Sleep Problems in Pregnancy: Achieving Rest During Gestation

Executive Summary

Sleep problems during pregnancy represent one of the most challenging and universally experienced symptoms of gestation, affecting an estimated 75-95% of expectant mothers at some point during their pregnancy journey. The physiological, hormonal, and emotional changes of pregnancy create numerous obstacles to restful sleep, from physical discomfort and nocturia to anxiety and hormonal disruption of normal sleep architecture. Unlike ordinary insomnia, pregnancy-related sleep disturbances are intertwined with the fundamental changes occurring in the body and often require specific approaches tailored to the unique demands of gestation. Understanding the causes of pregnancy sleep problems and implementing effective management strategies can help expectant mothers achieve the rest they need for their own health and their baby’s development.

This comprehensive guide explores the factors contributing to sleep disturbances during pregnancy, distinguishes between normal pregnancy sleep changes and patterns requiring professional attention, and provides extensive guidance on natural treatment approaches including homeopathic remedies, Ayurvedic practices, sleep positioning strategies, relaxation techniques, and lifestyle modifications. For expectant mothers in Dubai seeking holistic and integrative approaches to managing sleep problems, this resource combines modern sleep science with time-tested traditional approaches to support restorative rest throughout pregnancy.

What Are Sleep Problems During Pregnancy?

Sleep problems during pregnancy encompass a range of disturbances including difficulty falling asleep, frequent nighttime waking, early morning awakening, restless sleep, insomnia, sleep-disordered breathing, and uncomfortable sleep due to physical symptoms. Understanding the specific nature of your sleep disturbances helps guide appropriate treatment strategies.

Normal Sleep Architecture Changes occur during pregnancy due to hormonal shifts and physiological adaptations. Progesterone, while essential for pregnancy maintenance, has a soporific (sleep-inducing) effect that can cause daytime sleepiness while also fragmenting nighttime sleep. Estrogen increases during pregnancy, affecting sleep regulation and potentially contributing to vivid dreams and sleep disruption. The increased metabolic demands of pregnancy, elevated body temperature, and frequent need to urinate all contribute to sleep fragmentation. These changes, while normal, can leave women feeling unrefreshed despite spending adequate time in bed.

Common Sleep Disturbance Patterns during pregnancy follow predictable patterns across trimesters. First trimester sleep problems often involve excessive daytime sleepiness, difficulty staying awake, and nighttime waking, all while the total time spent sleeping may actually increase. Second trimester often brings relative improvement, with some women experiencing better sleep than in the first or third trimesters. Third trimester sleep problems typically involve difficulty finding comfortable positions, frequent urination, heartburn, leg cramps, and general physical discomfort that significantly disrupt sleep. Understanding these patterns helps set realistic expectations and guide appropriate interventions.

Insomnia During Pregnancy involves difficulty falling asleep, staying asleep, or both, despite adequate opportunity for sleep. Pregnancy insomnia may result from physical discomfort, anxiety about pregnancy and parenting, hormonal changes, or the combination of factors that make comfortable sleep difficult. Women with insomnia may lie awake for hours unable to fall asleep, wake frequently during the night, or wake far earlier than desired and be unable to return to sleep. The resulting sleep deprivation can significantly impact daytime functioning, mood, and overall wellbeing.

Restless Legs Syndrome affects an estimated 15-25% of pregnant women, significantly more than in the non-pregnant population. This neurological condition creates an irresistible urge to move the legs, particularly at rest, that is temporarily relieved by movement. Symptoms typically worsen at night, making sleep difficult. Restless legs syndrome during pregnancy often begins in the second or third trimester and typically resolves within a few weeks of delivery. Iron and folate deficiency may contribute to this condition.

Common Causes of Sleep Problems During Pregnancy

Understanding the causes of sleep problems during pregnancy enables targeted management strategies and helps expectant mothers make informed choices about treatment approaches. The causes are multifactorial, involving hormonal, physical, psychological, and environmental factors.

