Evening and Overnight Nausea
It is not uncommon for women to wake up feeling normal during early pregnancy only to get more nauseous as the day goes on, especially the late afternoon, into the evening, and overnight.
For women who cannot sleep at night due to their symptoms, fatigue and exhaustion start to have a cumulative effect even after just a few days, and women need to manage their symptoms the best they can to avoid physical and mental health complications.
Women need to take one night a time, recover/rest during the day, and remain strong in their ability to cope with symptoms as they appear each evening. Women should try to implement some of the management strategies described below when they are able to, and call their HCP at any point they feel they can no longer adequately tolerate or manage their nausea and/or vomiting.
Note: Acid reflux is a common cause of nausea/vomiting – especially at night – including in non-pregnant individuals. Women with evening symptoms, which may get worse throughout the day simply due to eating, may be suffering from acid reflux (but not necessarily “heartburn”) which can be safely and effectively treated during early pregnancy. Further, treatment of acid reflux can significantly reduce nausea and/or vomiting.
Background
For some women, nausea has a predictable pattern; these women may discover they feel fine in the morning, but their nausea gets progressively worse as the day goes on and may last overnight. This affects their ability to sleep – and then eventually – to function during the day.
Combating nausea at night can be quite different than fighting it during daytime hours. Evening nausea usually means a woman is fighting her nausea/vomiting alone, while everyone else in the house is asleep. This can be very lonely, and the night can drag out for what feels like days.
Further, evening and overnight nausea can be seemingly “invisible” to a woman’s partner or other household members, therefore women with this pattern of nausea can feel even less understood. These women need adequate support, not only to retain their ability to cope, but a significant lack of sleep in early pregnancy can lead to complications (see Sleep).
Identify the Pattern and Make a Plan
Once women have recognized their pattern of nausea peaks in the late afternoon, early evening, or overnight, they can start to make changes to potentially avoid these peaks, or at least make them dramatically easier to tolerate.
Even if women wake up feeling their absolute best for the day, this is still the time to implement certain strategies. Beginning management techniques as early as possible – to the point they become a part of a woman’s everyday life – is considered the most optimal approach until symptoms start to subside.
For example, if a woman begins to feel nauseous on a regular schedule around 2:00 in the afternoon, she should pay attention to her food intake just before; does lunch trigger it? Does it get better if meals are broken down differently? Can she eat a normal breakfast but then immediately start to eat small items afterward for every hour? Does eating small amounts of food from the start of the day until 2:00 pm have any beneficial effect?
If women pay attention to these possible triggers, they can learn where to make adjustments. In the above example, the woman may realize she should be cautious with lunch – eating slower beginning around noon, and then start tapering off for the rest of the day. She would also realize she should hydrate as much as possible in the morning/early afternoon, and plan all major responsibilities, errands, or meetings prior to 2:00 pm.
Women may also recognize the prenatal vitamin they take shortly after dinner (to avoid nausea in the morning) is actually giving them nausea in the evening (read Prenatal Vitamin with NVP).
It is important that women aim for small goals. Women should not attempt to plan out their day to keep nausea away all night; just start small. What steps can she take to at least keep her nausea tolerable until the end of the workday? If that becomes achievable, she can then try to aim for 7:00 pm, and eventually – late enough to fall asleep. Some women believe if they can just get to the point where they can fall asleep, they may be able to sleep through their nausea.
Prepare/Manage Work and Family
Recognizing this pattern early also helps women prepare their family and work lives. NVP tends to get progressively worse through the first trimester, peaking between 9 and 10 weeks. Women need to take advantage of their nausea-free times as much as possible.
Employment: Women should –
Ask their supervisor (if comfortable with this) for a flexible work schedule if their employment allows, such as going in earlier so they can leave earlier, or even teleworking for a few weeks (read Employment in Be Ill Prepared).
Move all meetings, calls, reports, shifts, or anything else that may be relevant to the morning.
Go to bed early and wake up early, so they can take time to get out of bed; however, some women may need to stay up very late so they can be tired enough to fall asleep.
Consider taking the following day off work if they have several days in a row where they lose a significant amount of sleep due to nausea/vomiting. Women should try to avoid letting sleepless nights stack up without any type of break.
