Pregnancy Insomnia: Why You Can't Sleep, What's Driving It and How to Support Better Rest Naturopathically

29 Oct

I thought I had avoided pregnancy insomnia throughout my pregnancies until my third baby came along. At the time we were building a tiny home in the middle of the rainforest at Mount Warning, NSW, with off grid solar power. I remember lying awake for 3-5 hours every night in the pitch black, no power and no way of getting back to sleep. I leaned on so many different sleep hygiene techniques and of course dived into my herbal dispensary and some of it worked but only sometimes… Since then, this has been a special area of research for me as a Naturopath who works with Mums from preconception to post-partum and in the thick of mothering, it’s something that comes up time and time again for my clients, I knew it was time to put all the information I’ve learnt over the years into a journal post for you.

A 2024 systematic review and meta- analysis estimated that approximately 43.9% of pregnant women experience insomnia symptoms, but I always argue in clinic, just because something is relatively common doesn’t mean it’s something we should simply accept and endure. The interesting thing with pregnancy insomnia is that there is rarely one single cause, rather a compounding effect driven from physiological changes, stress and cortisol, pregnancy symptoms, deficiencies, mental health and circadian rhythm. As with every condition I’m treating in clinic, I want to investigate your unique underlying drivers before I jump straight into giving you herbs and supplements, so that’s what we will unpack below – what could be driving it for you and ultimately how can we get you sleeping better.

What are the 7 most common underlying drivers I see in clinic?

1. Hormonal and physiological changes

Progesterone is often pointed to as a driver of pregnancy insomnia due to it’s role in neuronal health, it plays a role in influencing neuronal inhibition (calming down brain activity). However, given its predominantly calming, inhibitory effects, I’m cautious about attributing sleep disruption to progesterone. In the context of both progesterone and oestrogen we could look at pregnancy rhinitis – the increase in nasal mucosal blood flow and congestion can make nasal breathing more difficult and potentially contribute to snoring, repeated awakenings and fragmented sleep. And then we’ve got cortisol - maternal cortisol concentrations rise physiologically throughout pregnancy, which can be exacerbated if you are already feeling stressed and overwhelmed yourself. This is a big driver I see in clinic and the underlying force of my own pregnancy insomnia (hello building an off grid tiny home in the middle of the rainforest!) Cortisol is involved in circadian rhythm and helps to coordinate wakefulness and sleep timing, which can be impaired via stress thanks to the HPA axis (hypothalamic-pituitary-adrenal axis). I don’t know many women in pregnancy who aren’t stressed or at the very least in a state of heightened nervous system arousal as they navigate the complexities of preparing to welcome a baby into the world. Some symptoms to look for if you think this might be you are that classic ‘wired but tired’ presentation, feeling easily agitated or overstimulated, racing thoughts at night in these insomnia episodes, hypervigilance, and a general feeling of being unable to fully relax or let go of things.

2. Physical symptoms

Of course, it would be remiss of me not to mention all those fun pregnancy symptoms that can impact our sleep maintenance. Things like nausea, reflux, heartburn, pelvic and back pain, leg cramps, fetal movements, restless leg syndrome, frequent urination and genuinely just feeling so uncomfortable! Usually these are what will wake you up from your sleep, whilst the other drivers are stopping you from falling back to sleep…

3. Blood sugar dysregulation

Research suggests a bidirectional relationship between sleep and blood sugar regulation during pregnancy. A 2018 meta-analysis found that sleeping fewer than 6–7 hours per night was associated with higher odds of gestational diabetes, while a 2020 review found that poor subjective sleep quality was associated with a 43% increase in the odds of gestational diabetes. Although this doesn’t prove that blood sugar fluctuations cause insomnia, it highlights the relationship between good quality sleep and blood sugar regulation. From a nutritional perspective, including protein and healthy fats alongside fibre-rich carbohydrates at dinner may support satiety and provide a more sustained supply of energy overnight. This may be helpful if hunger is contributing to night waking too.

4. Nutritional deficiencies

Iron – this is a big one guys! And why I work so hard to get my clients preconception iron stores up before the inevitable haemodilution of pregnancy, a 2025 Australian consensus statement reports that iron deficiency impacts 70% of Australian pregnancies, and a 2020 scoping review found positive associations between iron deficiency and general sleep disturbance in some studies across age groups. Low iron availability is also linked to restless leg syndrome.
Magnesium – it’s important for our neuromuscular function and aids us to wind down, supporting our stress response. It’s one to consider if you are experiencing a heightened stress response and/ or getting leg cramps overnight.
Vitamin D – some of our Vitamin D receptors are present in regions of the brain involved in sleep regulation. Observational studies have linked low vitamin D status with poorer sleep quality and some sleep disorders.

