Insomnia during pregnancy is often related to the other various symptoms, aches, pains and worries commonly experienced in pregnancy.

While insomnia is extremely frustrating at night, if you are managing well during the day, you are probably getting enough sleep and should not worry. Your negative moods, fatigue, poor energy, and overall absence of wellness will let you know when this lack of sleep is taking its toll. Stress reduction and maintaining internal calm are crucial for health and well-being as is getting enough sleep, which is just as important, if not more so, than diet and exercise, so make them among your top priorities.

Please consult your integrative practitioner if this has been a chronic problem for you even before pregnancy, as you may suffer from clinical depression or anxiety, hyperthyroidism, chronic high levels of stress, or other health problems that should be evaluated.

Once more serious conditions have been ruled out, try the suggestions below. Also, consider seeking out a classical homeopath, acupuncturist, hypnotherapist, holistic counselor, or breathwork practitioner who can offer wonderfully effective alternatives to dealing with this problem.

Natural Insomnia Prevention

Many foods, drinks and drugs contain stimulating substances that disturb sleep. For example, coffee, tea, chocolate, and soda that contain caffeine, and certain cold, asthma, allergy, pain and psychiatric medications can all keep you awake. Avoid these whenever possible, especially after 4 pm, and ask your provider about alternative prescriptions. Avoid alcohol as well. Aside from its harmful effect on your unborn baby, it may help you fall asleep initially, but can disrupt your sleep cycle, causing early or frequent waking during the night.

Four to five hours before bedtime, depending on the severity of your trouble falling or staying asleep, avoid the following:

• Large meals

• Unhealthy vegetable oils, processed and refined foods, gluten and cane sugar

• Drinking lots of fluids

• Vigorous exercise

• Stimulating or upsetting books, movies, or news reports

• Performing busy work or frustrating tasks

• Intense conversations or arguments

• Electronic media

These activities rev up your nervous system, cause inflammation and blood sugar imbalances, make you feel tense, agitated or excited, and thus interfere with sleep. You do need to stay well hydrated by drinking at least 64 ounces of filtered, spring or well water per day between meals (at least 20-30 minutes before or 2 hours after eating), but try to do get most of your hydration during the daytime.

Do not go to bed hungry. Eat high quality protein and fat at dinner, and a bedtime snack before bed like a bowl of gluten free oatmeal with organic nut milk, avocado and egg, apple and nut butter, or a yummy nutrient dense nut/seed crunch or bar.

Shorten your daytime nap to no more than 20 minutes, or awaken earlier if this is the culprit.

Engage in moderate exercise for 30 minutes 5 days per week during the morning or afternoon (such as brisk walking, dancing, swimming, cycling, low impact aerobics). Regular aerobic activity has many health benefits, as well as helping you feel more energized during the day and sleep better at night.

Honor your body’s circadian rhythms, getting up and going to bed around the same time each day. Make sure you get plenty of fresh air and adequate exposure to sunlight. Weather permitting, try to spend at least 30 minutes outside with nature in the early morning or late afternoon sun each day. At night, keep lights dim. This is why people sleep better when camping - so if you need a reset, spend a week vacation camping!

In the evening, avoid prolonged exposure to blue and artificial bright light. Block out blue light with special glasses and if you must be online, download the free app to minimize blue light on your devices. Ideally, your rooms should be lit by no more than a reading light and amber colored fire like light like calming Himalayan salt lamps. During the day, get out in bright natural daytime light. If you can not go outside, use 150-200 watt incandescent bulbs or full spectrum fluorescent lamps that supply 2,500 or more lux (equivalent to 150-200 watts.) Keep the light within 3 feet of where you are sitting.

Minimize the time you are on the computer and smartphone, especially in the evening. Remove them from your bedroom, as you create an environment within it that is a calming haven for rest and sleep. For help breaking addiction to the smartphone, do read How to Break Up With Your Phone: The 30-Day Plan to Take Back Your Life by Catherine Price. Put anti electromagnetic radiation devices, crystals, including those made from genuine shungite or black tourmaline in your bedroom to reduce EMF exposure. Sleep with an EMR protective blanket. Explore additional resources for more information and other practical suggestions to mitigate EMR exposure, especially in pregnancy.

If you like making lists of what you need to do or buy at the store, do your to do lists during the day. The day is a better time to journal your feelings, or even better, move them through your body with music. 

PREVENTING INSOMNIA THROUGH STRESS REDUCTION

Life is stressful and always has been, and eliminating all outside stress is not an option. But, you can learn to activate your own relaxation response and quiet your nervous system with breath awareness and relaxation techniques, thought control, and cutting down on the added burdens in your life. While easier said than done, this is an important time to be clear about your priorities. If you feel overstressed, which is interfering with your ability to sleep at night and then function during the day, your body is sending you a warning signal to rearrange your schedule to protect the health of you and your growing baby. Don’t be afraid to ask family and friends to help with chores or child care, or even better, treat yourself to hired help and healthy take-out meals. 

Before going to bed at night, as well as before rising in the morning, periodically throughout the day, in transit, while waiting, and whenever you feel stressed, triggered down or upset, practice the following deep abdominal breathing exercise: 

1. Exhale slowly through your mouth with an audible sigh, while consciously relaxing any muscle tension.

2. Inhale slowly through your nose for a count of 4. Imagine a pump expanding your abdomen, and lower back, down to your pelvic floor, causing you to inhale. Allow ribs to expand with air, then inhale air into your upper chest towards your collarbone and shoulders.

3. Exhale slowly through your mouth for a count of 4. Release effortlessly, in the same order you inhaled, returning to baseline, your abdomen, ribs, then upper chest. With each exhalation, try to let go and relax even more.

4. Repeat this cycle a total of 8 times or at least a few minutes. You may need to play with counts, using a count of 3 or maybe even 5 or 6. But keep the counts of inhale the same as the counts of exhale.  

5. Then extend, or double the exhale. For example, if you are inhaling to a count or 3, exhale to a count of 6, or if you are inhaling to a count of 4, exhale to a count of 6. And repeat this cycle for several minutes.

These are wonderful natural tranquilizers, especially if you do it often. While breathing be mindful, and just observe and release any muscle tension working your way slowly from head to toe, and then notice what you are currently seeing, hearing, smelling, feeling, tasting. Just watch without judgment…this brings you to the present and is deliciously relaxing. When doing this, sit up straight but comfortably, with your eyes closed, internally keeping your gaze between your eyes, or open and focused on a nonmoving distant object or place like where the floor meets the wall. This is meditation, combined with the benefits of breathwork.

Another great breathing technique that disengages your conscious attention from thought and relaxes the nervous system, and can be done any time (like when traveling, waiting in line, resting, bathing, or on the toilet) is box breathing. With this exercise, you add a timed pause between each inhalation and exhalation. 

1. Set a timer for 5-10 minutes.  

2. Inhale deeply into your belly as above for a count of 3.

3. Hold without tension for a count of 6.

4. Exhale to a count of 6 while consciously relaxing more and more.

5. Hold again without tension for a count of 3. 

6. Repeat until your timer chimes. You may love this so much you will want to do it for longer.

One more breathing exercise to try is forced exhalation: 

1. After a normal breath, try squeezing as much air out as possible using your intercostal muscles.

2. Next, allow the breath to come in naturally and deeply, but automatically.

3. Repeat the cycle for several minutes.

These techniques are simple to do, health enhancing, totally safe and without side effects.

Try to stay away from things and people that agitate your mind and raise your internal tension, and instead surround yourself as much as possible with calm centered people, things, sounds and places that inspire, relax and restore you to inner peace and serenity. Make a conscious effort to work on increasing your own feelings of forgiveness, appreciation, love, joy, optimism and healing, while letting go of anger, resentment, envy, fear, sadness and negativity. Most importantly, make a conscious effort to be aware of anxiety provoking, tension causing thought patterns that are not serving you, and to stop them or shift your attention to something more positive and ultimately change your mental state.

You have the ability to change your attitude and reaction to life experiences to more health enhancing responses. For example, you can surrender to, and totally accept unpleasant events over which you have no power, or you can view them as a wake-up call - an opportunity for personal growth and redirection. 

