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

When you're pregnant, falling asleep should be easy - but for many women, it’s anything but. Between the aching back, frequent bathroom trips, and heartburn that keeps you wide awake, sleep becomes a luxury. And if you’re snoring loudly, waking up gasping, or feeling exhausted even after 8 hours in bed, you might be dealing with something more serious: pregnancy sleep apnea.

Why Sleep Gets So Hard During Pregnancy

Your body changes in dozens of ways during pregnancy, and many of those changes directly impact how you sleep. Hormones like progesterone relax the muscles in your airway, making it easier for it to collapse while you sleep. Your growing uterus pushes up on your diaphragm, reducing lung capacity. Fluid retention causes swelling in your nose and throat - think of it like having a permanent cold. All of this adds up to obstructive sleep apnea (OSA), where breathing stops and starts repeatedly through the night.

It’s not rare. About 1 in 10 pregnant women develop sleep apnea by the third trimester. For those who are overweight or obese, that number jumps to nearly 1 in 4. And here’s the catch: most women don’t realize it’s happening. Snoring? Common. Tired all day? Just pregnancy. But untreated sleep apnea doesn’t just make you groggy - it raises your risk of preeclampsia, gestational diabetes, and even needing a C-section.

What Sleep Apnea Does to You and Your Baby

When your airway closes during sleep, your oxygen levels drop. Your brain wakes you up just enough to restart breathing - but you don’t remember it. This happens dozens of times a night, and your body stays stuck in survival mode. That constant stress triggers inflammation, raises blood pressure, and messes with insulin sensitivity.

Studies show women with untreated sleep apnea during pregnancy are:

• 2.3 times more likely to develop preeclampsia
• 1.7 times more likely to get gestational diabetes
• 2.1 times more likely to have a C-section

And it’s not just you. Low oxygen levels in mom can mean slower growth for the baby. Research from the NIH found that untreated OSA increases the risk of fetal growth restriction by 42%. The good news? Treating it early can cut those risks dramatically.

CPAP: The Most Effective Treatment - And How to Make It Work

The gold standard treatment for moderate to severe sleep apnea is CPAP - continuous positive airway pressure. It’s a small machine that delivers gentle air pressure through a mask to keep your airway open while you sleep.

For pregnant women, CPAP isn’t just safe - it’s life-changing. A 2023 study in JAMA Network Open found that women who started CPAP between 24 and 28 weeks reduced their risk of preeclampsia by 30% and gestational hypertension by 35%. That’s not a small benefit - it’s a major win for both mom and baby.

But getting used to CPAP during pregnancy? That’s the hard part. Your face swells. Your nose gets stuffy. The mask feels like a prison. Here’s how to make it work:

• Use nasal pillows instead of full-face masks - they’re lighter and less likely to irritate swollen skin.
• Turn on the humidifier and set it to 37°C - this cuts down on dryness and congestion.
• Try an auto-titrating machine - it adjusts pressure as your body changes week by week.
• Use a pregnancy-specific pillow like the Boppy Noggin CPAP Pillow to keep your head and neck aligned without crushing the mask.

Adherence is the biggest hurdle. Only about 62% of pregnant women stick with CPAP past 4 weeks. But those who do - especially with support - report huge improvements: less morning headaches, more energy, and better blood pressure. One woman on Reddit shared: “My AHI dropped from 18 to 6 in two weeks. I finally slept like I used to.”

Positioning: The Simple Trick That Helps (Even Without a Machine)

If your sleep apnea is mild - say, under 15 events per hour - changing how you sleep can make a big difference. The single most effective position? Left side.

Why? Lying on your left side takes pressure off your vena cava - the big vein that brings blood back to your heart. It also keeps your uterus from pressing on your diaphragm. Studies show sleeping on your left side reduces the apnea-hypopnea index (AHI) by nearly 23% in women with mild OSA.

But just rolling over isn’t enough. Most people roll onto their back during the night. That’s where pregnancy pillows come in. Full-body pillows - like the Leachco Snoogle or the U-shaped Boppy - hold you in place. You tuck one between your knees, hug one in front, and let the rest cradle your belly. This isn’t just comfort - it’s medical support.

Combine left-side sleeping with a slight head elevation - 15 to 30 degrees - using a wedge pillow. Don’t stack regular pillows; that bends your neck and can actually worsen apnea. A 7- to 8-inch wedge keeps your airway open and your stomach down.

