Research Spotlight: Sleep During Pregnancy

Trouble sleeping is common during pregnancy, just ask any expecting mother. Whether it’s extra trips to the bathroom, an inability to get comfortable, excessive heartburn or restlessness, getting a good night’s sleep is increasingly difficult as pregnancy progresses. In fact, more than 75% of pregnant women report issues sleeping during pregnancy.

Sleep disorders — such as insomnia, sleep apnea, restless leg syndrome, narcolepsy, and others — affect anywhere from 14-50% of pregnant women, depending on the research and how sleep disorders are measured. However, because sleep disruption is common in pregnancy, it is believed that many sleep disorders are underdiagnosed.

Jennifer Felder, PhD, a postdoctoral scholar with the Preterm Birth Initiative in the Department of Psychiatry at UCSF, sought to better understand the effects of poor sleep on birth outcomes. Felder and colleagues mined nearly three million California birth records from 2007 through 2012, extracting information on the unidentified mother’s medical history, her health throughout pregnancy, and her baby’s delivery.

Birth outcomes for the 2,265 women with a sleep disorder diagnosis were then compared to a control sample of women without such a diagnosis in their medical records. To uncouple the contribution of poor sleep from other risk factors such as smoking or hypertension, the control group was selected to identically match all other maternal characteristics, demographics, and obstetric factors. 

The study, published in Obstetrics & Gynecology, found that women with an insomnia diagnosis were 30% more likely than women without a sleep disorder to deliver preterm, and that this risk increased to 40% for those with sleep apnea.

Being born preterm — or more than three weeks before the typical full-term pregnancy of 40 weeks — claims the lives of more than 1 million babies worldwide every year. The 14 million annual survivors of prematurity often face a lifetime of health complications, with those born earliest at greatest risk.

“It’s really critical to identify risk factors for preterm birth,” says Felder. “It’s possible that by treating sleep disorders during pregnancy, we might be able to reduce the preterm birth rate.”

The authors also found that issues sleeping increased the likelihood of a very preterm birth. Women with insomnia or sleep apnea were about twice as likely as women without sleep disorders to deliver their babies more than six weeks early. 

Little research has examined how best to improve sleep during pregnancy. The Sleeping for Two tip sheet offers useful information on how to enhance sleep quality during pregnancy and the postpartum period.

Another solution is cognitive behavior therapy, or CBT, which doesn’t require taking any medications. Unlike sleeping pills, which many pregnant women prefer to avoid, participants in CBT learn to recognize and change behaviors that might be poorly affecting their sleep. They also learn lifestyle hacks that promote sound sleep, such as keeping your bedroom quiet, dark and cool, minimizing screen time right before going to bed, and how caffeine, diet and exercise can influence sleep habits.

Dr. Felder is currently recruiting for the Research on Expecting moms and Sleep Therapy (REST) Study to find out if this therapy will improve sleep during pregnancy and reduce the risk of preterm birth. “What’s so exciting about this study is that a sleep disorder is a potentially modifiable risk factor,” Felder explained, which if addressed could ultimately help improve birth outcomes.


Dr. Jennifer Felder, PhD, is a postdoctoral fellow with the Preterm Birth Initiative in the Department of Psychiatry at UCSF. Her research interests focus on improving the mental health and well-being of pregnant and postpartum women by targeting barriers to treatment, developing effective psychosocial interventions, and disseminating evidence-based therapies in innovative ways. As a postdoctoral fellow, she is examining the relationships between stress, depression, sleep, and maternal and offspring health outcomes, with the ultimate goal of developing more targeted and parsimonious interventions for both maternal and offspring health.