Hormonal Changes significantly impact sleep throughout pregnancy. Progesterone, while essential for maintaining pregnancy, causes drowsiness during the day but also fragments nighttime sleep. The relationship between progesterone and sleep is complex, with the hormone having both sedative and disruptive effects. Estrogen increases during pregnancy, affecting REM sleep and potentially contributing to vivid dreams and sleep disruption. The changing ratio of these hormones throughout pregnancy creates shifting sleep patterns that can be difficult to adapt to.

Physical Discomfort increases as pregnancy progresses and significantly impacts sleep quality. Finding comfortable sleeping positions becomes increasingly challenging as the abdomen grows. Lower back pain, pelvic pain, and hip pain can make falling and staying asleep difficult. Heartburn, which tends to worsen when lying down, can disrupt sleep. Shortness of breath, common in late pregnancy as the enlarged uterus pushes on the diaphragm, can make it difficult to breathe comfortably in certain positions. These physical discomforts create obstacles to restful sleep that require specific management strategies.

Nocturia and Frequent Urination disrupts sleep for most pregnant women, particularly in the first and third trimesters. In the first trimester, increased blood flow to the pelvic area and the pressure of the enlarging uterus on the bladder increase urinary frequency. In the third trimester, the baby’s head pressing on the bladder creates similar effects. The need to urinate multiple times per night is normal but significantly impacts sleep continuity. Learning to manage fluid intake timing can help reduce nighttime urination without causing dehydration.

Anxiety and Psychological Factors contribute significantly to sleep problems during pregnancy. Worries about pregnancy outcomes, fears about labor and delivery, concerns about parenting readiness, and the general psychological adjustments of impending motherhood can keep women awake at night. The increased cortisol (stress hormone) levels associated with anxiety can further disrupt sleep architecture. Racing thoughts at bedtime, often related to pregnancy or life changes, can make falling asleep difficult even when physically exhausted.

Sleep-Disordered Breathing including snoring and sleep apnea increases during pregnancy, particularly in women who are overweight, have asthma, or are carrying multiples. Hormonal changes can cause nasal congestion and swelling of the upper airway, contributing to snoring. Upper airway resistance syndrome and sleep apnea can cause repeated awakenings and significant sleep disruption. These conditions may have implications for both maternal and fetal health and warrant evaluation if suspected.

Gastroesophageal Reflux (heartburn) affects sleep by causing burning discomfort when lying down. The combination of progesterone relaxing the lower esophageal sphincter and mechanical pressure from the enlarged uterus creates ideal conditions for reflux when lying flat. Heartburn that disrupts sleep typically requires specific management including dietary modification and positioning strategies.

Leg Cramps and Restless Legs commonly disrupt sleep during the second and third trimesters. Sudden, painful muscle cramps in the calves or feet can wake women from sleep. Restless legs syndrome creates an uncomfortable urge to move the legs that is worse at rest and particularly problematic at night. These conditions have various contributing factors including mineral imbalances, circulation changes, and hormonal effects.

When to See Your Doctor About Sleep Problems

While most sleep problems during pregnancy are normal and can be managed conservatively, certain patterns and associated symptoms warrant medical evaluation.

Persistent Insomnia Not Responsive to Self-Care that significantly impacts your functioning, mood, or safety warrants professional attention. If you have tried conservative measures without improvement and sleep deprivation is affecting your ability to function during the day, discuss options with your healthcare provider. Cognitive behavioral therapy for insomnia (CBT-I) is considered safe and effective during pregnancy and may be recommended.

Signs of Sleep Apnea require medical evaluation. These signs include loud snoring with pauses in breathing witnessed by a partner, gasping or choking during sleep, excessive daytime sleepiness that makes it unsafe to drive or perform normal activities, and morning headaches. Sleep apnea during pregnancy can have implications for both maternal and fetal health and may require specific treatment.

