How to Sleep with Rib Pain During Pregnancy

At a certain point during pregnancy, it's common to feel like your growing fetus has taken over your entire belly. One minute they’re the size of a peach, and the next, they’re simultaneously kicking your bladder while headbutting your ribs. Before long, all that moving around can lead to uncomfortable rib pain that wreaks havoc on your sleep.

Rib pain in pregnancy is often musculoskeletal in nature and caused by pregnancy changes, including:

• Postural shifts: As your center of gravity changes, increased upper back curvature can strain rib joints and supporting muscles.
• Hormonal effects: Pregnancy hormones soften ligaments, making rib joints more mobile and potentially sore. Your rib cage may even expand.
• Fetal growth: In later pregnancy, your growing baby can push up into your diaphragm (as much as 4 cm), affecting breathing and lower rib position.

These factors can lead to joint instability, intercostal muscle strain, and even upper back pain. While rib pain is a common pregnancy complaint, it doesn't mean you have to suffer through sleepless nights. With a few adjustments to your sleeping position and some helpful tips, you can find relief and get the rest you so desperately need.

Best Sleep Positions for Pregnancy Rib Pain

When you have rib pain in pregnancy, the "best" sleep position can depend on where your pain is located, what’s causing your symptoms, and any other aches and pains you have. Experiment with the following sleep positions to see which is most comfortable for you.

Supported Side Sleeping

Your side is typically the best position to sleep throughout your pregnancy, particularly on your left side as this allows for the best circulation, but either will work.

Try these adjustments to support your body while you sleep:

1. Find a pillow that supports your head in line with your body, not tilted up or down. Add a folded towel as needed to get just the right height.
2. Hug a thick pillow to support your upper body and to keep it from twisting forward while you sleep.
3. Place a long pillow or two between your knees that is long enough to also support your ankles. The goal is to align your hips, knees, and ankles.

Which side you sleep on can depend on your symptoms. According to Natalie Russell, PT, DPT, if your pain is caused by joint instability and is aggravated by movement, lying with your painful side down may be helpful as this will stabilize the rib as you sleep. If your pain is caused by a muscle strain, the National Sleep Foundation suggests sleeping with your painful side up, which can relieve pressure from tender muscles. Try both sides to see which is more comfortable for you.

Pro tip: Nirja Gajjar, PT, DPT, tells her pregnant patients with rib pain to place a small, rolled-up towel under their waist (between the bottom of the ribs and top of the hips), which can help support the spine and ribs in a neutral position.

Modified Back Sleeping

If your pain is coming from your chest, or if sidelying feels uncomfortable, you can also consider this modified back sleeping position:

1. Find a pillow that supports your head in line with your body, not tilted up or down.
2. Place a thick pillow or two under your right side, from your shoulder down to your hips to tilt you toward your left. This modification of back sleeping allows for continued circulation.
3. Place a pillow or two under your knees as well to support your low back and to prevent it from rotating.

Pro tip: Some find it really comfortable to hug a small pillow to help support your upper body.

Semi-Reclined Sleeping

If you have a bed with an adjustable base, it can help to raise the back and sleep in a semi-reclined position to shift your body weight off of your ribs. If you can't adjust your bed, place a couple of thick pillows behind your back, so you are more upright, or try sleeping in a recliner.

Pro tip: Place some pillows or a wedge behind your knees as well, to fully support your body.

More Tips for Easing Pregnancy Rib Pain So You Can Sleep

Beyond finding a good soothing sleep position, it can help to find things that ease your pain before you get to bed.

1. Try a heating pad: Use a heating pad on the sore area before bed to help improve blood flow and ease muscle tension. Be sure to protect your skin with a few towels or layers of clothes to prevent burns. Just don't fall asleep with heat. A warm shower or bath before bed may also help. Be careful not to raise your core temperature though, and limit your heating pad use to 5 to 7 minutes at a time.
2. Gentle massage: For sore muscles, Russell said, "I have found self-massage to the area can be helpful when performed super gently."
3. Yoga stretches: For rib stiffness and muscle pain, gentle yoga stretches before bed can sometimes be soothing. Russell suggested gentle twisting exercises to help normalize rib mobility. Check out an example below:

4. Add support: When joint instability is behind your pain, some find that adding support is helpful. Christina McGee, PT, DPT, recommends kinesiotaping to her patients. This can add support to your joints as you sleep.

See a Pregnancy PT for Rib Pain

While most often the normal changes of pregnancy will lead to pain felt in your ribs or chest area, there are some important medical conditions that your OBGYN will want to rule out first (for example, a symptom of preeclampsia is epigastric pain, or pain felt in the area under your ribs on the right side).

If your rib pain is sudden and intense, worsening over time, not improving with rest, or accompanied by other symptoms, it's best to check in with your obstetric healthcare provider to see what could be causing your symptoms.

Once medical concerns are cleared, consider scheduling an evaluation with a pelvic physical therapist. PTs specializing in pregnancy care, like the PTs at Origin, can help with all your aches and pains, including rib pain and personalize advice to help you sleep.

Remember, when you're pregnant, sleep is essential. With these tips and proper support, you can find relief from rib pain and get the rest you and your growing baby need.