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

Why Sleep Gets So Hard During Pregnancy

By the third trimester, many pregnant women feel like they’re fighting sleep instead of getting it. Snoring wakes them up. Heartburn keeps them tossing and turning. No matter how they position themselves, nothing feels right. This isn’t just discomfort-it’s a sign something deeper is happening. Around 10.5% of pregnant women develop obstructive sleep apnea (OSA) by the end of pregnancy, and that number jumps to nearly 27% for those with obesity. Sleep apnea means your airway collapses briefly while you sleep, causing you to stop breathing for seconds at a time. Your body jolts awake just enough to restart breathing, but you never remember it. The result? Constant fatigue, high blood pressure, and a higher risk of preeclampsia and gestational diabetes.

What Causes Sleep Apnea in Pregnancy?

It’s not just about weight. Pregnancy changes your whole body’s anatomy. Hormones like progesterone relax the muscles in your throat, making them more likely to collapse. Your neck gets thicker, your nasal passages swell from increased blood flow, and your growing uterus pushes up on your diaphragm, leaving less room for your lungs to expand. These changes start early but hit hardest between 24 and 36 weeks. If you snore loudly, wake up gasping, or feel exhausted even after 8 hours in bed, you might have sleep apnea. Don’t assume it’s just "normal pregnancy tiredness." The American College of Obstetricians and Gynecologists now recommends all pregnant women be screened for sleep-disordered breathing at the first prenatal visit using a simple questionnaire.

How CPAP Therapy Works (and Why It’s the Gold Standard)

Continuous Positive Airway Pressure (CPAP) is the most effective treatment for moderate to severe sleep apnea during pregnancy. A small machine delivers steady air pressure through a mask, keeping your airway open while you sleep. Modern CPAP devices for pregnant women are smarter than ever. The ResMed AirSense 11 Pregnancy Mode, cleared by the FDA in 2022, automatically adjusts pressure as your breathing changes throughout the night. Most women start at 6-8 cm H₂O and increase slightly each trimester. Studies show that using CPAP between 24 and 28 weeks reduces the risk of preeclampsia by 30% and gestational hypertension by 35%. The key? Consistency. Women who use CPAP at least 4 hours a night, 5 nights a week, see the biggest benefits. But getting used to it takes work.

Overcoming CPAP Challenges During Pregnancy

Many women quit CPAP because of discomfort. Nasal dryness, facial swelling, and mask leaks are common. The solution? Use a nasal pillow mask instead of a full-face mask-it’s lighter and less likely to press on swollen cheeks. Humidification set to 37°C helps with congestion. A 2023 study found that 82% of women stuck with CPAP when they got personalized fitting help from a sleep clinic, compared to just 58% with standard care. If your mask leaks because your nose is swollen, try the Boppy Noggin CPAP Pillow. It’s designed to cradle your head and keep your airway aligned while you sleep on your side. One user reported her apnea-hypopnea index (AHI) dropped from 18 to 6 in two weeks. Don’t give up after a few bad nights. Most women adapt within 7-14 days, especially with two follow-up visits to fine-tune the setup.

Positioning: The Simple Trick That Can Cut Apnea in Half

If you have mild sleep apnea (AHI under 15), changing your sleep position can make a huge difference. Sleeping on your back makes apnea worse because gravity pulls your tongue and soft tissues backward. Sleeping on your left side is best-it improves blood flow to the placenta and reduces pressure on your airway. A 2022 study from Brown Health found that left-side sleeping reduced AHI by 22.7% in women with mild OSA. But staying on your side all night? Hard to do. That’s where pregnancy pillows come in. Full-body pillows like the Leachco Full Body Pillow Pro ($89.99) wrap around you, supporting your belly, back, and legs to keep you aligned. Avoid stacking regular pillows-it can tilt your neck and make breathing worse. Instead, use a wedge pillow under your upper body (7-8 inches high) to elevate your head. This helps both apnea and reflux.