Severe Restless Legs Syndrome that significantly disrupts sleep and does not respond to self-care measures may require medical evaluation. Severe RLS can indicate underlying iron deficiency or other conditions that need treatment. Discuss your symptoms with your healthcare provider to rule out contributing factors and explore treatment options.

Depression or Anxiety Affecting Sleep warrants professional mental health support. If sleep problems are accompanied by persistent sadness, loss of interest, excessive worry, panic attacks, or thoughts of self-harm, seek help immediately. Mental health conditions during pregnancy are common and treatable, and getting help supports both your wellbeing and your baby’s development.

Medication Review with your healthcare provider is important, as some medications can affect sleep. Review all supplements and medications you are taking with your provider to identify any that may be contributing to sleep problems. Never start new medications, including sleep aids, without consulting your healthcare provider first.

Natural Treatment Options for Sleep Problems in Pregnancy

Homeopathic Remedies for Sleep Support

Homeopathy offers a gentle approach to managing sleep problems during pregnancy, addressing both the immediate symptoms and the constitutional susceptibility that may contribute to sleep disturbances. Homeopathic remedies are considered safe during pregnancy when prescribed by qualified practitioners.

Coffea Cruda addresses insomnia with an overactive mind, where thoughts race and prevent sleep despite physical exhaustion. Women needing this remedy experience heightened mental activity at bedtime, with ideas and thoughts flowing rapidly and preventing relaxation. They may be sensitive to noise and external impressions, and may have vivid dreams. This remedy suits women who are intellectually engaged, creative, or anxious about upcoming events.

Chamomilla addresses irritability and difficulty sleeping, particularly when associated with physical discomfort or teething (in the case of children, but with relevance for pregnancy gum changes). Women needing this remedy are extremely irritable and impatient, with a tendency to be easily offended and difficult to please. The physical discomfort that prevents sleep may include back pain, leg cramps, or general achiness. They often feel hot and want to be uncovered, despite being chilly otherwise.

Passiflora Incarnata (Passionflower) is a homeopathic remedy that addresses nervous exhaustion and insomnia with an overactive mind. Women needing this remedy experience difficulty falling asleep due to racing thoughts, worry, or physical restlessness. The picture may include neuralgic pains, headaches, and general nervous tension. This remedy is particularly appropriate for women whose insomnia has a clear stress or anxiety component.

Arsenicum Album addresses anxiety-driven insomnia with restlessness and worry, particularly about health and security. Women needing this remedy are anxious and fastidious, with a fear of disease and a need for things to be in order. They often experience midnight or early morning waking with inability to return to sleep, accompanied by anxiety about the cause of waking. Physical symptoms may include chills, thirst for small sips, and weakness.

Nux Vomica addresses insomnia with irritability and overstimulation, particularly when caused by overwork, stress, or stimulant use. Women needing this remedy have difficulty falling asleep due to an active mind and physical tension. They may have a history of using coffee, alcohol, or other stimulants, and may experience heartburn or digestive disturbance alongside sleep problems. This remedy suits driven, Type A personalities who have been pushing themselves too hard.

Working with a qualified homeopathic practitioner ensures proper remedy selection based on your complete symptom picture. Our homeopathic specialists at Healer’s Clinic provide personalized consultations to match remedies to your individual symptoms and constitution.

Ayurvedic Approaches to Sleep During Pregnancy

Ayurveda views sleep (Nidra) as one of the three pillars of health, alongside proper diet (Ahara) and mindful living (Brahmacharya). During pregnancy, quality sleep is essential for both maternal and fetal health, and Ayurvedic practices support restful sleep through dietary, lifestyle, and herbal interventions.

