Pregnancy and Sleep: How to Manage Apnea, Reflux, and Positioning for Better Rest

When you’re pregnant, sleep shouldn’t feel like a battle. But for many women, lying down at night brings more than just tiredness-it brings snoring, gasping for air, heartburn that keeps you upright, and the constant struggle to find a comfortable position. You’re not alone. About 1 in 10 pregnant women in their third trimester develop obstructive sleep apnea, and that number jumps to nearly 1 in 4 if you’re overweight. Sleep problems during pregnancy aren’t just annoying-they’re linked to serious risks like preeclampsia, gestational diabetes, and even cesarean delivery. The good news? You can fix this. With the right strategies, you can sleep deeper, breathe easier, and protect both your health and your baby’s.

Why Sleep Gets So Hard During Pregnancy

Your body changes fast when you’re pregnant. Hormones like progesterone relax your airway muscles, making it easier for them to collapse while you sleep. Your growing uterus pushes up on your diaphragm, so your lungs don’t expand as fully. Fluid retention causes swelling in your nose and throat, narrowing your airway even more. By the third trimester, your neck circumference might have increased by 2-3 inches. That’s not just a fashion change-it’s a physical barrier to breathing. Add to that the acid reflux that wakes you up at night. The same hormones that relax your airway also relax the valve between your stomach and esophagus. When you lie flat, stomach acid creeps up, burning your throat and making it hard to get back to sleep. And no matter how tired you are, sleeping on your back becomes dangerous-it can compress the main vein that sends blood back to your heart, lowering oxygen flow to your baby. It’s not laziness. It’s not bad sleep habits. It’s your body adapting to pregnancy-and it needs help.

Recognizing Sleep Apnea: More Than Just Snoring

Snoring during pregnancy is common. But if you’re snoring loudly, choking or gasping for air at night, waking up with a dry mouth or headache, or feeling exhausted even after 8 hours in bed, you might have obstructive sleep apnea (OSA). The American College of Obstetricians and Gynecologists now recommends all pregnant women be screened for sleep apnea at their first prenatal visit using a simple questionnaire called the Berlin Questionnaire. Don’t wait for symptoms to get worse. A 2022 study found that women who had untreated sleep apnea during pregnancy were more than twice as likely to develop preeclampsia and nearly twice as likely to need a C-section. The risk of gestational diabetes also goes up. The good news? Treating it early cuts those risks significantly. The gold standard test is a sleep study-either at a lab or at home with a portable monitor. It measures how many times you stop breathing per hour (called the AHI). If your AHI is above 15, you have moderate to severe apnea. Even mild cases (AHI 5-14) can affect your health and your baby’s growth.

CPAP Therapy: The Most Effective Treatment

Continuous Positive Airway Pressure (CPAP) is the most proven way to treat sleep apnea during pregnancy. It works by gently pushing air through a mask to keep your airway open. Studies show CPAP reduces your AHI by up to 78% and lowers your risk of preeclampsia by 30% and gestational hypertension by 35% when started between 24 and 28 weeks. But many women quit because the mask feels uncomfortable. That’s why newer models are designed specifically for pregnancy. The ResMed AirSense 11 Pregnancy Mode automatically adjusts pressure as your body changes. The AirTouch F20 Pregnancy Edition has a softer silicone cushion that fits better as your face swells. Many women find nasal pillows (small prongs that sit at the nostrils) more comfortable than full-face masks because they don’t press on swollen cheeks. Humidification is critical. Pregnancy causes nasal congestion, and dry air makes it worse. Set your machine’s humidifier to 37°C-it keeps your airways moist and reduces the 41% of women who stop CPAP because of dryness. Adherence is the biggest hurdle. Only 62% of pregnant women stick with CPAP beyond four weeks. But in clinics that offer personalized training-like a 30-minute fitting session and follow-ups at 3 and 7 days-adherence jumps to 82%. Don’t go it alone. Ask your OB or sleep clinic for support.

