How to Sleep When Pregnant With Twins

Why sleep gets harder sooner

RCOG says the problems many pregnant women experience, including heartburn, swollen ankles, varicose veins, backache and tiredness, are all more common in multiple pregnancies. Twins Trust lists heartburn, pelvic girdle pain, nausea and exhaustion as things that pile up when you are pregnant with twins or triplets, especially if you are also working or looking after older children.

Two babies means the physical changes of late pregnancy arrive at an earlier gestation. The advice does not change. The timetable does.

The position rule, and where it comes from

The NHS says not to lie flat on your back for long periods, particularly after 16 weeks, because the weight of the bump presses on the main blood vessel bringing blood back to your heart and this can make you feel faint. That guidance is written for exercise, but the mechanism is the same at night, and it is the reason side sleeping is recommended in later pregnancy.

If you wake up on your back, roll onto your side and go back to sleep. You are not doing anything wrong by having moved in your sleep; the advice is about the position you settle into, not a rule you can break unconsciously.

Setting yourself up

Most of what helps is unglamorous. A pillow between your knees keeps your hips and pelvis in line, which matters more with a heavier bump. A pillow or rolled towel wedged behind your back stops you rolling flat. Something under the bump takes the drag off the round ligaments that run down each side. A full-length pregnancy pillow does all three at once, which is why they exist.

Raising the head of the bed slightly, by putting something solid under the legs at the head end, helps more with reflux than stacking pillows does, because stacking pillows tends to bend you at the waist.

Reflux, breathlessness and rib pain

Heartburn is one of the symptoms RCOG says is more common in multiple pregnancy, and it is worse lying down. Eating earlier in the evening and avoiding large meals close to bedtime is the standard advice and is free to try. If it is stopping you sleeping, say so at your next appointment rather than working through it; treatment exists and this is a normal thing to ask about.

Breathlessness when lying down is common when there is more pressure under the diaphragm. Breathlessness at rest is different. Twins Trust names feeling breathless at rest or having palpitations as a reason to contact your maternity team urgently, and RCOG lists sudden breathlessness among the symptoms to report immediately in a multiple pregnancy. Do not sit on that one.

Pelvic girdle pain

Pelvic girdle pain is the pain around the pubic bone, hips and lower back that makes turning over in bed genuinely difficult. RCOG's patient information on pelvic girdle pain describes it as common in pregnancy and treatable, and says physiotherapy is the mainstay. NICE NG137 lists a women's health physiotherapist in the enhanced team that a twin or triplet pregnancy can be referred to, so this is a referral your maternity team is set up to make.

Practical tricks that physiotherapists commonly suggest include keeping your knees together when turning over, using a satin sheet or plastic bag under your hips to slide rather than twist, and getting in and out of bed in one movement rather than swinging one leg at a time.

Daytime rest is not a luxury

Twins Trust is direct about this: rest is just as important as activity, and if you have older children it is worth asking a partner, friend or relative to help with childcare so you can nap or simply sit down. The NHS notes that tiredness in pregnancy is common and often improves with rest rather than with pushing through.

One important distinction. Resting when you are tired is sensible. Prolonged bed rest is not: NICE NG137 lists bed rest among the things not to offer routinely to prevent spontaneous preterm birth in a twin or triplet pregnancy. Rest because you need to, not because you think it will keep the babies in.

Tiredness that is worth a blood test

NG137 says teams should be aware of the higher incidence of anaemia in women with a twin or triplet pregnancy compared with singleton pregnancies, and asks for a full blood count at 20 to 24 weeks in addition to the routine booking test, repeated at 28 weeks. RCOG explains why: developing babies use a lot of iron, and treatment is offered if levels are low.

So exhaustion that feels heavier than tiredness, especially with breathlessness on mild exertion, is worth mentioning. There is a specific test for it and it is already in your schedule.

Getting back to sleep at 3am

Waking to use the bathroom is unavoidable when two babies are pressing on your bladder, so the goal is to make going back to sleep easier rather than to stop waking. Keep the light dim on the way, avoid picking up your phone, and if you are awake for more than about twenty minutes, get up and do something dull in low light rather than lying there.

The NHS notes that tiredness in pregnancy is common, particularly in the first and third trimesters, and that it usually improves with rest rather than by pushing on. With twins the third trimester version arrives earlier, so the point at which you need to take naps seriously arrives earlier too.

When broken sleep is a symptom

Lying awake because you are uncomfortable is one thing. Lying awake because your mind will not stop is another, and it is common in a twin pregnancy. NG137's enhanced team includes a perinatal mental health professional, and referral is based on need rather than automatic. Saying "I am not sleeping and I am frightened" at an appointment is enough to start that conversation.