Sleep-Promoting Diet in Ayurveda emphasizes foods that are grounding, nourishing, and easy to digest. The diet should favor warm, cooked foods that are sweet, sour, and salty in taste (the first three tastes), while minimizing bitter, pungent, and astringent foods. Warm milk with spices (such as nutmeg, cardamom, or saffron) taken before bed is a traditional sleep-promoting beverage. Avoiding caffeine, heavy meals, and stimulating foods in the evening supports natural sleep onset. Eating the evening meal at least 3 hours before bed allows for proper digestion before sleep.

Abhyanga (Self-Massage) with warm sesame oil before bed has profound effects on sleep quality. The massage stimulates circulation, calms the nervous system, and has a grounding effect that promotes restful sleep. Focusing on the feet and scalp, areas rich in nerve endings that influence relaxation, can be particularly beneficial. The warmth of the oil and the rhythm of the massage create a meditative state that transitions the body and mind toward sleep.

Dinacharya (Daily Routine) for sleep involves consistent sleep and wake times that align with natural circadian rhythms. Going to bed by 10 PM and waking with the sun supports optimal hormonal balance and sleep quality. The evening should involve a gradual wind-down period of 1-2 hours that includes calming activities, dim lighting, and transition from the day’s activities. Avoiding stimulating activities, bright screens, and emotionally charged interactions in the evening supports natural sleep onset.

Brahmi (Bacopa Monnieri) and other nervine herbs support sleep and calm the nervous system during pregnancy. Brahmi, in particular, is considered safe during pregnancy and has been used traditionally to support mental clarity and restful sleep. Taken as a tea or in capsule form under practitioner guidance, Brahmi can help ease the mental activity that prevents sleep. Jatamansi (Nardostachys jatamansi) is another traditional herb for sleep, with calming and grounding properties.

Yoga Nidra (Sleep Meditation) is a guided relaxation practice that promotes deep rest and can be used to fall asleep. This practice involves systematically relaxing different parts of the body while maintaining awareness, effectively training the nervous system to enter a restful state. Many women find that practicing yoga nidra at bedtime helps quiet the racing thoughts that prevent sleep. Our prenatal yoga classes at Healer’s Clinic include yoga nidra practices specifically designed for pregnancy.

Sleep Positioning Strategies

Proper sleep positioning during pregnancy supports both maternal comfort and fetal wellbeing, while improper positioning can contribute to discomfort and potentially affect blood flow.

Left Side Sleeping is generally recommended during pregnancy, particularly in the third trimester. This position optimizes blood flow to the uterus by avoiding compression of the inferior vena cava (the large vein returning blood from the lower body) and the aorta (the main artery). The left side is preferred over the right because it keeps the uterus away from the liver and optimizes blood flow to the heart. However, the most important factor is finding a comfortable position you can maintain, as quality sleep is also essential.

Pillow Support Systems can significantly improve comfort and support during pregnancy sleep. A pregnancy pillow that runs the length of the body provides support for the belly, hips, and legs. Placing a pillow between the knees aligns the hips and reduces lower back strain. A small pillow or rolled towel under the belly provides additional support. A pillow behind the back prevents rolling onto the back and provides back support. Experimenting with different pillow configurations helps find the most comfortable setup.

Graduated Position Changes for women who have traditionally slept on their back or stomach can make the transition to side sleeping easier. Using a body pillow from early pregnancy establishes the habit before the belly makes back sleeping uncomfortable. Positioning the pillow against the back can help prevent rolling onto the back during sleep. Accepting that some nights will involve position changes is normal and expected.

Elevation Strategies for specific symptoms can improve sleep quality. Elevating the upper body slightly with a wedge pillow or additional pillows can help with heartburn and shortness of breath. Elevating the legs on a pillow can help reduce swelling and may ease leg cramps. The specific elevation needed varies by symptom and individual preference.

Relaxation and Stress Management

Relaxation techniques address the psychological components of pregnancy sleep problems, calming the nervous system and preparing both body and mind for restful sleep.

