Why do many women feel so tired throughout pregnancy? Pregnancy is a time of joy and excitement for most women, but it also means coping with daytime sleepiness and a wide range of new sleep issues. Changing hormone levels are responsible for fatigue and sleep problems during pregnancy. Rising progesterone levels contribute to excessive daytime sleepiness, especially in the first trimester, and many women experience insomnia due to emotions and anxiety about labor and delivery, balancing motherhood and work, or their changing relationship with their partner. During the second trimester, with nausea subsiding and hormones leveling off, many women may find relief and more rest. Experts encourage expecting mothers to enjoy the second trimester, and continue to get as much sleep as possible instead of packing in more activities. Pregnant women can try sleeping on their side with their knees and hips bent or using pillows to alleviate lower back pressure. If heartburn becomes a problem at night, sleeping with the head elevated on pillows and sticking to bland foods during the day may help. The third trimester is the most sleep challenged stage of pregnancy. With increased frequency of urination, inability to get comfortable and exhaustion from trying to keep up with the demands of their normal schedules, some women find themselves struggling to stay awake. Back pain, muscle aches, and general discomfort generally mark the third trimester as the body prepares for birth. One study showed by the end of pregnancy 97.3% of the women in the study were waking at night – an average of 3.11 times each night. Snoring, leg cramps and restless legs syndrome symptoms are also common. Poor sleep can affect labor and delivery. Researchers from the University of California at San Francisco recently found that women who slept fewer than 6 hours per night had longer labors and were 4.5 times more likely to have cesarean deliveries. Based on these findings, the researchers recommend that doctors discuss both sleep quantity and sleep quality with their pregnant patients as part of basic prenatal care and stress the importance of “sleeping for two”.