Can’t sleep? If you’re like many pregnant women, insomnia may be leaving you wide-eyed and frustrated, even while you’ve never been more tired in your life. Not being able to fall asleep or stay asleep is a common issue for many people, and pregnancy adds another wrinkle to the sheet, so to speak. Here’s what you need to know:

Why does insomnia happen in pregnancy?

While you might think an inability to rest comfortably is solely a problem of later pregnancy stages, when your belly’s bulk interferes with…well, everything, the first twelve weeks can also be a sleepless minefield. One trigger is the surge of the hormone progesterone, which triggers sleepiness. Good, right? Except when it prompts you to doze off during the day—and you end up staring at the ceiling at night.

Other physical changes may make your usual restful routine more challenging, chiefly nausea (morning sickness is really a poor descriptor for many moms to be who feel green around the gills around the clock) and breast tenderness. As your baby grows, your uterus may press on and crowd your internal organs—like the bladder, which prompts more trips to the bathroom.

As your pregnancy progresses, sleep may be interrupted thanks to your growing girth literally getting in the way of a good night’s rest. You may also be experiencing aches and pains as your joints loosen and soften in preparation for birth. And let’s not forget your potentially burgeoning anxiety as you move through the weeks and months before baby arrives. Nighttime is prime time to worry about everything from how childbirth will play out to how you’ll bond with your baby to whether there’s lead paint lurking in the nursery (hint: probably not, but as long as you don’t try to remove it, you’re fine.)

What can you do about insomnia in pregnancy?

Fortunately, plenty. The same advice offered to help overcome sleep problems when you’re not pregnant can and should be applied now, such as enforcing regular sleep and wake times as much as possible; keeping your bedroom dark, quiet and on the cool side; avoiding caffeine either entirely or at least after the morning hours (something you should either eliminate or drastically limit while pregnant in any case); banning the blue light of most electronic screens from the bedroom (and avoiding stimulating screen-use for the hour or so before you hit the sack); and front-loading your (important!) hydration earlier in the day, tapering off water consumption a couple of hours before bed.

Other remedies specific to your pregnant state:

- Physical discomfort. Feather your “nest” with a body pillow and/or other pillows that help you prop, cushion, and support your form in whatever way makes you feel best. It’s smart to try to sleep on your left side for best blood flow to your baby. A pillow between your knees can help you keep your hips aligned, easing aches and pains.
- Heartburn. This common pregnancy complaint—when stomach acid backs up in your esophagus—can annoy you in particular when you lie down to sleep. One solution is to sleep with your upper body slightly elevated, on pillows, or with a prop under the head of your mattress. You should also avoid greasy, fried, and spicy foods, which are notorious heartburn triggers.
- Racing thoughts. Try meditation or guided imagery to help calm your mind when you want to wind down for sleep. Taking a childbirth class? Good! Many teach relaxation exercises to use during labor. Why not try them out now?
- Pre-parenthood anxiety. Talk! Discuss your hopes, dreams, and fears with your partner, your mother, your friend, your doctor, your online community. The more you air your worries, the less they’re likely to keep you up at night.

A final note: Though you may be tempted to pop a sleeping pill (either prescription or over-the-counter), doing so without a doctor’s okay may not be wise. A 2015 report in the American Journal of Obstetrics & Gynecology reported that some sleep aids (such as benzodiazepines), while not linked to birth defects, may be connected to pre-term birth or low-birthweight. The report also concluded that not enough research is available to assess their safety in pregnancy. If you have concerns about any medication you take, please talk to your doctor.