Progressive Muscle Relaxation involves systematically tensing and releasing different muscle groups throughout the body, promoting physical relaxation and body awareness. Starting at the feet and moving upward, each muscle group is tense for 5-10 seconds, then released completely. This practice helps release physical tension that may be preventing sleep and provides a focus for the mind away from racing thoughts.

Deep Breathing Exercises activate the parasympathetic nervous system, which promotes rest and digestion. The 4-7-8 breathing technique involves inhaling for 4 counts, holding for 7 counts, and exhaling for 8 counts. This pattern slows the breath and heart rate, signaling the body to relax. Practicing during the day makes the technique easier to employ at bedtime when sleep is needed.

Guided Visualization for sleep involves imagining a peaceful, calming scene in detail, engaging all the senses. The visualization should be of a place that feels truly relaxing to you, whether a beach, forest, mountain meadow, or cozy room. Focusing attention on this mental image prevents the racing thoughts that can prevent sleep and creates a relaxed state conducive to rest.

Mindfulness Meditation practiced during the day and at bedtime develops the ability to observe thoughts without getting caught up in them. This skill is particularly valuable for pregnancy insomnia, where worry about sleep or about pregnancy can create cycles of anxious thought that prevent rest. Regular mindfulness practice improves overall sleep quality and reduces the time needed to fall asleep.

Establishing a Wind-Down Routine creates a consistent signal to the body and mind that sleep is approaching. This routine should begin 1-2 hours before bed and include calming activities such as light reading, gentle stretching, warm baths, or time with a partner. Avoiding screens, stimulating work, and emotionally charged conversations during this time supports the transition to sleep.

Home Remedies and Self-Care for Sleep Problems

Beyond formal treatment systems, practical self-care strategies can help establish and maintain healthy sleep patterns during pregnancy.

Consistent Sleep Schedule supports natural circadian rhythms. Going to bed and waking at the same time every day, including weekends, reinforces natural sleep-wake cycles. This consistency makes it easier to fall asleep and wake naturally. Even on days when sleep was poor, maintaining a consistent wake time helps regulate sleep patterns.

Optimized Sleep Environment creates conditions conducive to rest. The bedroom should be dark, quiet, and cool (typically 65-68°F or 18-20°C). Blackout curtains, eye masks, and earplugs or white noise machines can address environmental disturbances. A comfortable mattress and pillows that support pregnancy bodies are investments in sleep quality. The bed should be used only for sleep and intimacy, creating an association between bed and sleep.

Limiting Fluids Before Bed reduces nighttime urination that disrupts sleep. While adequate hydration throughout the day is essential, reducing fluid intake in the evening, particularly after 7-8 PM, can decrease nighttime trips to the bathroom. Balancing this with daytime hydration is important to avoid dehydration.

Avoiding Stimulants in the afternoon and evening supports natural sleep onset. Caffeine, even when consumed earlier in the day, can remain in the system and affect sleep. Caffeine sensitivity often increases during pregnancy, so even amounts previously well-tolerated may now affect sleep. Chocolate, tea, and some sodas contain caffeine and should be limited in the evening.

Regular Exercise during the day supports better nighttime sleep. Moderate exercise, such as walking, swimming, or prenatal yoga, promotes deeper, more restorative sleep. Exercise should be completed at least 3-4 hours before bed, as exercising too close to bedtime can be stimulating. The best time for exercise is typically in the morning or early afternoon.

Managing Daytime Napping carefully prevents napping from interfering with nighttime sleep. Short naps of 20-30 minutes before 3 PM can provide rest without affecting nighttime sleep. Longer or later naps can make falling asleep more difficult. If nighttime sleep is poor, limiting naps may help consolidate sleep at night.

Prevention Tips for Sleep Problems in Pregnancy

While not all sleep problems during pregnancy can be prevented, certain strategies can reduce severity and support healthy sleep throughout pregnancy.

