Having trouble sleeping? Here are some ideas to get better rest in pregnancy

Sep 13

Many women have difficulty falling asleep at night or report they wake repeatedly and have difficulty going back to sleep. This is all too common during pregnancy due to the growing baby, fetal movements, restless leg syndrome, heartburn, increased stress and anxiety, and frequent need to urinate. Sleeping less than 6 hours per night is associated with high blood pressure, depression, and preterm birth. We want to help you get a good nights sleep for your health and your baby’s health. This handout includes some suggestions for how to cope with insomnia and lifestyle recommendations and natural remedies that may promote restful sleep.

Lifestyle Recommendations:

Regular exercise increases the body’s calcium utilization, which in turn helps with relaxation. Mild aerobic exercise three times per week, for at least 20 minutes each time, is ideal. Walking is one of the most beneficial types of exercise during pregnancy. Exercise during the day, not at night, or after dinner.
Try to drink the majority of your fluid intake before dinner and not right before bed so that it is less likely that you will need to get up as many times during the night.
If you feel hunger is keeping you up at night, eat a snack before bed. If you wake up in the night, eat another snack.
Caffeine and caffeinated foods like coffee, chocolate, and soda can interfere with calcium absorption because they bind to calcium receptor sites.

The Bed Time Routine:

Begin slowing down in the evening. You cannot expect to push yourself all day and then have your body suddenly switch gears and fall asleep immediately at night.
Eat 3 hours or more before bedtime. The body does not tend to fall asleep easily when it is digesting food. Eating your last meal several hours before bed helps many women fall asleep. If you need a snack right before bed, eat something that is quickly digested and does not contain protein or carbs, like tangerine slices or grapes.
2-3 hours before bed, minimize using any technology with a screen or blue light. This may include your phone, iPad, or computer. Artificial light interferes with the production of melatonin. As the sun goes down, use fewer and fewer lights, and only yellow light, until you only have a lamp on at bed time.
Create a nightly routine for yourself where you de-stress and wind down by doing something you enjoy that quiets the mind. This may be reading a book, taking a bath (add some epsom salts and lavender essential oil) or working on a hand project, like crocheting or knitting. Some women find that they need to do all of these things in their routine to relax and have a good night sleep.
“Herbal baths help you sleep. Create a nightly bedtime ritual: a cup of your favorite relaxing bath, add 1 quart of lavender or chamomile infusion or 5 to 10 drops of lavender essential oil. Soak for a while, feeling the baby’s movements in your womb, and consciously relaxing your muscles. Let the water ease your tension away.” -Romm
Have a warm drink before bed. A cup of tea or warm milk with some cinnamon is very relaxing.
If you have trouble falling asleep because you have a lot on your mind, you may find it helpful to journal your concerns, fears, worries, or all of the things you are remembering you need to do the next day. Keep a journal or pad of paper beside your bed to write down a few words or decompress the days and weeks of events that are on your mind.
It is important that you realize you deserve to sleep and need that time for yourself. You do not need to be productive 24 hours per day. Do you tend to feel guilty for having a bed time routine and taking some time to yourself? Sleep is important to our health. We are worthy of sleep and the time and effort it takes to get a good night sleep, including a bed time routine.
Middle of the night insomnia may be from low blood sugar. Eat plenty of food at dinner, especially good fats, like butter or avocados
In addition to the above suggestions, you may find implementing one, or a few, of the following, to be helpful.

Comfort Measures:

If leg cramps keep you up, do some gentle stretches before bed, especially calf stretches.
Use lots of pillows, or a body pillow, to keep you comfortable at night.
“Rest Smart in positions that let your baby’s back settle in your “hammock.” While in bed or on the couch, always use a pillow between your knees and ankles. This prevents the leg hanging and pulling gently on the hips creating torsion (a twist) in the pelvic floor and hip joints. Supported ankles may help prevent a lose of balance in the pelvis, but aren’t enough to restore balance. Make a little pillow nest to lay nearly on your tummy. Pillows hold your weight off the baby. Use your breastfeeding pillow, curve your body pillow, or semi-inflate a swim doughnut to dip your belly in the “nest.” It’s so comfy. Sometimes you may want to just lay on either side. One hip is directly over the other, like a right angle. Don’t lean back, at least not for long. Leaning back without support can give you a muscle cramp. Change sides frequently for comfort and to help the uterus be a little more symmetrical. See a photo and a drawing of a resting position with the mom on her left side, in the photo, her back is at a “right angle” to the mattress, on the drawing she is in “Left Lean-over” and her belly is a bit towards the mattress on one side. Pillows under chest and pelvis and knee help the angle. Whoops, there is no pillow under the ankle! Add one.” -Gail Tully of Spinning Babies

Acupressure point bladder 10 on the back of the head on either side of the spine “is one of the significant acupressure and acupuncture points for sleep that relieves insomnia, stress and exhaustion that also aids in relaxing and clearing the head and bringing thoughts to rest. It is also useful for treating shoulder pain, back pain, nasal congestion, sore throat and skin problems. In order to stimulate this point curve your fingers and place the fingertips on the thick muscles on the back of the neck. Apply firm pressure on the muscles of 1 minute as you breathe deeply.”

A support person can apply 10 to 15 pounds of pressure with the heel of one hand to the sacrum for 2 to 3 minutes at bedtime to bring on relaxation and sleep.
An eye pillow can be filled with flaxseed and lavender and slept with to induce sleepiness.