You can always try to focus as much attention as possible on the present moment, literally without letting your thoughts wander into past or imagined future. For more information about this and other great ways to improve your health and well being, read a recent blog on Natural Remedies and Resources for Stress. While it is not only helpful to express your troubling feelings to a sympathetic ear, it is also essential to develop the skills of self mastery and empowerment.

Reduce inner tension and increase feelings of calm by taking a “healing interval” for a few minutes several times per day to sit quietly with your eyes closed and think and do absolutely nothing, practicing slow deep breathing, meditation, QiGong, Tai Chi, yoga (especially Yin, prenatal, gentle and restorative), or progressive muscle relaxation techniques (yoga nidra).

A popular relaxation technique is to tense your whole body and then relax each muscle one by one, starting at your head and face, then moving downward, ending up visualizing yourself completely calm, relaxed, heavy and limp like a rag doll or your napping dog or cat.

Consider making yoga, breath awareness, conscious breathwork and meditation a regular part of your daily routine, even if just for 20-30 minutes each morning or evening, in addition to the “healing intervals” throughout your day. 

Focus on the moment and what all your senses are telling you, just watching feelings and thoughts come and go without judgement as if they were flowing with the river. Locate the nearest Zen Center (Zen is NOT a religion and does not conflict with any religion), read Marc Lesser’s Book Accomplishing More by Doing Less, or any book by Thich Nhat Hanh, Pema Chodron, or Shunryu Suzuki to learn the basics of mediation and Zen practice.

SLEEP HYGIENE

Develop a regular bedtime relaxation routine such as:

• Gentle stretching

• Yin, gentle, or restorative yoga - like spending 10 minutes laying down with your legs resting up the wall

• Meditation 

• Gentle breathing exercises

• Soaking in a very warm bath with Epsom Salts and 5-10 drops of your favorite essential oil. 

• Reading from a boring, soothing or light drama book before bed

• Recite a calming mantra if needed as you close your eyes

• Listen to effective audio programs that actually train your body to sleep, using sleep phones.

• If noise or lights are keeping you awake, use noise canceling headphones and eye mask combined and/or install black out curtains.

You can create a regular winding down and soothing ritual at night before going to bed, combining a few calming and nurturing techniques like preparing a cup of relaxing Chamomile, Lavender or Lemon Balm tea, turning on some soft tranquil music and lighting a candle, while you take a warm bath with a few rose petals or lavender. Follow this by 5-15 minutes of various restorative yoga poses in silence, eyes covered with a lavender infused eye pillow. Don’t forget to pee just before bed. Read a little inspiration and settle into sleep.

High calcium/magnesium and soothing herbs can help, which include nettle, red raspberry leaf, oat straw, and dandelion greens prepared as infusions. To make an infusion:

1. Combine a handful each of nettle, red raspberry leaf and dandelion with a pinch of oat-straw.

2. Add mixture to 1 qt boiling water in a glass canning jar.

3. Cover and steep for 4-8 hours. 

4. Strain.

5. Add fresh lime or lemon juice, mint leaves or a dash of honey to taste (optional).

6. Drink 1-4 cups daily.

You can make a lovely calming infusion for your evening tea, which is more effective than the ready made teas, by mixing a pinch of each dried herb: chamomile, lavender and lemon balm. Add to 1 cup boiling water, steep covered in a glass mason jar for 15-20 minutes, strain, add lemon, fresh mint or honey to taste, and drink. If you are concerned about drinking too much before going to sleep and needing to get up to go to the bathroom, use capsules or tinctures instead.

Experiment with essential oils, alone or in combination in your bath with Epsom Salts, and see what will best help you sleep. Add 5-10 drops of the essential oils of Chamomile, Vanilla, Lavender, Rose, Geranium, Frankincense, Jasmine, Marjoram, Basil, Citrus, Sandalwood, and/or Neroli to your evening bath, in your diffuser and onto your pillow if needed. Soak for awhile in the bath, and practice your mindfulness. Let the feel, sound and smell of the water and essential oils ease your tension and consciously allow your muscles to release and relax.