Managing Reflux Without Medication

Heartburn during pregnancy isn’t just annoying-it can disrupt sleep and worsen apnea by causing throat irritation. The fix isn’t just antacids. Elevating the head of your bed by 6-8 inches (not just your head with pillows) prevents stomach acid from flowing up. Avoid eating within 3 hours of bedtime. Skip spicy, fatty, or acidic foods. For quick relief, try Gaviscon Advance ($14.99 for 500ml). Unlike regular antacids, it forms a protective foam barrier on top of your stomach contents without being absorbed into your bloodstream. It’s safe during pregnancy and works fast. If you’re still waking up burning, talk to your provider about safe, short-term options like sucralfate or calcium-based antacids.

What About Other Treatments?

Some women wonder about mouthpieces or surgery. Mandibular advancement devices (MADs), which push the jaw forward, work well for non-pregnant people-but they’re not recommended during pregnancy. Your jaw and hormones are changing, and there’s no safety data. Surgery? Absolutely not. The only proven, safe options are CPAP, positional therapy, and lifestyle changes. Weight gain should follow Institute of Medicine guidelines: 11.5-16 kg for normal weight, 5-9 kg for obese women. Losing weight during pregnancy isn’t advised, but staying within these limits helps reduce pressure on your airway. Even small changes-like walking 20 minutes after dinner-can improve digestion and reduce reflux.

When to Get Tested and What to Expect

Screening starts early. If you snore, feel tired during the day, or have high blood pressure, ask for a sleep evaluation. The STOP-Bang questionnaire (used since June 2024) is now the standard tool at 28 weeks. If you score high, you’ll likely get a home sleep test-a small device you wear overnight that tracks breathing, oxygen, and heart rate. It’s not as detailed as a full sleep study in a lab, but it’s accurate enough for most cases. Results come back in a few days. If you have moderate or severe apnea (AHI ≥15), CPAP is the next step. For mild cases, start with positional therapy and reflux management. Don’t wait until you’re exhausted. Every week of untreated apnea increases your risk of complications.

What Happens After Baby Arrives?

Many women think sleep apnea disappears after delivery. For some, it does-especially if they lost weight. But 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 went away. That’s why the Brown Health clinic recommends a follow-up sleep study at 12 weeks postpartum. If your apnea was mild and you’re feeling great, your provider might just monitor you. But if you still snore, feel tired, or have high blood pressure, don’t ignore it. Untreated sleep apnea doesn’t just affect pregnancy-it can lead to long-term heart problems.

Real Stories, Real Results

"I thought my exhaustion was just pregnancy," says Sarah, 32, who was diagnosed at 28 weeks. "I started CPAP and within two weeks, I stopped having headaches. My blood pressure dropped from 145/95 to 118/76. I actually slept through the night for the first time in months." On the flip side, Maria, 29, waited until 34 weeks to get tested. "I thought it was normal. By then, I had gestational diabetes. My doctor said if I’d started CPAP earlier, it might’ve been preventable." These aren’t rare cases. A 2022 survey found women waited an average of 14.3 weeks before getting evaluated. The longer you wait, the higher your risk.

What’s Changing in 2026

By 2027, the American Academy of Sleep Medicine predicts that 65% of prenatal clinics will screen for sleep apnea routinely. New tech is helping. The Apple Watch Series 9 can now detect moderate to severe sleep apnea with 89% accuracy-no machine needed. If your watch shows frequent drops in oxygen during sleep, talk to your doctor. Research is also underway to see if starting CPAP before 20 weeks can reduce fetal growth restriction, which affects 42% of babies born to mothers with untreated OSA. The goal isn’t just better sleep-it’s healthier moms and babies.

Quick Takeaways

• Snoring + fatigue = possible sleep apnea. Don’t ignore it.
• CPAP is the most effective treatment-start between 24-28 weeks for best results.
• Left-side sleeping with a pregnancy pillow cuts apnea by over 20%.
• Elevate your whole upper body (6-8 inches), not just your head, to fight reflux.
• Use Gaviscon Advance for safe, effective heartburn relief.
• Get screened early. Waiting increases risks for you and your baby.
• Follow up after birth-even if you feel fine, your long-term heart health is at stake.