The Surprising Connection Between Insomnia and Anxiety in Pregnant Women

Poor sleep during pregnancy can do much more than just cause tiredness. A study that followed women from pregnancy to postpartum found that poor sleep can significantly increase the risk of anxiety, obsessive worries, and emotional distress. The good news? This is one of the easiest factors to identify and treat.

Anxiety is one of the most common emotional difficulties during pregnancy and after the baby's birth. Many women experience constant worries, fears related to the baby's health, insecurities about motherhood, and even repetitive thoughts that are difficult to control.

While hormonal and emotional factors are already known to influence this process, new research suggests that there is another important element that often goes unnoticed: sleep quality.

To investigate this relationship, researchers followed 231 women from the beginning of their pregnancies until six months postpartum. Participants answered interviews and questionnaires at four different times: at the beginning of pregnancy, at the end of pregnancy, six weeks postpartum, and again six months later.

The scientists assessed various aspects of mental health, including anxiety levels, obsessive thoughts, obsessive-compulsive symptoms, emotional coping strategies, and sleep quality.

An important aspect of the study was that the researchers did not simply analyze whether women slept well or poorly at a single point in time. They monitored the evolution of sleep throughout the entire perinatal period, allowing them to observe which factor appeared first: worsening sleep or increased anxiety. This approach is important because it helps to understand the direction of the relationship between the two phenomena.

The results showed something quite interesting. Women who slept fewer hours were more likely to develop anxiety later in life. Furthermore, reduced sleep time was also associated with increased obsessive thoughts, excessive worry, and symptoms similar to those seen in obsessive-compulsive disorders.

In other words, it wasn't just that anxious women slept worse; in many cases, sleep deprivation seemed to precede the worsening of emotional symptoms.

Researchers also found that insomnia symptoms were strongly linked to psychological distress. The more difficulty a woman had falling asleep, staying asleep, or getting restorative sleep, the higher her average levels of anxiety, obsessive thoughts, and compulsive symptoms throughout pregnancy and postpartum.

Interestingly, the reverse was not observed with the same strength: anxiety did not seem to predict future significant changes in sleep patterns.

Another relevant finding was the role of emotional coping strategies. Women who possessed better resources for dealing with stress, such as social support, problem-solving skills, and healthy ways of managing worries, showed less influence of insomnia on anxiety.

This suggests that learning effective ways to cope with stressful situations can help protect mental health even when sleep-related difficulties occur.

The authors conclude that sleep may be one of the most important modifiable factors for preventing anxiety during pregnancy and after childbirth. Since sleep quality can be improved through behavioral interventions, medical guidance, and healthy habits, identifying and treating sleep problems early can represent a simple and effective strategy to reduce maternal psychological distress and promote a healthier pregnancy.

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Subjective sleep disruption, coping, and anxiety and related symptoms in the perinatal period: findings from a longitudinal study

Rebecca C Cox, Caroline P Hoyniak, Jack Samuels, Jonathan S Abramowitz, Gerald Nestadt, Eric A Storch, Rashelle Musci, Paul Nestadt, Lauren M Osborne, and Mary Kimmel

Sleep.  zsag089, 1 April 2026DOI: 10.1093/sleep/zsag089

Abstract: 

Anxiety is common during the perinatal period and is associated with adverse maternal and infant outcomes, highlighting a need to identify predictors of perinatal anxiety. Accumulating research implicates sleep disruption in perinatal anxiety and related symptoms, including obsessive-compulsive symptoms. We examined the associations among insomnia symptoms and sleep duration with perinatal anxiety, obsessive beliefs, and obsessive-compulsive symptoms and the moderating role of coping from pregnancy through postpartum. A sample of 231 women (agemean = 32.97 ± 4.36 years; 74% white) completed interview and self-report measures of sleep, coping, perinatal anxiety, obsessive beliefs, and obsessive-compulsive symptoms in early and late pregnancy, 6 weeks postpartum, and 6 months postpartum. Multilevel models were used for data analysis. Shorter sleep duration predicted increases in subsequent perinatal anxiety (B = -.63, p < .05) and obsessive beliefs (B = -2.17, p < .05), whereas perinatal anxiety and related symptoms did not predict subsequent sleep disruption (p’s > .05). Those who reported higher insomnia symptoms and shorter sleep duration reported higher perinatal anxiety (B = 1.19, p < .001; B = -3.18, p < .001), obsessive beliefs (B = 3.42, p < .001; B = -11.57, p < .001), and obsessive-compulsive symptoms (B = .69, p < .001; B = -1.94, p < .001) on average. The relation between insomnia symptoms and perinatal anxiety was moderated by coping (B = -.18, p < .01). These findings suggest that sleep disruption is a modifiable risk factor for perinatal anxiety and related symptoms.