Dear doctor, I am five months pregnant and have a nine-to-five job. However, I have been experiencing insomnia all night even when I feel exhausted. Sometimes I end up falling asleep at work. How can I beat insomnia and make my working hours more productive? Iribagiza

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Dear Iribagiza,

Pregnancy is a condition where balance of hormones changes in the body, causing several physical and emotional changes. This also includes changes in the food habits and also sleep pattern. Many women experience excess somnolence in early pregnancy and difficulty in getting sleep in later months.

There may be difficulty in falling asleep or staying asleep. As one does not get adequate sleep during the night, she is bound to feel drowsy in the day time, because the body needs seven to eight hours of sleep for sufficient relaxation.

There are multiple reasons for lacking sleep during pregnancy. Mental stress and apprehension about the forthcoming new addition to the family can disturb the sleep pattern. Traditionally, elder women in the family or neighbourhood give a long list of dos and don’ts for a pregnant woman. In this era, she also gathers a lot of information from the Internet and peer groups. Net result is that her mind is full of information, some factual, some on hearsay and experience, causing confusion and anxiety. This can result in insomnia.

As the pregnant uterus grows in size, it exerts pressure on the pelvic organs, including the urinary bladder. This causes frequency of urination which interferes with sleep. One is also more susceptible to urinary tract infection (UTI) during this period, causing frequency as well as urgency of urination, disturbing sleep in the process.

Pressure of the gravid uterus on the food pipe can cause heartburn which is aggravated by lying down. Nausea and or vomiting can make one feel sick and unable to sleep well. Pressure on the diaphragm causes shortness of breath as the pregnancy advances. In case of hypertension or cardiomyopathy developing during pregnancy, breathlessness can occur due to congestion of the lungs.

Abdominal discomfort and leg cramps are other causes that could make it difficult to sleep well. In addition, backache and heaviness of breasts are other factors that cause disturbed sleep. Insomnia can occur due to watching television till late in the night.

Diet and regular physical exercise are factors that can help one get sufficient sleep. One should take an adequate amount of fresh vegetables and fruits. Avoid a fatty and sugary diet and taking coffee in the evening. Drinking warm milk before bed helps in inducing sleep.

Avoid taking fluids in the late evening to avoid frequent urination in the night. Try to set a fixed sleep-wake routine. Go to bed at a fixed time every night. Switch off the TV or bright lights. Prayers, meditation or reading a good book before sleeping is useful. The sleep attire and bed clothing used should both be light and comfortable preferably made from cotton.

A word of caution here; never take a sleeping pill during pregnancy. Your lack of sleep will not harm the baby but sleeping pills can.