We all know that pregnancy can be exhausting, so why is it so many pregnant women have trouble sleeping? Well, there are several reasons why they can’t get that much-coveted full night of sleep, and more importantly, there are several things you can suggest as her Doula to help out.

Let’s start with why she can’t sleep
A lot of these seem very obvious to us, but if you ask the mother why she is having trouble sleeping she might not know exactly why. She may be able to name a chief complaint or two, but it’s often a combination of factors that are keeping her from getting good sleep.

Understanding sleep hygiene
When you are talking about lack of sleep the best place to start is with what doctors call sleep hygiene. If you’re not familiar with the term, sleep hygiene refers to the habits and practices that are conducive to sleeping well on a regular basis.

People that are not pregnant will have trouble sleeping if they fail to practice good sleep hygiene and being pregnant can definitely add some new variables to the equation. Before we get into the specific issues of pregnancy and sleep we are going to review basic sleep hygiene. If YOU have trouble sleeping, pay attention! This part applies to everyone.

There are four basic areas of concern when it comes to sleep hygiene:

The Sleep Schedule
This means going to sleep and waking up more or less around the same time each day and not skipping sleep to binge-watch TV shows. If a change in sleep patterns is required for work, it should be done gradually.

The Nightly Routine
This means following a pattern of behavior before going to bed. Spend some time winding down, dim the lights, read a book, brush the teeth, etc. When you do the same things every night before bed it conditions you so that doing them sends your brain subconscious messages that it’s time to go to sleep.

Healthy Daily Habits
This includes getting exposure to sunlight, which is critical for maintaining the circadian rhythm, getting some exercise, not eating late in the evening, and watching the caffeine intake (which of course, a pregnant woman should be doing anyway!)

Optimizing the Bedroom for sleep
This means making sure your bed is ready to receive you (for some of us that means it was made in the morning, for others, it could mean that the piles of clean laundry have been shoved off so you have room to crawl in!) Make sure the temperature is comfortable, the bed and pillow have the right softness/firmness for you and the amount of light and noise getting in the room is tolerable.

Those four areas are the key components of sleep hygiene. If you have trouble getting to sleep or staying asleep, or if you don’t feel rested even after a night of sleep you should seriously examine these areas of your life and make some positive changes.

As for our pregnant clients, it’s pretty easy to see how their changing condition can throw these areas out of whack. Here are some common examples of things that keep our clients from getting good sleep:

1. Frequent Urination
Pregnant moms have to pee. A lot. This is mostly due to the extra blood they are producing which is dramatically increasing the waste fluids their kidneys are putting out, but it also doesn’t help that junior is using her bladder as a bean bag chair. So getting up to go to the bathroom several times a night can be a reality for many mothers.

Staying hydrated is critical for mom, but if she can get her drinks in earlier in the day she will be better off at night. She can also make sure that the trip to the bathroom at night is lit with dim-relaxing light, like a night-light so she isn’t jarred awake by bright lights.

2. Indigestion
Dyspepsia, or as it is commonly known, indigestion, is another frequent complaint of pregnant moms. This can keep them up at night, especially if it is accompanied by excessive gas or heartburn. The best way to keep this at bay is by limiting food intake after 8 pm, to reduce the amount of churning the stomach is going to be doing while she is laying down.

3. Sleeping during the day
The body of a new mother is working overtime, so it makes sense that she would want to take naps during the day. There’s certainly nothing wrong with that, in fact, it’s good, but she shouldn’t overdo it. Let her know that if she is going to nap, she should try doing it before 3 in the afternoon if she wants to sleep at night.

4. Body aches and discomfort
Sometimes it’s just hard for a pregnant woman to get comfortable. After all, she has had her entire life up to this point to develop sleeping positions that are contoured to her body, and now, suddenly, that body shape has been radically altered. So she tries to compensate with body pillows and pillows wedged between her knees, under her belly, behind the small of her back, etc, and sometimes it works. Sometimes it doesn’t. Of course, there are often other factors as well. Roughly one in four pregnant women develop Restless Leg Syndrome [1] and some have swollen nasal passages leading to snoring and even Sleep Apnea.