Managing Reflux - Because Heartburn Is Not Just a Nighttime Nuisance

Heartburn during pregnancy? Nearly 80% of women deal with it. But if you’re lying flat after dinner, stomach acid creeps up into your esophagus - and that can trigger or worsen apnea. Acid irritates the throat, causing swelling and spasms that block your airway.

Here’s what actually works:

• Elevate the head of your bed by 6 to 8 inches - not just your head. Use bed risers or a firm wedge under the mattress legs. Pillows alone won’t cut it - they just bend your neck.
• Avoid eating within 3 hours of bedtime. Even a light snack can trigger reflux.
• Use Gaviscon Advance (alginate-based). It forms a protective foam barrier on top of your stomach contents. Unlike antacids that get absorbed, it stays put - safe for pregnancy and effective.
• Sleep in a slightly upright position. Even 20 degrees helps. Combine this with left-side sleeping for maximum effect.

One study showed that women who combined positional therapy with reflux management saw a 40% drop in nighttime awakenings - not because their apnea disappeared, but because the triggers were quieter.

What Doesn’t Work (And Why)

Not all “sleep solutions” are created equal. Some are marketed heavily but lack evidence - or worse, could be risky.

Mandibular advancement devices (mouthpieces that push your jaw forward) work well for non-pregnant people with sleep apnea. But during pregnancy, hormonal changes loosen your jaw joints and ligaments. These devices could cause pain, misalignment, or long-term TMJ issues. The 2023 SASM/SOAP guidelines specifically advise against them during pregnancy.

Over-the-counter sleep aids - even “natural” ones like melatonin or valerian - are not studied for safety in pregnancy. Skip them. Your body is already doing enough.

Weight loss sounds logical, but you shouldn’t try to lose weight while pregnant. Instead, follow the Institute of Medicine’s guidelines: gain 11.5-16 kg if you’re normal weight, 5-9 kg if you’re obese. Too much weight gain worsens apnea. Too little can harm the baby. Balance is key.

When to Get Tested - And Who Should Be Screened

You don’t need to wait until you’re miserable. The American College of Obstetricians and Gynecologists now recommends screening all pregnant women for sleep apnea at the first prenatal visit using the Berlin Questionnaire. If you snore loudly, feel exhausted during the day, or have high blood pressure, you should be referred for a sleep study.

Home sleep tests are now accepted for low-risk patients. They’re cheaper and easier than going to a lab. A 2021 AASM update confirmed they’re accurate enough for pregnancy screening - as long as you follow the instructions.

But here’s the problem: only 32% of OB practices screen for it. Most doctors still think snoring is “just pregnancy.” Don’t wait for them to bring it up. If you’re tired, snoring, or waking up choking - speak up. Ask for a referral to a sleep specialist.

What Happens After Baby Arrives?

Many women assume their sleep apnea disappears after delivery. And for some, it does - hormone levels drop, swelling goes down, and breathing improves. But not everyone.

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 resolved. That’s a red flag. Your body may have been signaling an underlying risk.

Some clinics, like Brown Health, recommend a follow-up sleep study at 12 weeks postpartum. Others, like the NIH, say observation is enough. Either way, don’t ignore ongoing symptoms. If you’re still tired, snoring, or waking up gasping after delivery - get checked. You’re not “just tired.” You might still need treatment.

Real Talk: What Women Are Actually Experiencing

On Reddit, a woman wrote: “I started CPAP at 26 weeks. My husband said I stopped snoring the first night. I cried because I hadn’t slept through the night in months.”

Another said: “I thought the pillow was a gimmick. Then I bought the Leachco one and slept like a baby. No more numb arms. No more waking up screaming from heartburn.”

But the struggles are real too. “The mask hurt my face. I hated the noise. I wanted to quit.” That’s normal. Most women do. But with the right support - a good clinic, a patient tech, a comfortable pillow - 82% stick with it, according to Sleep Healthy PA.

Don’t give up because it’s hard. The first week is the worst. By day 14, most people feel like a new person.

What’s Changing in 2025

The field is moving fast. In September 2023, ResMed launched the AirTouch F20 Pregnancy Edition - a CPAP mask with a softer silicone cushion designed for swollen faces. In 2024, Apple Watch Series 9 got FDA-cleared to detect moderate to severe sleep apnea - no lab needed. That could mean earlier diagnosis, even before symptoms get bad.

The NIH is now running the PREGSLEEP trial, testing whether starting CPAP before 20 weeks can prevent fetal growth problems. And by 2027, experts predict 65% of prenatal clinics will screen for sleep apnea - up from just 32% today.

This isn’t just about better sleep. It’s about protecting your health, your baby’s health, and your future.