Prepare their commute. For women who start work early in the day, the commute to work may be easy, but the commute home could be challenging if they are already feeling moderate to severe symptoms. Women should read more detailed information on getting through a commute or how to prepare their car.
At some point, depending on how long NVP lasts, women may find it too difficult to work at all if they have to keep using the daytime to recover from all-night nausea or vomiting; women should have a serious conversation with their supervisor about their options.
Under U.S. federal law, employers need to make reasonable accommodations for women suffering a condition during pregnancy, of which NVP may apply (read Working with NVP).
Family: Women should –
Ask partners/other adult family members to read “Morning Sickness” Introduction so they can learn real facts about NVP and understand its symptoms, duration, cyclical nature, and possible resulting complications. Partners may cope better themselves with this change to their lives as well if they have a better expectation of what lies ahead.
Explain to family members they may be on their own for dinners, homework, evening responsibilities and functions, and nighttime routines.
Prepare freezer meals (during nausea-free times) or ask other family members to do the same.
Explain that on the weekends, they may start to feel sick late in the afternoon or early evening and that certain social aspects may change for a few weeks.
Women with young children can also explain this is only temporary, and that she is fine, but needs to rest as much as possible after school/work for a little while.
Mentally Prepare
Women can also prepare themselves for their evening/overnight nausea. Women should read how to prepare their bedroom and bathroom. This can help set them up for success, especially if other family members are asleep. Women do not want to be searching for things they need throughout the house and in the middle of the night.
Women should try not to panic every late afternoon/evening as they begin to feel nauseous, thinking of the potential long night ahead. They should remember they will eventually have a night that is finally better, when they start recognizing that each night was not as bad as the night before.
Panicking may also make symptoms works; women should remind themselves that once they start feeling sick, that they have a plan, they have various ways to try and control it, and if they can no longer do that on their own, they can call their HCP.
When nights are particularly bad, women should try to restart their mindset each morning and enjoy their nausea free moments as much as possible to help them emotionally for the upcoming night. It is critically they only take one night at a time.
Some women will have nights in the thick of it where they tell themselves they cannot do this anymore, which is easy to feel when they are not getting any sleep. Women need to call their HCP when they get to this point – and ideally, before.
Falling Asleep
Women should not wait until late at night to go to bed if they are tired. If a woman finds that she could fall asleep for the night around 6:30 or 7:00 pm, she should go to bed then. If she waits until much longer, it could actually be harder to fall asleep (read more).
Further, if this helps her wake up earlier in the morning (and nausea-free), she could use that time to eat a nutritious breakfast and get certain responsibilities done if she needs to (work emails, school lunches, chores, etc.). If going to bed earlier helps her sleep and wake up nausea-free, but she is waking up for the day around 4:00 am, that may be the best option until symptoms subside.
It is possible, however, that if the woman goes to bed too early, she could wake up in the middle of the night nauseous, and then have extreme trouble going back to sleep while fighting nausea all night long.
Therefore, women who suffer with late evening/overnight nausea will have to use trial-and-error to determine the best time to go to sleep, and which method works best (which could also change).
There are many different strategies women can use to try to fall asleep or get through their nausea. Women should keep an open mind; even if something immediately sounds like it will not be effective, it is hard to tell what works on nausea until it is tried (read Sleep and Rest with NVP more for information).
Women should consider:
A sleep mask
Hum/sound machine
Soft music
Trying cool washrags on their forehead; for ice cold rags, women can keep a few folded wet rags in the refrigerator.
Women who get very cold at night while fighting nausea may find better utility from rags that have been soaked in warm water; however, these rags do not stay warm very long.
A television in the background on a timed dimmer (guide or music) channel for a soft, peaceful blue light
Sleeping in a different room from their partner (or make the partner temporarily move), or experimenting with where to sleep (couch, arm chair, love seat, etc.)
Sleeping in the “S position on their side”; some women find that lying flat either on their back or stomach can make nausea worse
Mental distractions; these distractions can help keep the mind occupied and distracted from nausea until they fall asleep
Engaging in appropriate sleep hygiene habits
Recording a bunch of television shows during the day or finding shows or movies to record/watch so their playlist has plenty of options in the middle of the night if they cannot sleep
For safety, especially women that like to walk around the house in the middle of the night to keep themselves distracted, they should consider leaving a few lights on and wear non-skid socks so they can do this safely.