Complementary Modalities:

If your insomnia is exacerbated by back, hip, or other pain, consider addressing that discomfort through massage or chiropractic adjustment. Studies show that massage and chiropractic care during pregnancy aid in reducing insomnia because they relieve chronic discomfort and promote relaxation and reduction of cortisol.

Studies on acupuncture have been shown to reduce insomnia significantly compared to control groups in pregnant women.

Food and Supplements:

Tart Cherry Juice contains high levels of tryptophan, the precursor to melatonin, which is a hormone needed at night to induce sleep. Drink 4-8oz. about 30 minutes before bed to promote sleep.

Adequate levels of calcium and magnesium help insomnia and also promote muscle relaxtion. A deficiency in calcium can induce anxiety, tension, and insomnia. If you experience insomnia, leg cramps, anxiety, constipation, frequent Braxton hicks, or cravings for chocolate, fatty foods, alcohol, or soda, I often recommend a calcium/magnesium supplement as these are often signs of calcium/magnesium deficiency. All of the supplement options listed below absorb well. You may choose based on preference of pills vs. liquid and your budget. Most of these supplements include vitamin D but it is a very small dose. If you are already taking a vitamin D supplement for low vitamin D, you do not need to discontinue it:

Calcium/Magnesium with D3 by Solgar
Natural Calm Plus Calcium by Natural Vitality
Liquid Calcium Magnesium Citrate Plus D3 by Bluebonnet
SuperCal Plus by Young Living (not SuperCal because it contains wintergreen and lemongrass essential oils)
MegaCal by Young Living

Another source of calcium/magnesium is NORA tea, an herbal blend of nettles, oatstraw, red raspberry leaf, and alfalfa. When herbs high in vitamins and minerals are steeped over night and made into an infusion, the nutrients are suspended in the water. When drunk, the infusion washes over the gut flora and the vitamins and minerals are easily absorbed. If you would like to try this herbal infusion to promote sleep and over all health, ask your midwife for more information.
B vitamin deficiency may cause insomnia. If you lack energy during the day and struggle with lack of sleep at night, you may benefit from taking more B vitamins. Take in morning, not at night. B-Right or Methyl B-12 by Jarrow are recommended.

Herbs:

Chamomile is a nervine that is calcium rich and aids digestion. Chamomile tea is safe to drink during pregnancy and can be drunk as desired.

Valerian root is an herbal sedative that is safe during pregnancy. The recommended dosage is 10 to 25 drops of tincture before bed time, up to twice or three times per day or 1 cup tea up to several cups/per day. Prolonged use and large doses is to be avoided because it can be addictive. Studies show valerian is just as effective in small doses as benzodiazepines in helping people fall asleep with no morning hangover.
Skullcap a gentle nerve tonic promotes restfulness, stress reduction, and sleep. It is best used in tincture form, about 15 drops, or half a dropperful, at a time, but it can be prepared as a tea or in infusions. You can take it up to four times a day during periods of acture stress or twice before bedtime with a fifteen-minute interval. Skullcap tincture can also be added to chamomile tea.
Relaxing Sleep Tincture by HerbPharm contains valerian, passionflower, hops, chamomile and catnip. These herbs are nervines and sedatives which calm the mind, relax muscles, and induce sleep. Dose is as recommended on the bottle. These herbs are generally regarded as safe during pregnancy but should not be taken in the first trimester.

Sleepy Nights for Pregnancy by Wish Garden is an herbal glycerine blend that contains Milky Oat tops, Linden leaf and flower, Passionflower aerials, Scullcap aerials, and Hawthorn berry. These herbs calm the mind so that your tired body can fall asleep. Sleepy Nights offers classic herbs to support natural sleep.

Homeopathics:

Aconite 30C is very effective in calming quiet nervous tension and fears or anxious episodes that may be preventing sleep.
Rescue Remedy Sleep spray or liquid melts. Not the gummies with melatonin

Essential oils:

Diffuse cedarwood, lavender, orange, frankincense, patchouli, white angelica, RC, peppermint, peace and calming, gentle baby, dream catcher, stress away, or surrender, or any combination that smells good to you.
Tranquil or Stress Away roll ons are helpful for a lot of women. Consider making your own roll on with a combination of oils. Cedarwood, lavender, and orange is a popular combination. Use on your feet and on your chest and neck.

Put a couple drops of lavender, peace and calming, frankincense, or other relaxing oils on your feet before bed.
If you have trouble with nightmares or vivid dreams, diffuse or apply topically, dream catcher, white angelica, orange, and/or vetiver. Lavender and cedarwood increase vivid dreams for some.

References:

A Midwife’s Handbook by Sinclair pg. 37-38

Beautiful Babies by Kristen Miachaelis pg. 138
The Natural Pregnancy Book by Aviva Romm, MD pg. 220-223
The Pregnancy Book by Sears and Sears pg. 286
Heart and Hands by Davis 5th ed. Pg. 52
Botanical Medicine for Women’s Health by Romm, et al. 1st ed. Pg. 392-394
Holistic Midwifery Vol. 1: Care During Pregnancy by Anne Frye pg. 1025
Gentle Babies 5th ed. By Debra Raybern pg. 67
Blue Light Has A Dark Side by Harvard Edu: https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side