Expectant moms worry about the sleep deprivation they'll face once their bundle of joy arrives. But how about getting a solid night of sleep when you're still pregnant? No easy task, as many women discover soon after seeing those joyful two pink lines on a stick. "From the middle of my first trimester, I was waking up every few hours," says Melissa Halpern, of Brooklyn, New York. "Initially, it was constant peeing, then it was heartburn or leg cramps." But you don't have to spend nine months tossing and turning. Click to the following slides for tips on beating common pregnancy sleep stealers, trimester by trimester.
The Cause: Breasts become painful early on, thanks to skyrocketing estrogen and levels of hCG (human chorionic gonadotropin, the hormone produced by the placenta during pregnancy). While these hormones prep your breasts for milk production, they also make them much more sensitive. "And as the breasts grow, women who were tummy sleepers may find that this is now impossible because any pressure on the breasts is painful," says Barbara Dehn, R.N., author of Your Personal Guide to Pregnancy. "You may have to learn how to sleep in other positions, which can also lead to getting fewer winks."
Shut-Eye Solution: A hot shower just before bed can ease you into dreamland, and acetaminophen (e.g., Tylenol), which is safe during pregnancy, can alleviate soreness, says Kellie Flood-Shaffer, M.D., associate professor of obstetrics and gynecology at Texas Tech Health Sciences Center, in Lubbock, Texas. If it's difficult to sleep on your stomach and you can't get comfortable on your back, reposition your pillows: Sleeping on your side and using a body pillow might do the trick.
The Cause: "I felt like I had to pee all the time," says Milena Alberti, of New York City, mom to Sebastian, nearly 3, and David, 8 months. "I was up every three hours." Why does this happen? "First, your uterus is growing and pressing on your bladder," Dehn explains. Plus, you're in hormonal flux and your body is releasing increased amounts of progesterone, which relaxes smooth muscles, such as the bladder.
Shut-Eye Solution: Stop your fluid intake at least two hours before bed -- a lesson that Alberti quickly learned. Because hormones and space constrictions are to blame, there's little else you can do. The good news: Your need to pee constantly will temporarily subside in your second trimester.
The Cause: Once again, blame your fluctuating hormones, namely your skyrocketing progesterone in the first and second trimesters. It causes your blood vessels to dilate, leading to headaches, which in turn may lead to sleep loss, Dr. Flood-Shaffer says.
Shut-Eye Solutions: Acetaminophen is a safe fix, Dr. Flood-Shaffer advises. You can also apply a cool towel to your forehead. This will help the blood vessels contract while relaxing muscles and relieving the headache. And get rest when you can, if not at night, then by taking a catnap during the day; this will give your body a much-needed break from any fatigue-induced headaches, she explains.
The Cause: You're too big to sleep on your stomach, but you're told to avoid sleeping on your back. When you lie on your back, the weight of the uterus can compress the inferior vena cava, the vein that transports blood from your lower body to your heart. To compensate, your body works harder to pump blood to your heart; as a result, your blood pressure increases and the blood flow to the uterus slows down. This isn't good for you or the baby, which is why doctors recommend sleeping on your left side. What's the benefit? When you sleep this way, your uterus pushes forward (and thus alleviates pressure on your heart), ensuring that your baby will get plenty of blood and oxygen through the night.
Shut-Eye Solution: You don't have to sleep entirely on your side; with the help of a pillow, you can trick yourself into thinking you're sleeping in your favorite old position. While on your back, place a pillow underneath your right hip, Dr. Flood-Shaffer suggests, so your uterus will be tilted but your upper chest and back will be flat. This ensures proper blood flow and will help you doze off.
The Cause: You don't need to eat an Italian sub at warp speed to have heartburn while pregnant -- being pregnant is enough. And again, thank your growing uterus, which compresses the stomach and sends its contents shooting toward the esophagus -- ergo, reflux.
