By the third trimester, you may have forgotten what it feels like to sleep well. Between the trips to the bathroom, the aches, a baby who seems most active at midnight and the thoughts that arrive the moment you close your eyes, a good night's sleep can feel out of reach. Late pregnancy is genuinely one of the hardest times to get the sleep you need, or to feel rested at all.

Why sleep gets so hard right now

A lot is happening in your body, and most of it is working against an easy night. The size of your belly makes it harder to find a comfortable position. Pressure on your bladder means more trips to the bathroom. Hormonal shifts affect the quality of sleep you do get. Your body temperature may run warmer than usual. And for many people, there's worry about the upcoming birth and what comes after it.

Research suggests that by late pregnancy, around 60% of pregnant people experience insomnia, defined as difficulty falling or staying asleep.

What can actually help

None of these suggestions will fix everything. But some people find one or two make a real difference.

Position. Sleeping on your left side is often more comfortable in late pregnancy and is generally recommended by care providers. Nutrients and oxygen flow slightly more easily when you sleep on your left side, but there’s no need to worry if you find yourself sleeping on your right side. Side sleeping (right or left) is safe throughout pregnancy. While sleeping on your back is not recommended later in pregnancy due to the weight of the uterus, if you do wake up on your back, don't panic — simply reposition and go back to sleep. Pillows can help, either one between your knees and/or one under your belly. A pregnancy pillow, if you have access to one, is designed for exactly this.

Bathroom trips. Using a small nightlight (rather than the overhead light) can make it easier to fall back asleep after a bathroom trip. Staying half-asleep is the goal. You can also be proactive by limiting liquids before bed and emptying your bladder as fully as you can.

Winding down. Have a bedtime routine to cue your mind and body for sleep. A warm bath or shower before bed, or a few minutes of slow breathing or gentle stretching, can help your body shift into a more restful state. This doesn't need to be an elaborate routine — even five minutes counts. Consider limiting screen and phone time before bed, and throughout the night, if possible.

Caffeine. Cutting off caffeine after noon can make a difference, even if you don't notice the effect right away.

Acid reflux: Try sleeping on your left side, as described above, and elevating your head and upper body with extra pillows or a bed wedge to keep heartburn at bay (if you elevate just your head, it could make matters worse). An antacid like TUMS, or even a handful of raw almonds, can help reduce stomach acidity. You could even try logging what you eat to identify trigger foods — possible culprits include tomatoes, citrus, fried foods and chocolate. These can be very different from person to person. If acid reflux persists and disrupts your sleep, you can ask your doctor for a prescription to help ease it.

Your mind. If your thoughts are busy at night, some people find it helps to write down what's on their mind before bed. The goal isn’t to solve anything, it’s just to get it out of your head. Childbirth education classes or a conversation with your care provider can also help reduce the specific anxieties that come with this stage. Limiting screen and phone time can also help.

Get rest during the day if you can. Remember, while sleep is the most restorative form of rest, engaging in other rest practices throughout the day, like lying down, meditation or even some gentle exercise, can be restful and help you fall asleep at night.

This is exhausting

We understand that advice like this can feel like pouring a cup of water on a house fire, especially when you’re exhausted. Sleep challenges in pregnancy can be really hard, and there isn’t a simple fix. We don’t want to minimize that experience by offering tips, but the hope is that even small adjustments might bring a bit of relief.

If you're the non-birthing parent or support person: You may be watching your partner struggle with sleep and feeling unsure what to do. Some of the most useful things are practical: not minimizing how depleted they feel, taking care of morning or evening routines so they can sleep in or go to bed early. Your sleep matters too! You're heading into a demanding period. If you're both exhausted, that's worth talking about together, reaching out for support from others or talking to your care provider.

Sleep and your mental health

Sleep difficulty during pregnancy isn't just uncomfortable — it's worth paying attention to for your mental health as well. Consistently poor sleep is a recognized risk factor for perinatal mood and anxiety disorders (PMADs). That is the clinical term for conditions like depression and anxiety that can develop during pregnancy or after birth. This doesn't mean struggling to sleep means something is wrong. It means that sleep matters for your mental health.

If you have a personal or family history of depression, anxiety or bipolar disorder, and specifically if you have experienced a psychotic episode, protecting your sleep is especially important. Mention this to your care provider if you haven't already.

A note on sleep tracking

Apps and wearables that track your sleep can feel helpful. However, some people find that paying close attention to sleep data actually makes things harder. It increases focus on whether you're sleeping "enough," which can make it more difficult to relax. If tracking is adding to your stress, it's fine to stop. If you’ve been asked to track your sleep by your health provider, of course, continue to do so, but you can always have a conversation about different ways in which you can/should track your sleep.

One small thing

You don't need a whole new routine, just one thing to try.

Pick something that sounds manageable: a different pillow arrangement, a warm shower before bed or leaving your phone in another room. That's enough for tonight.

If sleep has been hard and it's affecting how you feel during the day, bring it up at your next appointment. If you'd like to find perinatal mental health support in your area, our Service Finder connects you with support near you. You don't need to know what's wrong to use it.

This article was developed using sourced educational content from Canadian Perinatal Mental Health Trainings CPMHT, and informed by the collective knowledge and expertise of CPMHT professionals and Karen Clarke, BA, MSW, RSW, Doula Open Book Doula, Counselling and Consulting Services, as well as the following cited research and clinical practice guidelines: