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

Why Sleep Gets So Hard During Pregnancy

By the third trimester, lying down doesn’t feel like rest-it feels like a battle. You’re tired, but every position hurts. Your nose is stuffed, your stomach burns, and you wake up gasping. You’re not alone. About 1 in 10 pregnant women develop obstructive sleep apnea (OSA), and that number jumps to nearly 1 in 4 if you’re overweight. Snoring isn’t just annoying-it’s a red flag. When your airway collapses during sleep, your body drops oxygen levels, your heart races, and you never fully rest. Over time, this raises your risk of preeclampsia, gestational diabetes, and even needing a C-section.

What’s Really Causing Your Sleep Problems

Your body changes fast during pregnancy, and those changes directly mess with your sleep. Hormones like progesterone relax the muscles in your throat, making it easier for your airway to block. Your growing uterus pushes up on your diaphragm, so you can’t take deep breaths. Fluid retention swells your nasal passages, turning every night into a stuffy-nose marathon. And as your belly grows, lying flat becomes impossible without feeling like you’re suffocating. All of this adds up to sleep apnea, acid reflux, and the constant need to reposition.

How to Tell If You Have Sleep Apnea (Not Just Snoring)

Not every snorer has sleep apnea-but if you’re waking up choking, your partner says you stop breathing, or you’re exhausted even after 8 hours, it’s time to ask your doctor. The STOP-Bang questionnaire is now the standard screening tool used at 28 weeks. It asks about snoring, tiredness, observed breathing pauses, high blood pressure, BMI, age, neck size, and gender. If you score 3 or higher, you need a sleep study. Home tests are now common and accurate enough for low-risk cases. Don’t wait until you’re miserable-early detection cuts your risk of serious complications by up to 30%.

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

Continuous Positive Airway Pressure (CPAP) is the gold standard. It uses gentle air pressure to keep your airway open. For pregnant women, it’s not just helpful-it’s protective. A 2023 study showed that using CPAP between 24 and 28 weeks reduced preeclampsia risk by 30% and gestational hypertension by 35%. But many women quit because the mask feels uncomfortable. The key is getting the right fit. Nasal pillows (small prongs that sit at the nostrils) work better than full-face masks when your face swells. Look for models with built-in humidifiers set to 37°C-this stops dryness, which is a top reason people abandon treatment. ResMed’s AirSense 11 Pregnancy Mode automatically adjusts pressure as your body changes, and the AirTouch F20 Pregnancy Edition has a softer cushion designed for swollen skin. Adherence jumps from 58% to 82% when you get a 30-minute setup session with a sleep technician who walks you through mask fitting and troubleshooting.

Positioning: The Simple Fix That Works for Mild Cases

If your sleep apnea is mild (AHI under 15), sleeping on your left side can cut your breathing pauses by nearly 23%. Why left? It takes pressure off your vena cava, the big vein that brings blood back to your heart. It also helps your kidneys flush fluid, reducing swelling. But staying on your side all night? Impossible without help. That’s where pregnancy pillows come in. Full-body pillows like the Leachco Snoozer or Boppy Noggin CPAP Pillow hold your belly, back, and legs in place 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. For reflux, elevate the head of your bed by 6-8 inches using blocks under the legs-not just pillows. Pillows alone can bend your neck and worsen apnea. A wedge pillow at 7-8 inches height is ideal.

Taming Heartburn: What Actually Works (And What Doesn’t)

Heartburn during pregnancy isn’t just spicy food-it’s hormones relaxing the valve between your stomach and esophagus. Lying down makes it worse. Avoid eating within three hours of bed. Skip chocolate, caffeine, citrus, and fried foods. Instead of antacids with aluminum or magnesium (which can cause side effects), choose alginate-based ones like Gaviscon Advance. It forms a foam barrier on top of stomach acid, blocking reflux without being absorbed into your bloodstream. One bottle (500ml) costs about $15 and lasts most of the third trimester. Pro tip: Sleep in a semi-reclined position. Even a 30-degree tilt helps more than you think.

What Doesn’t Work (And Why You Should Avoid It)

Mandibular advancement devices-mouthpieces that push your jaw forward-are popular for non-pregnant sleep apnea patients. But during pregnancy, your jaw and ligaments are loosening due to hormones. These devices can cause jaw pain, tooth movement, or even TMJ issues. The 2023 SASM/SOAP guidelines explicitly advise against them in pregnancy. Also, avoid sleeping on your back. Even if you feel fine, it can cut blood flow to your baby and worsen apnea. And don’t rely on over-the-counter sleep aids. Most are unsafe in pregnancy and don’t fix the root problem.

When to Start Treatment (And Why Timing Matters)

There’s a sweet spot: between 20 and 28 weeks. Starting CPAP before 28 weeks gives your body the best chance to reduce risks. Each week of consistent use before 28 weeks lowers preeclampsia risk by nearly 5%. If you’re diagnosed later, don’t wait. Even starting at 32 weeks still helps. The goal isn’t perfection-it’s consistency. You don’t need to wear it 8 hours every night right away. Start with 4 hours, add an hour each night. Most women find they can’t sleep without it after 7-14 days. Follow-up visits at day 3 and day 7 make a huge difference in sticking with it.

What Happens After Baby Arrives

Many women think sleep apnea disappears after delivery. It often improves-but not always. Studies show that 58% of women who had pregnancy-related OSA develop chronic high blood pressure within 10 years, even if their apnea seemed to vanish. The American Academy of Sleep Medicine now recommends a follow-up sleep study 12 weeks postpartum if you were diagnosed during pregnancy. If your symptoms return or you’re still snoring, don’t ignore it. Your long-term heart health depends on it.

Real Talk: What Women Are Actually Saying

On Reddit, one user wrote: “CPAP saved my third trimester. My blood pressure dropped in two weeks. But my nose swelled so much the mask leaked.” Another said: “I cried the first night. It felt like a torture device. But now I can’t sleep without it.” Amazon reviews for pregnancy-specific CPAP pillows average 4.2 out of 5. The top complaints? Mask leaks, machine noise, and feeling claustrophobic. The top wins? More energy, no morning headaches, and better moods. The biggest regret? Waiting too long to get tested. On average, women had symptoms for over 14 weeks before seeing a doctor.

Your Action Plan: What to Do Today

1. If you snore loudly, wake up gasping, or feel exhausted daily, ask your OB for the STOP-Bang questionnaire.
2. If you’re diagnosed with OSA, start CPAP between 20-28 weeks. Ask for nasal pillows and humidification.
3. Buy a full-body pregnancy pillow (Leachco, Boppy, or similar) and sleep on your left side.
4. Elevate your upper body 6-8 inches with a wedge, not pillows.
5. Stop eating 3 hours before bed. Use Gaviscon Advance for heartburn.
6. Don’t use mouthpieces or sleep aids.
7. After delivery, schedule a sleep check-up at 12 weeks if you had OSA.

What’s Changing in 2025

Apple Watch Series 9 now detects sleep apnea with 89% accuracy-no test needed. If you’re wearing one and it flags possible apnea, take it seriously. ResMed’s pregnancy-specific CPAP algorithms are now standard in new machines. Hospitals are slowly adding sleep apnea protocols for labor, since untreated OSA triples anesthesia risks. The NIH is running a major trial to see if starting CPAP before 20 weeks can prevent fetal growth problems. By 2027, sleep screening will be routine in most prenatal clinics. You don’t have to wait for the system to catch up. Start now.