Shut-Eye Solution: Propping your upper body with pillows can prevent acid from moving upward. You should also avoid carbonated drinks, eating before bedtime, and indulging in big meals, even if your cravings tell you otherwise. If you take all these precautions and still experience heartburn, you might want to seek some relief from an over-the-counter product. "At this point in pregnancy, you can use Tagamet, Prilosec, antacids, or Mylanta to ease discomfort," Dr. Flood-Shaffer says. But to be on the safe side, contact your ob-gyn to get her go-ahead.
The Cause: "As the baby settles into a head-down position for delivery, his head will press against the bladder, and many women get up four to six times each night to urinate," Dehn says. (Tell us something we don't already know!) In addition, your kidneys are now working overtime, filtering your blood and producing urine at nearly double the rate than before pregnancy, which can lead to more frequent urination.
Shut-Eye Solution: As in the first trimester, avoid drinking anything a few hours before you hit the sack, Dr. Flood-Shaffer says. Just be sure to compensate for this by getting more water throughout the day. When you do urinate, lean slightly forward to fully empty your bladder. And don't hold in your pee: It can lead to a urinary tract infection -- not what you need at this stage of your pregnancy!
The Cause: Doctors speculate that these are related to the additional pressure on your legs from the extra weight you're carrying, slowed blood circulation during pregnancy, or the pressure the fetus places on the nerves that travel to your legs. Certain mineral deficiencies might also cause calf cramps. "Your muscles utilize magnesium, potassium, and calcium to contract, and an imbalance to these electrolytes causes muscle cramps," Dr. Flood-Shaffer says. "When the baby begins to calcify its bones in the third trimester, it uses its mother's calcium stores. So if the mom doesn't get enough calcium in her diet, she'll deplete her stores and get muscle cramps, which usually occur at night."
Shut-Eye Solution: Flexing your foot when a cramp strikes may help. Another tip: Stretch out your calves before bedtime. For a good stretch, stand on a step and drop the heel of one foot off the back, then switch after 30 seconds. Also, get regular prenatal exercise: Take brisk walks or pop in an exercise video at home. You'll keep your blood circulating, which can reduce the frequency and intensity of the cramps. Be sure there's plenty of calcium, magnesium, and potassium in your diet. Some nutritional powerhouses that contain all three minerals are spinach, yogurt, and salmon (for calcium, get canned salmon with soft, edible bones). Finally, keep water handy: Dehydration can cause an electrolyte imbalance, leading to muscle cramps.
The Cause: Up to 20 percent of all expecting women experience a tingling or burning sensation in their legs that creates an urge to move their lower limbs, says Grace Pien, M.D., a sleep expert at the University of Pennsylvania Health System Division of Sleep Medicine. But what causes the twitchiness? "We suspect that RLS during pregnancy is related to anemia, and it's debated by many whether this is because of an iron deficiency or a folate deficiency," she says.
Shut-Eye Solution: Try boosting your iron and folate intake beyond what your prenatal vitamins offer, but seek the advice of your ob-gyn first, Dr. Pien recommends. Apply a heating pad for 15 to 20 minutes to help ease the compulsion to move your legs. The good news: Within a few weeks of giving birth, you'll see your RLS disappear entirely.
The Cause: For most women, snoring is nothing more than an annoying side effect of pregnancy. But for some, the problem is more serious: They may go on to develop obstructive sleep apnea, a disorder in which you stop breathing for brief periods of time, says Dr. Pien.
If your husband has complained that you sound like a buzz saw at night, ask him to pay attention to your breathing. If he discovers that you're not breathing steadily, speak with your doctor immediately. The lack of oxygen can disrupt your sleep, but, more critically, it can stunt your unborn baby's growth. Sleep apnea has also been linked to high blood pressure and cardiovascular disorders, not to mention fatigue. Women who suffer from the disorder rarely feel well rested, as their snorts or gasps wake them up as many as 100 times a night, Dr. Pien says.
Shut-Eye Solution: If you're diagnosed with sleep apnea, you may need a device, a continuous positive airway pressure mask, that is placed over your mouth and nose to help prevent breathlessness, and, in turn, help you sleep better.