more than 20%. The best position? Left side. Why? Lying on your left side takes pressure off the vena cava, the big vein that returns blood to your heart. It also reduces reflux and improves oxygen flow to your baby.
But sleeping on your side isn’t easy when your belly is huge. That’s where pregnancy pillows come in. A full-body pillow (like the Leachco Snoogle or Boppy Total Body Pillow) wraps around you, supporting your belly, back, and legs. One user on Amazon wrote: “My AHI dropped from 18 to 6 in two weeks-just by staying on my side.”
Don’t just use regular pillows to prop yourself up. Elevating your head with pillows can actually worsen apnea by bending your neck. Instead, use a wedge pillow under your upper body-6 to 8 inches high-to keep your airway open without straining your spine.
Managing Reflux Without Medication
Heartburn during pregnancy is common-but it’s not harmless. Lying down after eating lets stomach acid creep up into your esophagus, burning your throat and waking you up. Worse, it can trigger coughing and choking that mimics sleep apnea.
Here’s what actually works:
- Elevate the head of your bed by 6 to 8 inches. Use bed risers or blocks under the bedposts-not just pillows. Pillows bend your neck and make apnea worse.
- Avoid eating within 3 hours of bedtime. Your stomach needs time to empty.
- Use Gaviscon Advance. It’s an alginate-based antacid that forms a protective foam barrier on top of stomach contents. It doesn’t get absorbed into your bloodstream, so it’s safe during pregnancy. A 500ml bottle costs about $15 and lasts weeks.
- Avoid trigger foods: spicy dishes, chocolate, caffeine, citrus, and fried foods.
Many women report fewer nighttime awakenings and less throat irritation within just a few days of making these changes.
What Doesn’t Work (and What to Avoid)
Not all sleep aids are safe during pregnancy. Mandibular advancement devices (mouthpieces that push your jaw forward) are effective for non-pregnant adults-but they’re not recommended during pregnancy. Your jaw and TMJ are already under stress from hormonal changes, and these devices can cause pain or long-term damage.
Also avoid sleeping pills, even “natural” ones like melatonin. There’s no safety data for their use in pregnancy, and they don’t treat the root cause of apnea.
And don’t rely on “natural” remedies like essential oils or herbal teas unless your provider approves them. Some herbs can stimulate contractions or affect blood pressure.
What Happens After Baby Is Born?
Many women assume their sleep apnea disappears after delivery. It often improves-but not always. A 2023 study found that 58% of women who developed sleep apnea during pregnancy went on to develop chronic high blood pressure within 10 years, even if their apnea seemed to resolve.
That’s why some clinics, like Brown Health, recommend a follow-up sleep study at 12 weeks postpartum. If your symptoms are gone and you’ve lost weight, you might not need another test. But if you still snore, feel tired, or have high blood pressure, get checked. Pregnancy-induced sleep apnea can be a warning sign of future cardiovascular problems.
Real Stories, Real Results
“I ignored my snoring until I started waking up with headaches every morning,” says Sarah, 31, in her third trimester. “My OB told me to get tested. I was skeptical-but after two weeks on CPAP, my blood pressure dropped from 145/90 to 118/76. I slept through the night for the first time in months.”
Another woman, Maria, 29, says: “I tried every pregnancy pillow. None worked until I got the Leachco with the built-in wedge. I stopped waking up choking. My baby’s movements felt more regular.”
But not everyone has a smooth experience. “I got the CPAP machine, but the mask hurt my nose. I quit after a week,” says Jenna, 33. “It took three different masks and a nurse coming to my house to find one that fit.”
Support matters. If you’re struggling, ask for help. Many hospitals now offer sleep coaches who come to your home to adjust your equipment.
What’s Changing in 2025
Technology is catching up. In September 2023, ResMed launched the AirTouch F20 Pregnancy Edition-a CPAP mask with a softer silicone cushion designed for swollen faces. Its humidity system now adjusts automatically based on room temperature, which helps with dry noses.
Apple Watch Series 9 now has a sleep apnea detection algorithm validated in a 2024 JAMA Internal Medicine study with 89% accuracy for moderate to severe cases. While it’s not a diagnostic tool yet, it can alert you to patterns worth discussing with your doctor.
By 2027, experts predict 65% of prenatal clinics will screen for sleep apnea routinely. Right now, only 32% do. That’s changing fast.
Your Action Plan
If you’re pregnant and struggling to sleep, here’s what to do:
- Screen yourself using the STOP-Bang questionnaire. If you score 3 or higher, talk to your OB.
- Start with positioning. Sleep on your left side with a full-body pillow. Elevate your upper body with a wedge-not pillows.
- Manage reflux. No food 3 hours before bed. Use Gaviscon Advance. Elevate your bed, not just your head.
- Get tested if you snore, gasp, or feel exhausted. Don’t wait until it’s ‘bad enough’.
- If diagnosed with OSA, start CPAP between 20-28 weeks. Use nasal pillows, humidification, and a pregnancy pillow to make it work.
- Ask for support. Don’t suffer in silence. Ask your clinic for a sleep coach or follow-up visit.
- Follow up postpartum. Even if you feel better, check your blood pressure and sleep quality at 12 weeks.
Sleep isn’t a luxury in pregnancy. It’s medicine. And treating it isn’t optional-it’s essential for your health, your baby’s, and your future.