Make sure your mattress is comfortable, you have enough pillows and blankets, the noise is minimum, and the light, temperature and ventilation are adjusted to your comfort level. Use natural bedding to minimize toxic exposure that disrupts sleep. Try sleeping on Earthing Grounding sheets. Many have had much success with using a white noise machine, Dream Pad pillow or pillow speaker, which creates soothing sounds that helps promote sleep. Others like the Dream Pad Pillow or pillow speaker, or find that earplugs and an eye mask help to cut out noise and light they can not control. Create a restful environment in your bedroom and keep all of the things that cause you stress (like computer, smartphone, to do lists, unpaid bills, unfinished work or projects) in other rooms. Get a simple alarm clock without light instead of using your phone, and keep it out of your easy reach or vision while in bed. Or use a Sunrise alarm clock with sunset nightlight.

Many sleep better when the room temperature is cool (in the mid 60s degrees) and they are not hot, by adjusting the thermostat, open a window, use a cooling mattress pad topper or Chilipad. Be sure to make your bedroom as dark as possible.

Ideally, go to bed not much later than 10:00 or 11:00 PM and get up at a consistent time each day. Try not to sleep in more than an hour, even on weekends, to keep within your circadian rhythm. The later you go to bed, the more trouble you will have sleeping, even though you are exhausted.

SLEEP SUPPLEMENTS

Reputable brands of the supplements and remedies I recommend include Innate Response, Wish Garden, Gaia, Herb Pharm, Wise Woman Herbals, Pure Encapsulations and Eclectic Institute, or any of those in my online holistic apothecary.

Take 500-1000 mg of calcium and/or 500-1000 mg of magnesium before sleep. Natural Calm is a wonderful powdered liquid magnesium. It is important to understand that individual needs will vary. Some individuals will need more Natural Calm than others. Start with 1 teaspoon daily, and increase your dose up to the point of loose stools. This will be the dose you will need to maintain for regular use. The final amount taken could range anywhere from a 1/4 teaspoon to 3-4 teaspoons. This could be taken all at once or split into 2-3 smaller doses throughout the day. If you get diarrhea, it is a sign that you used too high a dose, and you need to cut it back to the point where the diarrhea does not reappear. Also, some feel better using an equal ratio of calcium to magnesium, others do best taking double the amount of calcium than magnesium, or vice versa.

Try homeopathic Calms Forte if your symptoms are related to stress, refer to books like Homeopathy For Pregnancy, Birth and Your Baby’s First Year by Miranda Castro for a remedy specific to your unique symptoms, or consult with a classical homeopath for more personal guidance. Get a flower essence kit and look for a Bach Flower remedy that fits your particular situation, such as White Chestnut if persistent unwanted thoughts or mental arguments are preventing sleep.

Also, you can try fresh creamy milky oat tops. Take 1 dropperful of the tincture of fresh creamy milky oat tops in its most potent form 1-2 times daily, especially effective when taken over time. 

Add a TBS of all natural grass-fed gelatin Collagen Hydrolysate in a little apple sauce or gluten free oatmeal in the evening, or about an hour before bed.

Other herbs helpful for insomnia for occasional use only are listed below. Try each of the natural remedies for a few nights to see what is most effective. If it is going to help, its benefits should show up within a day or two (unless otherwise specified).

• If insomnia is related to feelings of internal stress and anxiety, try Passionflower. You can take capsules with at least 0.8% flavonoids, as directed on bottle 2-3 times per day as needed, or 1-2 dropperfuls of tincture 1-2 times before bed (after the first trimester).

• Motherwort, ½ - 1 dropperful of the tincture in water or juice no more than every 2 hours, or up to 3 times per day in a period of more acute stress.

• Skullcap, ½ dropperful twice before bedtime with a 15 minute interval.

• Chamomile tincture, 1-2 dropperfuls before bed. 

• Lemon Balm in doses 300 mg early evening and before bed. This can be quite sedating, so take precautions, or try lower doses in effective combination formulas.

• St. John’s Wort, 1 dropperful of tincture or 300-600 mg of capsules at bedtime.

• Valerian, 2 capsules of standardized extract or one dropperful of the tincture in juice to help with taste a half an hour before you go to bed..