She should talk to her doctor if she thinks she might have Restless Leg Syndrome, Sleep Apnea, or another medical condition. If the issue is just getting comfortable, it’s a process of trial and error to find the right combination of pillows and positioning.

5. The Baby is very active at night
This is a very common complaint among pregnant mothers. They say that the baby is far more active at night when the mother is trying to sleep. This is actually very normal and healthy-even though it might interfere with the mother’s sleeping. If it is keeping her awake, it might be because the baby’s motion is causing her concern. You can help her adjust her thinking by sharing this information with her.

The mother is busy moving during the day, and that motion “rocks” the baby to sleep. You may have noticed that many babies, young children (and some adults) fall asleep very easily in a moving vehicle-it’s the same effect. So naturally, since the baby is being “rocked to sleep” all day long when the mother is actively moving around when mom lies down at night to sleep the baby is wide awake! So let your client know that it’s perfectly normal and healthy for the baby to be active at night, and instead of worrying about the increased activity, she should try to be reassured by it. If she takes that to heart, the baby’s motions might just help her go to sleep!

6. General anxiety
Life can be full of worries, and pregnancy doesn’t make them go away. In fact, it can bring new ones along with the joy and expectation that accompany it. If excessive worrying is keeping the mother awake there are a few things she can try that are known to be very helpful.

She can make a to-do list for the next day before going to bed. While that might sound like it would add stress, it really helps. Once it is written down, she can stop thinking about it. It’s there, on the list, and it will be taken care of tomorrow. No need to think about it anymore.

Another tried and true sleep inducer is reading. It should be a book or a magazine, not an online article (screen light is stimulating), and it should be lighthearted pleasure reading. Nothing too exciting or intense, and if possible, not pregnancy or baby-related! A pleasant diversion is what is needed, not an exciting page-turner or an aggravating piece of political punditry.

7. Cramps!
The mother might be experiencing cramps in her legs and feet at night. This is very common and is why we train our Doulas to do the foot exercises with the mother when they do their home visits. Frequently stretching the feet and calves throughout the day can actually help to prevent this, as can staying hydrated.

She can also ask her partner to massage her feet and calves before going to bed.

8. Limit screen time
Let the mother know that the cellphone has only one function after bedtime, and that’s to communicate during an emergency. The worst thing to do is to scroll social media accounts while trying to go to sleep. Even reading helpful pregnancy blogs should be avoided at night time. Staring at a screen wakes the brain up, which is of course the opposite of what she should be trying to do.

9. Get exposed to sunlight during the day
This doesn’t mean tanning, or even being outside. The human brain has a small peas-sized structure called the pineal gland that is involved in the production of melatonin, a wonderful little hormone that regulates the sleep-wake cycle. Amazingly, this gland reacts to sunlight viewed by the eyes, just having the blinds/curtains open during the day helps it regulate your sleep. So make sure your client is at least seeing some sunlight through her windows if she is not getting out often.

10. Get out of bed when not sleeping
Most doctors agree that if a person is in bed but can’t fall asleep, the best thing to do is to get out of bed and do something boring. Wash and fold laundry, do the dishes, organize the cans in the pantry-whatever humdrum boring activity that needs to be done. She should avoid anything stimulating, like watching TV, getting caught up on “paperwork” playing sudoku, etc. The reasoning behind this is that according to doctors when you lay in bed and can’t sleep you are just conditioning your brain to accept laying in bed awake-and that’s not good sleep hygiene! So tell her that if she can’t sleep, get out of bed, take care of some boring chores that need to be done, and then try again in 30-40 minutes or when she finally feels her eyes start to get heavy.



[1] Restless legs syndrome and pregnancy: A review