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

Why Sleep Gets So Hard During Pregnancy

By the third trimester, falling asleep shouldn’t feel like a battle. But for nearly 1 in 10 pregnant women, it is. Snoring that’s louder than ever, waking up gasping, heartburn that keeps you upright-all of it is connected to changes your body is going through. Hormones relax the muscles in your throat, your growing belly pushes up on your diaphragm, and fluid retention swells your nasal passages. These aren’t just inconveniences. They’re signs of sleep-disordered breathing, especially obstructive sleep apnea (OSA), which affects up to 27% of pregnant women with higher body weight.

Left untreated, this isn’t just about tiredness. OSA raises your risk of preeclampsia by more than double, increases your chance of gestational diabetes, and makes cesarean delivery more likely. The good news? You can fix this. And the earlier you act, the better the outcome-for you and your baby.

What Sleep Apnea Looks Like in Pregnancy

It’s not just snoring. If you’re waking up with a dry mouth, headaches in the morning, or feeling exhausted even after 8 hours in bed, you might have sleep apnea. During apnea episodes, your airway collapses briefly, cutting off oxygen. Your brain jolts you awake just enough to breathe-but you don’t remember it. That’s why many women don’t realize they have it until their partner notices the pauses in breathing.

Research shows that by 28 weeks, the risk spikes. Your neck gets thicker, your nasal passages swell, and your body holds onto more fluid. These changes make your airway narrower. Obese pregnant women (BMI over 30) face the highest risk-nearly 1 in 4 develop OSA. And here’s the kicker: if you had sleep apnea before pregnancy, it’s likely to get worse.

The American College of Obstetricians and Gynecologists now recommends screening all pregnant women using the STOP-Bang questionnaire at your 28-week checkup. It asks simple questions: Do you snore? Do you feel tired during the day? Has anyone noticed you stop breathing? If you answer yes to three or more, you need a sleep study.

CPAP Therapy: The Most Effective Treatment

If you’re diagnosed with moderate to severe sleep apnea (AHI over 15), CPAP is the gold standard. It’s not optional-it’s preventive care. A CPAP machine delivers gentle air pressure through a mask, keeping your airway open all night. Studies show that starting CPAP between 24 and 28 weeks cuts your risk of preeclampsia by 30% and gestational hypertension by 35%.

But it’s not one-size-fits-all. Many women quit because the mask is uncomfortable. That’s why new models are designed specifically for pregnancy. The ResMed AirSense 11 Pregnancy Mode auto-adjusts pressure as your body changes. The AirTouch F20 Pregnancy Edition has a softer silicone cushion that doesn’t dig into swollen cheeks. Humidifiers set to 37°C help with nasal congestion-something that affects 80% of pregnant women.

Adherence is the biggest hurdle. Only 62% of women stick with it past four weeks. But when clinics offer personalized coaching-like fitting the mask while you’re pregnant, teaching you how to clean it, and adjusting pressure at each visit-adherence jumps to 82%. Don’t give up after a rough first week. Most women say it gets easier after 7-14 days.

Positioning: The Simple Fix That Works

If your apnea is mild (AHI under 15), changing how you sleep can make a big difference. Sleeping on your back is the worst position-it lets your tongue and soft tissues collapse into your airway. Sleeping on your left side is the best. It improves blood flow to your baby, reduces pressure on your liver, and opens up your airway.

A 2022 study from Brown Health found that left-side sleeping alone reduced the apnea-hypopnea index by nearly 23% in women with mild OSA. But staying on your side all night? That’s hard without help. 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, support your back, and gently hold you on your side. One user reported her AHI dropped from 18 to 6 in two weeks after switching to the Boppy pillow.

Don’t just stack regular pillows under your belly. That can twist your spine. Use a wedge pillow under your upper body-7 to 8 inches high-to elevate your head without bending your neck. This helps with both apnea and reflux.

Taming Heartburn and Reflux at Night

Heartburn during pregnancy isn’t just spicy food. It’s hormones relaxing the valve between your stomach and esophagus, plus your baby pressing up from below. Lying flat makes it worse. The solution isn’t just antacids-it’s positioning and timing.

