Tuesday morning on WMBI a caller asked if there was something safe that her daughter could take in her 7th month of pregnancy to help her sleep.  In the midst of a busy morning of calls, I gave her a kneejerk response by recommending the antihistamine diphenhydramine, the active ingredient in Benadryl.  This approach is safe, as diphenhydramine is a pregnancy category B medication (meaning that studies in humans have proven it to be generally safe for the unborn child).  However, I did not take the opportunity to discuss other natural remedies, as well as behavioral strategies for sleep in the later stages of pregnancy.  My response brought to light one of the problems in our health care system, namely, that the increasing demands of insurance companies and health care systems force doctors to rush through an office visit, and we often fall back to the old playbook of the most commonly recommended pharmaceutical solution, rather than exploring other ‘natural’ and behavioral remedies. I felt like I did the radio equivalent of a rushed office visit on Tuesday. Thankfully, I have the opportunity to follow up and explore those alternatives here.

Sleep patterns are clearly altered for pregnant women as they approach the birth of their baby.  The expanding uterus presses on the surrounding organs, making it difficult to last the night without having to get up to empty the crowded and shrunken bladder.  The sheer discomfort of the expanding abdomen, and the often corresponding back pain, make it difficult to sleep comortably, especially if the woman is used to sleeping on her stomach.  I believe that the disturbed sleep can help prepare an expecting mom for motherhood.  Once the baby is born, new moms are called upon to spend odd hours nursing and caring for their baby.  Every new parent knows that while their newborn may sleep 18 out of 24 hours, the sleep usually comes in 90-120 minute spurts followed by 1-2 hours of wakefulness.  Furthermore, newborns tend to have an opposite sleep cycle after birth, spending more time sleeping during daytime hours and more time awake at night.  In a way, the woman who has to adapt to irregular sleep patterns is being trained for the physical demands of early motherhood.

That being said, there are some simple ways to improve sleep during pregnancy.  The basic behavioral recommendations to improve sleep still apply.  Try to wake up and go to bed around the same time every day.  Avoid caffeine in general, but especially in the afternoon and evening.  It is important to continue to drink plenty of water during pregnancy, but try to limit your intake for 2-3 hours prior to sleep, and be sure to empty your bladder fully before bed.  Many women state that sleeping on the side and placing a pillow between the legs provides additional comfort.  Continuing to exercise during pregnancy is safe, and regular exercise has a positive impact on sleep.

Regarding “natural” sleep aids, some are safe in pregnancy and some are not.  It is important to remember that herbal and ‘natural’ remedies are not regulated by the FDA, so they can claim anything they want on their packaging without having to prove their claims with scientific studies.  Also, the FDA does not test the products to ensure that the ingredients listed on the label are actually contained in the supplement.  Some of the more popular sleep aids are below.

Melatonin is a chemical that resets the body’s 24-hour clock, called the Circadian rhythm.  Pregnant women have naturally lower melatonin levels, and these lower levels may be important to the baby’s development.  Therefore, I would not recommend melatonin durnig pregnancy.

Chamomile is commonly used to make tea that is used by many as a sleep aid.  Most would consider chamomile tea to be safe, but probably not the more concentrated chamomile oil.  I can safely recommend chamomile tea during pregnancy.

Valerian is an herb that has a mild effect on the body and is one of the safer herbal sleep aids, however, there is conflicing evidence about whether it is safe during pregnancy.  Therefore, I would play it safe and not use valerian during pregnancy.

5-HTP is a supplement used for depression that can also aid in sleep.  It affects serotonin levels, and while many doctors consider serotonin-altering medications to be generally safe in pregnancy, we do not have convincing evidence that it is completely safe.  Therefore, I would not recommend 5-HTP.

Kava was once a popular herbal supplement used for anxiety symptoms and insomnia.  Many problems with kava have been uncovered, including its harmful effects on the liver.  I do not recommend taking kava for any reason.

Tryptophan is not available as a supplement but is present in turkey, cheese, nuts, beans, eggs, and milk.  High levels have induced fetal tumors in laboratory animals, so seeking out tryptophan in high doses is not advised.  The amount of tryptophan in a glass of warm milk would be safe, and it may be enough to assist with falling asleep.

In summary, about the only “natural” sleep aids that I recommend are warm milk or chamomile tea.  Making some behavioral changes may also help with sleep during pregnancy, but in the later stages, it is probably unrealistic to maintain normal sleep patterns.  If you find yourself wide awake and frustrated as your due date nears, take a moment and pray for your baby.  It’s a great way to prepare yourself spiritually and emotionally for the arrival of your child, while your body trains itself physically for more sleepless nights ahead.

