​​​​​​​​​​​​​​​​​​A baby is on the way! With all the excitement and anticipation, you might expect a few restless nights – but what happens if you're literally struggling to fall asleep during pregnancy?

Insomnia and sleeplessness are very common among expectant mothers. As your body goes through hormonal and physical changes over the nine months of pregnancy, Christopher Carls, DO, with The Christ Hospital Physicians – Obstetrics & Gynecology says it's important to have upfront talks with your OB/GYN about getting quality sleep.

“I really like having these conversations with my patients. It often ends up being a fairly complex issue," Dr. Carls says. “A lot of times there are underlying things we can optimize, even if it's just sleep hygiene."

Starting with the basics of sleep hygiene

Everybody needs to sleep, but modern lifestyles create a lot of diversions that keep us from getting the right amount of shuteye. There's always a new binge-worthy show, someone texting, or an email from work that's nagging in the back of the mind.

Dr. Carls suggests getting back to the basics of healthy sleep hygiene so that the bedroom is a sanctuary free from everyday distractions – especially anything with an electronic screen attached.

“I always recommend against screens, bright lights, TV, phones, and computers that emit an ultraviolet frequency of light which can trick the brain into thinking its daytime when it's actually nighttime," Dr. Carls says.

Another way to protect your sleep sanctuary is to establish a wind-down routine. Then, only get into bed when you're truly ready to go to sleep.

“If you're not all the way wound down, try to find something else relaxing to do that will get you into that place where you're ready to go to sleep," Dr. Carls says. This can include reading a book (yes, the kind with actual paper and pages!) or taking a warm bath or shower to establish a sense of calm.

Baby on board: which way to lay?

If you're a belly sleeper, you know that baby bump is eventually going to have you looking for a different sleep position. “As we get into the mid-second trimester when uterine size becomes an issue in terms of which ways to lay, we typically recommend the left lateral position," Dr. Carls says.

So why lay on the left side instead laying on your back or even on your right side? It comes down to the anatomy of your blood vessels.

“The aorta and the major vein that returns blood to the heart are right behind the uterus, so if you're on your back that causes direct compression of that blood vessel," Dr. Carls explains. “We say left lateral because that big vein is on the right side."

It's hard to keep track of how you're laying when you're asleep, but there are some useful tools for encouraging positions that offer you extra support. “Pregnancy pillows are popular these days. There are even support pillows that have a hole for the pregnant belly to rest in to be flat on your belly. A lot of my third trimester moms' dream is sleeping on their belly." Dr. Carls says.

Restless legs syndrome during pregnancy

Studies have shown that up to one-third of women may experience restless legs syndrome (RLS) during pregnancy. RLS causes an itchy, burning sensation that usually eases up when you move your legs, but the nagging urge to keep moving can also keep you up at night.

The exact causes of RLS are not well known and could vary from woman to woman, but research suggests it could be tied to hormonal imbalances or dietary deficiencies. Your doctor may talk to you about adding a supplement or prescription medication to calm RLS.

Avoiding caffeine, good sleep hygiene, and massaging your legs before bed may help ease some of the symptoms at night. And staying active during the day may also help with RLS along with providing you with all the health benefits that come with exercise.

“We recommend 30 minutes a day, three to four days a week of low to moderate exercise like walking, running, or even working in the yard," Dr. Carls says. “When we're doing that during the day, we're generally more tired and ready for bed at night."

All those bathroom runs!

Doctors recommend getting in at least 64 ounces (a half-gallon) of water every day during pregnancy. As baby grows and presses down on your bladder, you're going to end up peeing a lot more often. Which could mean extra nighttime trips to the bathroom.

With some planning ahead, Dr. Carls says you can still get in the water you need while preserving your sleep time. “Maybe set a clock on how late you want to stop drinking water. Two or three hours before bed is probably optimal," Dr. Carls says.

Heartburn and acid reflux during pregnancy

Those hormonal and physical changes your body experiences during pregnancy can also lead to bouts of heartburn or acid reflux – especially heading into the third trimester.

“Be active in managing acid reflux because that can become a nighttime problem as you lay down," Dr. Carls says. “That lower part of the esophagus is much more open during pregnancy and allows stomach acid to come back up."

“If you're having difficulty sleeping because of heartburn, try to eat at least three hours before bed and don't immediately lay horizontal after you eat," Dr. Carls advises. It's also recommended to avoid spicy, fried, and acidic foods like citrus fruits.

Over-the-counter acid blocking medications can help treat the problem, but some can be very high in sodium.

Women with anxiety and depression during pregnancy have potential for sleep issues

Most women are familiar with the concept of postpartum depression​, but mood disorders like anxiety and depression during pregnancy can cross over into sleep in a very big way.

“A patient may say I haven't slept in a month. Well, that's not normal. Let's talk about it," Dr. Carls says. “I like troubleshooting this with my patients because oftentimes it's so multifactorial like a mood disorder."

“Once we work through some counseling or at least even knowing that anxiety is there, it ends up being a symptom of many other things," Dr. Carls says.

“A lot of times there are underlying things we can optimize, even if it's just sleep hygiene. Try some of the very basic things, but don't be afraid to talk to your doctor about what can we do to get you sleeping."

Seasonal allergies? Watch what medicines you take during pregnancy

Greater Cincinnati has a reputation for throwing everyone's allergies into a tizzy. Your tried-and-true cold and allergy medicine may not be the right choice during pregnancy if you also want to catch some Z's.

“Cold and flu medicines with phenylephrine (one of the active ingredients in Dayquil) promote a higher heart rate and slightly higher blood pressure that make you more activated, so stay away from daytime cold and flu medicines," Dr. Carls says.

Watch for signs of snoring or gasping for air while you sleep

You may not be aware that you're snoring at night, so pay attention if your bed partner says you are sawing some serious logs. Heavy snoring or waking up gasping for air could be a warning sign for conditions like obstructive sleep apnea.

“It's likely there's something underlying with the patient's anatomy that's predisposing them to have that, but pregnancy can make that worse," Dr. Carls says. “The belly is heavier. The lungs are slightly smaller in volume, and we gain extra fluid."

The extra weight and tissue during pregnancy can make it harder for air to properly flow through the head and neck area. “I've taken care of several patients in my career that suffer from obstructive sleep apnea that can benefit from a positive pressure system like a CPAP machine," Dr. Carls says.

Bottom line: Sleep is a serious subject for your pregnancy!

​You know your body best, so if something is feeling off with your sleep cycles while you're pregnant – have an open conversation with your OB/GYN or nurse midwife about it.

“You need sleep. We have things that are safe for you and your baby. Maybe it's just a small tweak or maybe there's something significant," Dr. Carls says.

Are you looking for an OB/GYN or nurse midwife to partner with during your pregnancy? Click or tap here to meet our providers with The Christ Hospital Physicians – Obstetrics & Gynecology, or call our new patient scheduling line at 513-585-3000.