Experimenting with temperature; some women get hot during nausea waves while others get cold (or both); women can prepare their bedrooms to give them as many options as possible to combat nausea at night
A weighted blanket; nausea and impending vomiting can cause shaking, chills, and a fast heart rate. Women can use a weighted blanket to help them call down – along with slow, deep, controlled breaths (read Vomiting for more strategies).
Women should also consider taking a brief, warm shower or bath. Warm running water may help some women relax enough to fall asleep once safely out. Women should not hesitate to take more than one if they need to.
However, women should avoid taking baths or showers if they are on medications for nausea that can make them drowsy. Women should also keep the water warm instead of hot, and be careful getting out, as lengthy baths can drop blood pressure and make women feel a bit weak/fatigued when standing up or getting out. Women should also avoid taking baths in the middle of the night if no one is available to help them if they need it.
Eating
It is possible that a high-protein snack before bed will help regulate blood-glucose levels over night and could prevent a woman from waking up nauseous (or from an empty stomach).
If women are already very nauseous before bed, this may be impossible. Therefore, women should try to get a higher protein meal as late in the day as possible, or at least some type of food as close to bed as they can. Women should not force food down food if they feel they cannot eat.
If women wake up in the middle of the night nauseous due to an empty stomach, they should put (non-refrigerated) food on their end table before they good to bed. This small snack in the middle of the night could be enough to help women fall back asleep until the morning. Women should experiment with different foods and different amounts to determine what is tolerated best.
If women are waking up in the middle of the night to use the bathroom, only to be nauseous when they try to go back to sleep, they can try to eat something small before laying back down, or they can taper off fluids toward the evening. However, staying hydrated is critical during NVP, therefore, women need to work hard at balancing hydration and not waking up in the middle of the night.
Note: Drifting in and out of sleep while coping with nausea and trying to eat can be unsafe. Women should make sure they are fully awake before trying to eat. Women should also consider sleeping propped up on a few pillows as soon as they lay back down.
Action
For women who cannot sleep at night due to their symptoms, fatigue and exhaustion start to have a cumulative effect even after just a few days, and women need to manage their symptoms the best they can to avoid physical and mental health complications. Women should also read:
Sleep and Rest (NVP)
Sleep (general pregnancy)
Acid Reflux (general pregnancy)
Causes and Contributing Factors (acid reflux and NVP)
Women need to take one night a time, recover/rest during the day, and remain strong in their ability to cope with symptoms as they appear each evening. Women should try to implement some of the management strategies described above when they are able to, and call their HCP at any point they feel they can no longer adequately tolerate or manage their nausea and/or vomiting.
Women should consider sharing their NVP experience (below), especially anything they did to help them through evening/overnight nausea to help other women currently experiencing this pattern.
Partners/Support
Evening and all night nausea is particularly difficult during pregnancy; as opposed to women who feel nauseous first thing in the morning or during the day, those women can at least sleep at night. However, when women are constantly nauseous and losing sleep, this can lead to physical and mental health complications very quickly.
Further, it can feel very lonely. If a woman is sick during the day, she has more resources and people that can help her get through it, or at least to sit with or comfort her. In the middle of the night, most of the household is sleep.
If a pregnant woman is suffering moderate to severe nausea/vomiting in the evening and throughout the night, partners should do as much as possible to ease any daytime burden from her so she can focus on resting and recovering from the night before (chores, errands, responsibilities, child care, school functions).
Partners should also read how to prepare various aspects of their lives if this were to be the case for several weeks or longer. Women can feel absolutely fine – normal even – first thing in the morning, but then go downhill quickly as the day progresses. This is considered normal.
Taking action/control of the situation by purposefully changing the household routine for a little while to help the woman avoid complications is the most positive way to help the entire family through these next few weeks.
Resources
Nausea and Vomiting of Pregnancy: Committee Opinion 189; January 2018 (American College of Obstetricians and Gynecologists)
Morning Sickness: Nausea and Vomiting of Pregnancy (American College of Obstetricians and Gynecologists)
Pregnancy sickness (nausea and vomiting of pregnancy and hyperemesis gravidarum) (Royal College of Obstetricians and Gynecologists)