You go to bed exhausted, sure you'll nod off the minute your head hits the pillow. Instead you find yourself wide awake, watching the minutes tick by. Or you wake up at four in the morning, unable to fall back asleep. Insomnia — a condition in which you have problems falling asleep or staying asleep — is very common during pregnancy. Considering all the changes you're going through, both physically and emotionally, it's not surprising that your sleep is affected.

Although many women sleep more during the first trimester than before they were pregnant, hormonal changes may make it harder for some women to sleep through the night. As your growing uterus puts pressure on your bladder, the frequent need to urinate can get you out of bed to go to the bathroom several times a night.

As the baby gets larger, you may find it harder to find a comfortable position for sleeping. An active baby also can keep you awake. Heartburn, leg cramps and nasal congestion are other common reasons for disturbed sleep in the later months of pregnancy.

Then there's the natural anticipation, excitement and anxiety you're bound to feel about your baby's arrival. You may have worries about the health of the baby and the changes the baby is going to create in your life. These feelings can make it hard to relax your mind and body. You may have frequent and vivid dreams about birth and the baby, which can also contribute to insomnia.

Although insomnia can be frustrating for you, it won't hurt your baby.

Prevention and self-care for insomnia

Worrying about lack of sleep will only compound the problem. If you have difficulty falling or staying asleep, try these suggestions:

• Start winding down before going to bed. Take a warm bath or do relaxation exercises. Ask your partner for a massage.

• Make sure your bedroom is a comfortable temperature for sleeping and that it's dark and quiet.

• Cut down on your fluids in the evening.

• Exercise regularly, but avoid overexertion.

• The best position for sleeping in late pregnancy is on your left or right side, with your legs and knees bent. Lying on your side takes pressure off the large vein that carries blood from your legs and feet back to your heart. This position also takes pressure off your lower back. Use one pillow to support your abdomen and another to support your upper leg. You can also try placing a bunched-up pillow or rolled-up blanket in the small of your back. This will help relieve pressure on the hip you're lying on.

• Don't lie awake worrying about not sleeping. Get up and read, write a letter, listen to relaxing music, or do needlework or some other calming activity.

• If possible, take short naps during the day to make up for missed sleep at night.

■ Medical care for insomnia

No medications for insomnia, including herbal remedies, are completely safe to use during pregnancy. If anxiety is keeping you awake at night, ask your health care provider about relaxation exercises that may help, or use the relaxation techniques you learned in childbirth classes.

If you're concerned that you may have a serious sleep disorder, consult your health care provider. If ongoing disturbing dreams or nightmares are causing you distress, it might be helpful to talk with a therapist or counselor.

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