In the final stage of her pregnancy, former BBB cast member Key Alves spoke about how difficult it was to rest. She said she spent the entire night sitting, propped up by several pillows, unable to sleep. “I feel very bloated. Tonight was terrible. I felt sick, short of breath, and my stomach became very painful,” the former volleyball player said. What situations is this type of discomfort associated with, and why do many pregnant women experience such nights?
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Obstetrician-gynecologist Nelio Vega Jr. explains that sleep changes are part of pregnancy, but they shouldn’t be treated as something trivial. “Although it is to be expected, it is important to look for care strategies. Frequent lack of sleep can have consequences for both the mother and the baby.
Sleep deprivation is associated with an increase in inflammatory markers and hormonal imbalance, which may lead to changes in blood glucose, excessive weight gain, and an increased risk of preeclampsia. For the baby, poor maternal sleep quality can affect oxygenation and intrauterine growth and increase rates of premature birth. Rest should be viewed as a part of prenatal care, as important as a balanced diet and medical care.
For otolaryngologist and sleep medicine specialist Paulo Reis, hormonal changes are the number one major trigger for rough nights. “The increase in progesterone causes daytime sleepiness and interrupts sleep at night. Added to this are physical discomforts – nausea, heartburn, cramps, back pain, the need to urinate frequently and the baby’s movements. Anxiety about pregnancy and childbirth also makes it difficult to relax and get deep sleep. Some conditions, such as restless leg syndrome and sleep apnea, become more common during this period and lead to less restful sleep.”
How sleep changes throughout pregnancy
According to the obstetrician, pregnant women in the first trimester of pregnancy can be expected to experience more fatigue, frequent naps and disturbed night sleep – a reflection of frequent urination and emotional adjustment to the new reality. In the second quarter there is a tendency to improve. “The body is now more adapted to hormonal changes and there is usually less physical discomfort. Many pregnant women experience more restful nights, although bouts of heartburn, nasal congestion or fetal movements can still interrupt the rest. It is the most stable period in pregnancy, and is a bridge between initial fatigue and final discomfort.”
But in the third quarter, the scenario changes again. “The growing uterus makes it difficult to find a comfortable position. Reflux, cramps, back pain and frequent trips to the bathroom make sleep more interrupted. The proximity of childbirth increases anxiety and promotes insomnia and light sleep. It is not uncommon for pregnant women to spend less time in the deep stages of sleep, which explains waking up tired even after several hours in bed,” notes the gynecologist.
What helps – and what hinders – at bedtime
With an enlarged abdomen, sleeping on the left side is the most common recommendation. According to a sleep medicine specialist, this position improves blood flow to the uterus, fetus and the mother’s kidneys, in addition to preventing pressure on the inferior vena cava. “Using pillows between the legs, under the abdomen, and behind the back increases comfort and helps maintain correct posture throughout the night.”
Rees highlights that simple habits make a difference: a consistent sleep routine, a dark and quiet environment, a temperature between 18°C and 21°C, and avoiding screens one hour before bedtime. Food is also important: a light dinner two to three hours before bed and reducing fluids in the two hours before bed. Nelio emphasizes that light physical activity and anxiety management are key allies.
When there are signs of more severe disorders — such as apnea, persistent insomnia or excessive daytime sleepiness — the obstetrician should evaluate the need for investigation and referral. The sleep doctor says: “The quality of sleep directly affects the health of the mother and the fetus. When sleep loses its quality for a long period, the body begins to show signs. That is when monitoring with a sleep specialist can avoid complications.”
During the postpartum period, in addition to interruptions caused by the baby, there are severe hormonal fluctuations that disrupt the sleep cycle. To minimize the effects, sleep medicine specialists recommend following the classic rule: sleep when the baby sleeps. Short naps of 20 to 30 minutes are more effective than trying to make up for long periods of being awake to do household chores.
“A shifting regime with a partner and regular practice of exercises adapted to each stage are also essential to maintain sleep quality,” he concludes.