Getting Sleep (with NVP)
Getting enough rest and sleep during early pregnancy (with NVP) is critical to avoid future pregnancy-related complications. A lack of sleep leads to worsened fatigue, which is already a major symptom of the first trimester. Further, fatigue is a well-known contributor to nausea, and nausea worsens fatigue – a difficult cycle to break.
Focusing on sleep can feel impossible when women have moderate to severe nausea and vomiting, especially if their symptoms peak in the evening or overnight. Women may need to adjust their home and work lives to take control of their ability to rest and sleep, in order to avoid worsened NVP (more below).
Women need to call their HCP if their symptoms are becoming more than they can handle on their own. Research indicates the earlier an HCP is involved, and the earlier certain management techniques are tried, the easier it is to control symptoms.
The ability for pregnant women to sleep gets worse as pregnancy progresses, making it even more important that women achieve adequate rest and sleep in the first trimester.
Background
Rest and sleep are essential for a pregnant woman’s mental and physical health. First trimester fatigue is reported to be so extreme in some women that researchers have even recommended women prepare their work and home environments, so they can achieve adequate rest.
NVP is also strongly associated with a lack of sleep, or trouble falling asleep – especially in women who suffer with evening/overnight nausea. Women with NVP can experience more severe fatigue than women without NVP.
Therefore, getting adequate rest and sleep is critical to the management of NVP symptoms. Fatigue, which is a common and sometimes debilitating early pregnancy symptom, makes nausea worse; further, nausea makes fatigue worse, which results in a difficult cycle to break (read more).
Adequate rest will help women conserve their energy and help them better mentally cope with their symptoms, especially if they are not eating or drinking as much as they normally do.
Further, a lack of sleep is common in pregnancy in general, which gets progressively worse. Therefore, if women do not obtain enough sleep during the first trimester, it may be very difficult to catch up later in the second or third trimesters (read Sleep).
Management
It is routinely advised that women get as much rest as possible, or at least rearrange their day so they can achieve some rest if/when they can.
While napping may be necessary during the day, research has indicated that a full night’s sleep may be more effective at combating NVP and fatigue than brief naps.
When women do finally get to rest or lie down for awhile, mental distraction techniques, controlled breathing, and mindfulness can help them relax their mind enough to truly get some rest.
It can be very difficult to do this if women are constantly thinking about all the things they need to get done, or if they are too focused on their symptoms.
Some women may find that lying down increases their nausea; therefore, these women may be more comfortable lying on a couch or bed at an incline.
Acid reflux in early pregnancy can cause nausea/vomiting in the evening and during the night. Many women in early pregnancy suffer from moderate to severe acid reflux and may not even know it.
If women experience severe nausea and/or vomiting in the evening or during the night, it could be their meals throughout the day making their reflux peak in the evening. Women with evening/overnight nausea should talk to their HCP about acid reflux. There are several safe and effective medications available during pregnancy. Read more.
Adequate hydration can be hard to obtain with moderate to severe NVP; however, hydration can combat fatigue and increase a woman’s ability to engage in light physical activity (walking). Physical activity is one of the best techniques for better sleep.
However, hydration too close too bedtime may mean the woman will be waking up several times to use the bathroom. For women with overnight nausea, the simple act of waking up can start a vicious nausea cycle.
Therefore, women can hydrate throughout the day and start tapering off in the evening to potentially avoid waking up. However – it is very important – that if a woman is unable to adequately hydrate during the day, but feels better toward the evening, she needs to consume fluids even possibly up to bedtime, to make sure she avoids dehydration. Dehydration can cause a cascade of complications during early pregnancy.
For women who wake up nauseous in the middle of the night, they should eat something with a bit of protein just prior to bed. If they suffer from acid reflux, this meal may need to be a bit earlier in the evening.
Additionally, if acid reflux is the cause, then eating in the middle of the night could also make it worse; this makes the protein meal even more important, as it can help keep something in the stomach for a little longer than simple carbohydrates.
If women do not believe they suffer from acid reflux, and are majorly affected by an empty stomach, they should have food near the bed (on the end table) they can grab very quickly and safely eat when they wake up. Safety is important, as some women may not even be able to lift their head until they have eaten something.
Foods that may work for this:
A piece of bread/roll in a plastic bag
Apple slices, cheese stick, or yogurt to-go tube (that a family member grabs from the refrigerator)
Banana (sliced may be more preferable; a family member can do this)
Dry cereal
Cereal bar
Pop-Tarts ®
Small amount of potato chips
*A note on crackers: crackers first thing in the morning – or even the middle of the night – likely will not go down well without something to drink. Therefore, if women cannot also drink water, the dry cracker could trigger their gag reflex if their mouth is too dry.
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.
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.
Women should go to sleep only when tired; women should not force a bedtime in which it takes them more than 10 to 20 minutes to fall asleep. Additionally, if women are tired much earlier in the evening (such as 7:00 pm), they should go to sleep then.
It is possible this will wake women up much earlier, so if women wake up early with nausea, they should consider eating right away.
If women wake up earlier (around 5:00 am) due to this earlier bedtime, but they are symptom free at that time, they can use that time to themselves, or get a head start on responsibilities for the day.
Women should not try to manage their symptoms and a lack of sleep on their own; they should ask their HCPs, partners, family members, and even their employers for help (read more).
Women need to get their HCP involved early; HCPs want to get a woman’s sleep managed quickly to avoid possible associated complications. NVP is progressive. Symptoms can compound, and managing fatigue, dehydration, nausea, vomiting, headaches, and an overall lack of energy at the same time can wreak havoc on a woman’s physical and mental health.
Additionally, HCPs can assess a woman’s overall condition and determine if other factors could be causing issues, such as iron deficiency anemia.
Women should consider (overlaps with Evening/Overnight Nausea):
A sleep mask
Hum/sound machine
Soft music
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 their temporarily sleep elsewhere), or experimenting with where to sleep (couch, armchair, 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 add to their playlist provides 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 temporary lights on 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).
Additional sleep hygiene tips are located in Sleep (general).
Action
Women may need to adjust their home and work lives to take control of their ability to rest and sleep, in order to avoid worsened NVP (backed by evidence).
Women have resources to help them to do this:
To help adjust their home lives, they should have their partner/other family members read the Partners/Support section of this page.
Women should also read Working with NVP to understand their options for reasonable accommodations at work.
Our Evening/Overnight Nausea page can help women manage their symptoms overnight
Our various Management pages can teach women how to use a combination of methods to help them fall asleep with NVP
Women need to call their HCP if their symptoms are becoming more than they can handle on their own. Research indicates the earlier an HCP is involved, and the earlier certain management techniques are tried, the easier it is to control symptoms.
Women should never attempt to take any over-the-counter medication to help them sleep without speaking to to their HCP.
Women should also consider sharing their NVP experience below, especially if their experience included difficulty sleeping due to their symptoms. They should also share what strategies they used to help them fall asleep (and stay asleep) to help women currently experiencing this same issue in early pregnancy.
Partners/Support
Partners and family members can have a major impact on a pregnant woman's ability to sleep, especially early in pregnancy. When women are constantly nauseous and losing sleep, this can lead to physical and mental health complications very quickly.
If a pregnant woman is losing a lot of sleep due to her NVP, 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).
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
Sleep Education (American Academy of Sleep Medicine)
Pregnancy search query (SleepFoundation.org)
Stress Management: Doing Progressive Muscle Relaxation (Michigan Medicine, University of Michigan)
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)