There are many foods that are healthier than cereal bars (like fresh fruits and vegetables), and I am not endorsing Nutri-Grain products, but I am a big fan of their new ad campaign. Watch their commercial here and be inspired to make a small change today.

About 2 weeks ago, the “Check Engine” light began to appear each time I started my car. When this happens, my emotions go through several stages. First, denial. “There’s probably nothing wrong, the light is just malfunctioning.” Next, anger. “I don’t have time to take my car in! Doesn’t it know this is a crazy week for me?!” Then I move into bargaining. “OK, car, if you can hang on for one more week, I’ll make sure to never again go over 3000 miles before changing your oil.” And finally… well, back to denial. “Hey, the light went off- I knew nothing was wrong.”

So I continued in my happy state of blissful ignorance until today. While crossing the mile-long bridge on I-294, the engine died. Uh-oh.

“What town are you in, sir?” came the voice at the other end. I looked around. I could explain where I was on the interstate, but I had no idea in which southwest Chicago suburb I currently sat. Even my high tech GPS and smartphone couldn’t tell me. Then I remembered the old-fashioned Chicagoland map book my wife had given me, “just in case.” I opened the book to my current location, and I wasn’t sure whether to laugh or cry as I spoke the name of the town to the motor club assistant.

“I’m in Justice,” I told her. Though I drive through it (or over it) nearly every day, I never knew there was a Justice, IL. I started to laugh. I happen to believe that God orchestrates all events in our lives, even the most mundane, and I was deeply amused at the thought of God allowing me to break down and land in Justice after ignoring my car’s warning signs. Justice indeed. There are consequences to actions and inactions, whether we want them or not.

Waiting for the tow truck, I pondered the other warning signs that many of us ignore. They occur in relationships, in our occupations, and in our health. I’m not usually big on the “your body is like a car” analogies, but there are a number of “Check Engine” warnings that our bodies give us that should not be ignored. Sometimes these warnings will appear for a while and then disappear, like my dashboard light. Don’t assume that means the problem has gone away. You should see your doctor if you experience any of these warning signs.

Excessive fatigue. I don’t just mean getting tired after a long day or a particularly busy week. If you find yourself feeling unusually tired all the time, it is not normal. It could be caused by a thyroid problem, low blood counts, or other more serious health conditions.

Unexplained weight loss or gain. If you changed your diet or exercise habits and notice a change in your weight, don’t worry. But if your lifestyle has not changed and you are suddenly lighter or heavier by more than 10% of your previous weight, you should see your physician.

Bleeding. Occasional nosebleeds are common, especially in the winter. Gums somtimes bleed with brushing, especially in the setting of gingivitis. Hemorrhoids can cause blood to show up on the toilet paper or occasionally on your stool. These types of bleeding are not concerning, but other types are. Blood in the urine, excessive bruising, dark, tarry or purplish stools, or coughing blood are all conditions that require immediate attention.

Sudden change in mental status. If you or a loved one starts behaving in ways that are uncharacteristic, such as forgetting something that was previously second nature, getting confused, or losing inhibitions and behaving completely out of character, it’s important to be assessed by your doctor.

Chest pain. There are many causes for pain in the chest. Unfortunately, we cannot easily determine the cause without sophisticated medical tests. A person having some indigestion may feel exactly the same as a person having a heart attack. For that reason, everyone who seeks medical attention for chest pain will receive a battery of tests to rule out a cardiac cause. Chest pain caused by a heart attack, or heart disease, does not always fall into the typical pattern of crushing pressure in the center of the chest radiating to the jaw or the arm with accompanying nausea, sweating, and shortness of breath. Sometimes it can present as simple abdominal pain. This is especially true among women, older adults, and people with diabetes.

This is by no means an exhaustive list, but it is a start. I hope this helps you determine when it is important to see your doctor. By the way, while waiting for the tow truck, a rainbow appeared over my head, reminding me that even God’s reminders of justice are an act of mercy.

On yesterday’s radio program, a woman called me to ask about the arthritis pain she was experiencing in her knees. She is not alone. Osteoarthritis of the knees is one of the most common joint disorders. It occurs when the cartilage padding between the bones wears down over time. Additional pressure on the knees, whether from being a Major League catcher or from being overweight, will cause that wearing-down process to progress more quickly.