Positioning: The Simple Fix That Works

If your apnea is mild (AHI under 15), changing your sleep position can make a big difference. Sleeping on your left side is the gold standard. It keeps your uterus off your major blood vessels and improves blood flow to your baby. It also reduces the number of apnea events by about 23% compared to sleeping on your back or right side. But staying on your side all night? Hard. That’s where pregnancy pillows come in. Full-body pillows like the Leachco Snoogle or the Boppy Noggin CPAP Pillow are designed to cradle your belly, back, and legs so you don’t roll over. One user reported her AHI dropped from 18 to 6 in two weeks after switching to the Boppy pillow. Elevating your upper body helps too. Don’t just pile up pillows-that can bend your neck and worsen apnea. Use a wedge pillow that lifts your head and chest 6-8 inches. This helps both your breathing and your reflux. A 2022 study showed this position improved oxygen levels by 3.2% compared to lying flat.

Taming Reflux Without Medication

Heartburn at night is one of the most common complaints in pregnancy. But how you handle it matters. Many women reach for antacids-but not all are safe. Avoid medications like ranitidine or omeprazole unless your doctor says so. Instead, try Gaviscon Advance, an alginate-based antacid that forms a protective foam barrier on top of your stomach contents. It doesn’t get absorbed into your bloodstream, so it’s safe for your baby. A 500ml bottle costs about $15 and lasts weeks. Timing matters too. Don’t eat within three hours of bedtime. Even a light snack can trigger reflux. Skip spicy, fatty, or acidic foods in the evening. Coffee, chocolate, and citrus are big triggers. And here’s a trick most people miss: elevate the whole head of your bed, not just your head. Place 6-8 inch blocks under the legs of your bed frame. This uses gravity to keep acid down. Pillows alone won’t do it-they just bend your neck and make apnea worse.

What Doesn’t Work (and Why)

You might see ads for mandibular advancement devices-mouthpieces that push your jaw forward to open your airway. They work well for non-pregnant people, but pregnancy isn’t the same. Hormones loosen your jaw joints, and your face swells. These devices can cause pain, jaw damage, or even affect your bite long-term. The Society of Anesthesia and Sleep Medicine advises against them during pregnancy. Weight loss? You shouldn’t try to lose weight while pregnant. But staying within the Institute of Medicine’s recommended weight gain range helps. If you started at a normal weight, aim for 25-35 pounds total. If you were overweight, aim for 15-25 pounds. Even small gains above the limit worsen apnea.

What to Expect After Baby Arrives

Many women find their sleep apnea disappears after delivery. But not all. A 2023 study found that 58% of women who had pregnancy-related sleep apnea developed chronic high blood pressure within 10 years-even if their apnea went away. That’s why some clinics, like Brown Health, recommend a follow-up sleep study 12 weeks after delivery. If your apnea is still there, you may need long-term CPAP or other treatment. If it’s gone, keep an eye on your blood pressure and sleep habits. Sleep apnea doesn’t just vanish-it can hide, waiting to come back.

Real Stories, Real Results

One user on Reddit shared: "I started CPAP at 26 weeks. My blood pressure dropped in two weeks. My headaches vanished. My husband finally slept through the night." Another said: "I thought the pillow was a gimmick. Then I used it and actually slept 7 hours straight for the first time in months." But not everyone gets help in time. A 2022 survey found that women typically waited 14 weeks before getting tested-even though they’d been snoring and waking up gasping for months. Don’t wait. If you’re tired all day, wake up with a dry mouth, or your partner says you stop breathing at night, talk to your OB. Ask for a sleep screening. You don’t need to suffer through your pregnancy. Better sleep isn’t a luxury-it’s part of your prenatal care.

Quick Checklist for Better Sleep During Pregnancy

• Use the Berlin Questionnaire at your first prenatal visit
• Ask for a sleep study if you snore loudly or stop breathing at night
• Start CPAP between 24-28 weeks if diagnosed with moderate-severe apnea
• Use nasal pillows and humidification to improve comfort
• Sleep on your left side with a full-body pregnancy pillow
• Elevate your head and chest 6-8 inches with a wedge, not stacked pillows
• Avoid eating 3 hours before bed
• Use Gaviscon Advance for reflux (not other antacids without approval)
• Don’t use mouthpieces or try to lose weight
• Get a follow-up sleep study 12 weeks postpartum if you had OSA