5. Thyroid health

Thyroid dysfunction (especially hyperthyroidism) in pregnancy is worth discussing as it plays a role in struggles with sleep onset and maintenance. We expect some significant changes and demand on your thyroid through pregnancy due to the massive hormonal needs on the body. Those that have previously had thyroid dysfunction are especially susceptible to struggles with their thyroid during pregnancy and post-partum. Regular monitoring of your thyroid during pregnancy is recommended regardless of if you have a history or not. If you are experiencing restless sleep alongside heat intolerance, heart palpitations, anxiety and feeling on edge, it’s a good idea to get it checked sooner.

6. Mental health

As we briefly discussed above with cortisol, pregnancy insomnia has a bidirectional relationship with anxiety, depressive symptoms, pregnancy-related worries and a heightened cognitive arousal. The 2024 systemic review that found 43.9% of pregnancies were linked to insomnia symptoms also found higher prevalence in studies involving greater depression burden.

7. Circadian rhythm

Circadian rhythm disruption may contribute to pregnancy-related insomnia by misaligning the body’s internal sleep-wake cycle. Evening exposure to bright or blue light can suppress or delay melatonin secretion, particularly impacting sleep onset. A 2026 review highlights the importance of circadian and hormonal rhythms during pregnancy and discusses how impacts to these may lead to further complications with fetal and maternal health.

Now that we’ve explored some of the underlying drivers of pregnancy insomnia, let’s look at how we can start addressing them with a personalised, naturopathic approach.

Start with your circadian rhythm

What to try:

Get outside for natural daylight soon after waking
Keep your sleep-time and wake-up time relatively consistent from day to day
Reduce bright, blue-enriched light exposure in the evening. Dim your lights and consider blue-light filters or glasses if you use screens at night
Keep your bedroom dark and avoid unnecessary light exposure during overnight waking

Review your bedroom environment

Consider whether your room is comfortable, quiet and dark, with adequate ventilation and a temperature that suits you. Pregnancy can make temperature regulation and physical comfort more challenging.

It may also be worth reviewing dust accumulation, bedding and pillow fabrics. Address any visible dampness, poor ventilation or mould.

Look at your sleep habits and bedtime routine

Establish a wind-down routine that gives your body time to transition out of the day
Reduce work, stimulating content and unnecessary screen use before bed
Avoid caffeine later in the day, particularly if you are sensitive to its effects
If you are lying awake becoming increasingly frustrated, try a quiet, low-light activity until you feel sleepy rather than repeatedly checking the time (kindle’s are great for this)
Avoid forcing an early bedtime if you are not sleepy; aim for a consistent routine that aligns with your actual sleep drive

Investigate nutrient deficiencies, thyroid health and blood sugar regulation with pathology

Eat balanced meals at dinner

Going to bed hungry, having an inadequate dinner or experiencing hunger overnight may make sleep more difficult for some people. Aim for protein, fats, complex carbs, fibre.

Take stress and mental health seriously

Pregnancy can coincide with significant changes in identity, relationships, work and expectations about becoming a parent. Anxiety, rumination and feeling constantly alert can make it difficult to transition into sleep, even when you are exhausted.

Consider what happens mentally when your head hits the pillow. Are you replaying the day, anticipating tomorrow, worrying about the birth or feeling unable to switch off? These patterns may indicate that stress and cognitive hyperarousal are contributing to your insomnia.

Psychological support can help you develop practical coping strategies, particularly if anxiety is persistent or affecting your daily functioning. A psychologist or therapist experienced in perinatal mental health may be helpful.

Consider supplements and herbal support

These are pregnancy safe supports but please check with your care provider if they are right for you: Magnesium Glycinate, Valerian, Chamomile, Oats seed, Oats Green, Passionflower, Reishi, Withania.

Explore evidence-based treatment for persistent insomnia

Cognitive behavioural therapy for insomnia (CBT-I) is one of the strongest evidence-based options to explore.

CBT-I is a structured treatment that addresses the thoughts, behaviours and patterns that perpetuate insomnia. It can include strategies to reduce sleep-related anxiety, rebuild the association between bed and sleep, regulate time in bed and develop more helpful responses to nighttime waking.

A 2025 randomised controlled trial found that a pregnancy-adapted CBT-I program reduced insomnia symptoms and improved sleep quality compared with usual care. A 2025 systematic review and meta-analysis of 31 studies involving 3,307 pregnant participants also found that non-pharmacological interventions improved self-reported sleep quality overall.

Here’s hoping you’ll be back to having sweet dreams soon! x