• CBD from hemp oil. This is the new rage, as it is gently calming, relieves anxiety and helps with sleep without the potential risks of the THC component of cannabis on the developing fetus. Results from anecdotal evidence and preliminary research, although sparse (as is common with most natural remedies in pregnancy), are promising. Make sure it is absolutely pure, and from a reputable source who can recommend proper dosing or from pharmacies licensed to dispense it. It is usually taken as several drops under the tongue every hour or so in the evening a few hours before bed.

When not pregnant, you can try the following and see what works best for you:

• Encapsulated Lavender oil - 1-2 80 mg capsules an hour before sleep, is as effective as benzodiazepine medications.

• Hops - If your sleeplessness is related to muscle tension or poor quality, broken light sleep from feeling stressed. Take 2 capsules of freeze dried extract of Hops at bedtime or a dropperful of tincture twice, ½ hour apart, starting an hour before bed for a nice deep sleep. 

• Ashwagandha - If you feel burned out, overstressed, exhausted but too wired to sleep, dissolve 1-2 tsp of the powder in your smoothie, tea or warm milk for 5-10 minutes 2-3 times per day, or take 2-3 dropperfuls of the tincture twice daily and before sleep, or 2-5 grams of the capsules daily in divided doses. 

• Rhodiola - As a tonic herb, take 100-200 mg twice daily (an extract standardized to 2-3% rosavins and 0.8-1% salidrosides). This usually improves anxiety and sleep, but needs to be taken more regularly. Obviously stop it if it is too stimulating and worsens insomnia.

• Magnolia - 200-400 mg an hour before sleep.

• Reishi mushrooms - 1 gram (2 capsules) an hour before bed.

• Kava Kava - A few drops up to a dropperfuls of the tincture or 150 -450 mg of the encapsulated liquid capsules before bed can be taken for occasional short term use only. Do not use if you are taking any substance including alcohol or medications that affect the liver, or you have any liver issues. This is one of my favorite herbs for anxiety and/or insomnia from inner stress and is usually well tolerated and very effective.

• California Poppy - Also for periodic use only, take 1-2 dropperfuls of the tincture before bed.

• Melatonin - Best for jet lag and after working the night shift, take under the tongue before bedtime starting at 2.5 mg and increasing up to 5 mg if needed.

Another helpful approach is using natural amino acid supplements:

•  5-HTP (hydroxytryptophan), 50-150 mg before going to sleep or up to 100-300 mg 2-3 times daily if anxious.

• L-theanine, 100-200 mg twice daily at lunch and bedtime is also very calming.

• GABA, up to 500 -700 mg, depending on how much you need to get to sleep.

For more information on using amino acids and increasing them naturally in your diet, read The Mood Cure by Julia Ross. Also read The Chemistry of Calm and The Chemistry of Joy by Dr. Henry Emmons for a more detailed and thorough information on the supplements, as well as wonderful suggestions for what really is most effective in the long term: self-relaxation and visualization exercises to deal with stress, quiet the mind, and find a stronger sense of long lasting true happiness.

DURING TIMES OF INSOMNIA

When sleeplessness strikes, don’t worry or fight it. Instead, try forcing yourself to stay awake with your eyes open rather than fall asleep, and simply lie there and rest. You may suddenly find yourself waking up in the morning. If you are still up after 30 minutes, turn the light on and read, listen to soothing music, a podcast or a radio talk show, fold laundry or do some other repetitive sedating chore, and then try again only when you start to feel sleepy.

To break an insomnia pattern, set a time 1-2 hours after your usual bedtime and force yourself not to go to bed until then. You’ll probably worry more about how to stay awake that long than about your inability to fall asleep, and you’ll be tired the next day, which should help you fall asleep easier the following night. Each night, move your “later bedtime” 15 minutes earlier until you’ve forgotten about your insomnia altogether. 

If you are having difficulty stopping all the worrisome and anxiety provoking thoughts, write them down with an action plan to deal with them in the morning. Now is the time to get out of your mind and focus on your breathing, practice your muscle relaxation techniques, visualization exercises or meditation and use your skills of self mastery.

Ideally, it is best to avoid sleeping pills on a regular basis, as some can have negative side effects for you and your baby, and they can lead to addiction. Please let your practitioner know if none of the suggestions mentioned above help and you are suffering and at your wits end, as they can prescribe relatively safe medications for occasional use.

If you need more personal guidance, schedule a consultation with me.