Insomnia is an extremely common health problem in America, affecting a staggering 40 million Americans. Women tend to suffer from insomnia more than men, with 63 percent of American women reporting poor sleep compared to 53 percent of men.Women experience more sleep problems during times of major physical and psychological changes. Insomnia is commonly reported during pregnancy, menstruation and menopause. Major fluctuations in hormone levels (e.g., estrogen, progesterone) coupled with discomfort (e.g., cramping, restless legs, physical discomfort of pregnancy) are typically to blame for sleepless nights. Overactive minds and worries about life changes/stressors can also worsen sleep.Pregnancy is a time of major physical and psychological change. Women’s bodies change dramatically over the course of 40 weeks, and their minds try to prepare for the little one coming into the household.

This is a time when sleep is essential, yet can be very hard to come by. Knowing what is most-commonly experienced during the three trimesters can help pregnant women be more proactive with any sleep problems that might arise throughout the trimesters.

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First Trimester: Many women feel excessively sleepy during the day. In fact, a strong urge to take a midday nap is very common (and recommended if you aren’t having too much trouble with insomnia). Pregnant women in their 1st trimester tend to sleep more overall, since the body is working hard to grow the developing baby and placenta (the organ that feeds the baby until birth). Although women sleep more during this early stage of pregnancy, their nighttime sleep is often briefly interrupted with the need to urinate, nausea or general psychological stress.

The Second Trimester: This is typically a time of respite, with a more normal sleep pattern. The growing fetus moves above the bladder, causing fewer trips to the bathroom at night. Morning sickness lessens during this time, and women generally don’t have physical discomfort.

The Third Trimester: The final months tend to be the most physically and psychologically taxing for pregnant women. Physical discomfort greatly increases, due to a growing belly, heartburn, sinus congestion, leg cramps, back pain and constipation. The baby, again, puts pressure on the bladder, and frequent nighttime urination returns. Women begin to worry more about the impending birth, things that need to be done before the baby arrives, and what life might be like after baby. Another reason sleep is broken up during this trimester is that it serves to prepare mom for the disrupted sleep that’s about to happen once the baby arrives.It is likely unrealistic to think that every night of sleep during pregnancy will be great. Despite the physical and psychological rollercoaster that’s to be expected during this time, there are some things that can be done to help.

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1) Pillows! Pillows can be your best friend during pregnancy. Experiment to see what work’s best for you. Many women find that laying on their side and adding extra pillows to help support beneath the stomach and lower back (by putting a pillow between your knees) can aid in pain relief. Full-body pregnancy pillows are available in stores and support the head, belly and lower back. Other women find wedge-shaped pillows helpful in supporting the lower back and belly.

2) Change your sleep position, if necessary. Side-sleeping (with knees slightly bent) is typically the most comfortable sleep position during the second and third trimester. It is best to get into the habit of side-sleeping earlier in pregnancy before you actually need to start. Side-sleeping alleviates pressure on the inferior vena cava (a large vein that carries blood back to the heart from your lower extremities). Some doctors even recommend that sleeping on the left side is ideal. But no need to obsess about your sleeping position. We all move throughout the night, and it’s not a problem. If you wake up and find yourself sleeping in a different position, just move back to your side. Worrying about your sleeping position will worsen your sleep.

3) Avoid liquids and heavy meals within three hours of bedtime. Less liquid means fewer trips to the bathroom. Avoiding heavy meals at night can help reduce heartburn. If you need to, have a light snack before bed that consists of carbohydrate and a little protein (e.g., a banana with a tablespoon of peanut butter, a whole-wheat cracker with a small slice of cheese). If you wake up at night with nausea, try some crystallized ginger or bland saltines to help ease your stomach.

4). Limit caffeine. Avoid coffee, soda, tea and chocolate after 2p.m. These foods can make it harder to fall asleep and lighten the quality of sleep overall. But if you must have caffeine, speak with your doctor first to make sure it’s OK during pregnancy and only consume it in the morning.

5). Exercise. Remaining physically active is beneficial to both you and your baby during pregnancy. But definitely talk with your doctor first to make sure it’s safe. Although exercise at any time of the day is good for your body, getting just 20 minutes of exercise five or six hours before bedtime is the optimal time to help you fall asleep faster and stay asleep longer.

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6). Restless legs. Restless Legs Syndrome (RLS) is a very common issue during pregnancy. As the nighttime gets closer, RLS sufferers experience a worsening, uncomfortable feeling in the legs that interferes with the ability to relax and fall asleep. If you have trouble sleeping because of RLS, talk with your doctor since there are effective treatments available. A simple blood test to check your iron levels may be all you need for a diagnosis, and your doctor might recommend a specific supplement to help. Some women notice more leg cramps that awaken them from sleep. For some women, simply increasing your calcium intake can help alleviate the problem.

7). Don’t lie in bed awake. Only sleep and sex are allowed in bed. If you can’t sleep and are lying there watching TV, thinking, or worrying, just get up. There’s nothing to be gained by tossing and turning. Instead, get up, go in another dimly-lit room, and do something quiet, calm and relaxing. You might even miss that quiet time once the baby arrives!

8). Make time to relax. This is the time to do it since it will become even more difficult to do once the baby arrives! Calming your mind and body will only help you sleep better. Even 20 minutes of relaxation can serve to lower stress levels and give you energy. Find a hobby you love that’s relaxing and make time for it.

9) Snore? The weight gain and hormonal changes seen in pregnancy can put a pregnant women at an increased risk of developing obstructive sleep apnea. Talk with your doctor if you snore, choke/gasp or stop breathing during your sleep. Untreated sleep apnea has been linked to a higher prevalence of premature births and pregnancy complications. Effective treatments are available and can help you feel better overall.

10). Take charge of your worries! Many pregnant moms find that joining a pregnant mom’s group or enrolling in childbirth or parenting classes can help alleviate some nighttime worries.

QUIZ: How’s Your Sleep?