First, elevate the head of your bed by 6 to 8 inches. Not just your head with pillows-your whole upper body. Pillows alone can bend your neck and make apnea worse. Use bed risers or a wedge under the mattress legs.

Second, stop eating at least three hours before bed. Even light snacks like crackers or yogurt can trigger reflux. Avoid citrus, chocolate, caffeine, and fried foods in the evening.

Third, use Gaviscon Advance. Unlike regular antacids, it forms a gel barrier on top of your stomach contents that stays put. It’s safe during pregnancy, doesn’t get absorbed into your bloodstream, and works for up to four hours. A 500ml bottle costs about $15 and lasts a month.

What Doesn’t Work (And Why)

Some solutions sound great but aren’t safe or proven for pregnancy. Mandibular advancement devices-mouthpieces that push your jaw forward-are common for non-pregnant adults. But pregnancy changes your jaw and TMJ. There’s no safety data. The Society of Anesthesia and Sleep Medicine advises against them.

Weight loss isn’t recommended during pregnancy. But staying within Institute of Medicine guidelines helps. If you’re normal weight, aim for 11.5-16 kg total gain. If you’re overweight, 7-11 kg is enough. Losing weight isn’t the goal-gaining the right amount is.

And don’t rely on apps or smartwatches alone. The Apple Watch Series 9 can detect sleep apnea with 89% accuracy, but it’s not a diagnostic tool. It’s a warning sign. If it flags you, get a formal sleep study.

When to Get Help-and What to Expect

If you’re snoring loudly, waking up choking, or exhausted all day, don’t wait. Talk to your OB-GYN. Ask for a referral to a sleep specialist. A home sleep test is often enough for pregnant women. It’s a small device you wear overnight that measures breathing, oxygen levels, and heart rate. No needles. No hospital stay.

Once diagnosed, your care team should help you choose the right CPAP mask, set up humidification, and schedule follow-ups. Some clinics offer free mask fittings and even loaner machines while you wait for insurance approval.

And yes, you can use CPAP during labor and delivery. Hospitals are starting to recognize this. Untreated sleep apnea increases anesthesia risks by over three times. If you’re planning a C-section or epidural, tell your anesthesiologist you use CPAP. They’ll need to know.

What Happens After Baby Arrives

Many women think their sleep apnea disappears after delivery. For some, it does. But not all. A 2023 study found that 58% of women who had pregnancy-related OSA developed chronic high blood pressure within 10 years-even if their apnea seemed to vanish.

That’s why the Brown Health clinic recommends a follow-up sleep study 12 weeks after birth. If your AHI is still high, you may need ongoing CPAP therapy. This isn’t just about sleep-it’s about your long-term heart health.

And if you’re breastfeeding? CPAP is safe. The machine doesn’t affect milk supply. In fact, better sleep helps with milk production and emotional resilience.

Real Stories, Real Results

"I thought I was just tired because I was pregnant," says Maria, 32, from Melbourne. "I was waking up 5-6 times a night, dizzy in the morning. My OB asked if I snored. I said yes-but I didn’t think it mattered. They sent me for a sleep test. My AHI was 22. I started CPAP at 26 weeks. Within two weeks, my blood pressure dropped. I slept through the night for the first time in months. I didn’t realize how much I’d been suffering." "I tried the pregnancy pillow first," says Lisa, 29, who had mild OSA. "It helped a little, but I still woke up gasping. I was scared of the mask. But after a 30-minute demo at the sleep clinic, I got used to it. Now I can’t sleep without it. My baby was born healthy, and I didn’t get preeclampsia." "I waited until 34 weeks," says one Reddit user. "By then, I was exhausted, my headaches were constant. My doctor said, 'You should’ve come sooner.' Don’t make my mistake."

What You Can Do Today

• If you snore loudly or wake up gasping, ask your OB-GYN for a sleep screening at your next visit.
• Start sleeping on your left side with a full-body pregnancy pillow.
• Elevate your head with a wedge under your mattress-not pillows on top.
• Avoid eating within 3 hours of bedtime.
• Keep a sleep diary: note snoring, fatigue, morning headaches.
• Don’t wait for symptoms to get worse. Early action protects your baby and your future health.