Early Establishment of Sleep Hygiene before significant sleep problems develop creates habits that support rest. Starting healthy sleep practices early in pregnancy, when sleep may still be relatively good, establishes routines that continue to support sleep as pregnancy progresses.

Proactive Management of Contributing Factors prevents individual symptoms from disrupting sleep. Addressing heartburn through diet and positioning, managing leg cramps through stretching and mineral intake, reducing fluid intake before bed, and managing anxiety through relaxation practices each contribute to better sleep. Waiting until sleep is significantly disrupted makes establishing new habits more difficult.

Building Sleep Resilience through consistent routines and practices prepares for nights when sleep may be more difficult. Having a reliable wind-down routine, relaxation techniques that work for you, and confidence in your ability to manage sleep challenges provides security that reduces the anxiety that can worsen sleep problems.

Acceptance of Sleep Changes reduces the frustration that can compound sleep difficulties. Understanding that some sleep disruption is normal during pregnancy, and that this phase is temporary, helps women approach sleep challenges with patience rather than anxiety. The goal is adequate rest rather than perfect sleep, and multiple strategies can be combined to achieve rest.

Frequently Asked Questions About Sleep Problems in Pregnancy

Is it safe to take sleep aids during pregnancy? Most sleep medications are not recommended during pregnancy due to potential risks to the developing baby. Over-the-counter sleep aids containing diphenhydramine are sometimes used short-term but should be discussed with your healthcare provider. Natural approaches including relaxation techniques, sleep positioning, and homeopathic remedies are preferred first-line treatments. Never start any sleep aid without consulting your provider.

How much sleep do I need during pregnancy? Most pregnant women need 7-9 hours of sleep per night, though individual needs vary. The important factor is feeling rested during the day. Some women find they need more sleep during pregnancy, and daytime napping may be beneficial. Listening to your body’s signals and allowing for additional rest supports both your health and your baby’s development.

Why am I so tired during the first trimester but can’t sleep at night? First trimester fatigue is caused by the enormous energy demands of building the placenta and the sedating effects of progesterone. Paradoxically, progesterone also fragments nighttime sleep, creating a situation where you are exhausted but unable to get restorative sleep. This typically improves in the second trimester as the placenta takes over and hormone levels stabilize somewhat.

Can I sleep on my back during pregnancy? Sleeping on your back in the third trimester can compress major blood vessels and potentially reduce blood flow to the uterus. Most healthcare providers recommend sleeping on your side, preferably the left side, during the second and third trimesters. If you wake on your back, simply roll to your side; occasional back sleeping is unlikely to cause problems.

What causes vivid dreams during pregnancy? Vivid dreams and nightmares are common during pregnancy and are thought to result from hormonal changes affecting REM sleep, increased emotional processing during sleep, and the psychological work of preparing for motherhood. These dreams are typically harmless, though they can be disturbing. Discuss recurrent nightmares with your healthcare provider if they are significantly disturbing your sleep or causing distress.

How can I manage frequent urination at night? Limit fluids in the evening, particularly after 7-8 PM, while maintaining adequate hydration during the day. Empty your bladder completely before bed. If you wake during the night, use a nightlight in the bathroom to avoid fully waking with bright lights. Accept that some nighttime urination is normal during pregnancy, but discuss with your provider if you have pain, burning, or other symptoms suggesting urinary tract infection.

Is restless legs syndrome harmful to my baby? Restless legs syndrome itself does not harm the baby, though the sleep disruption it causes can affect your wellbeing. RLS during pregnancy is often related to iron or folate deficiency, so discuss your symptoms with your healthcare provider who may recommend testing. Most cases resolve within weeks of delivery.

Why do I have trouble breathing at night during pregnancy? Shortness of breath at night can result from the enlarged uterus pushing on the diaphragm, reducing lung capacity. Progesterone also stimulates breathing, which can make you feel short of breath. Sleeping with the upper body slightly elevated, using pillows for support, and practicing gentle postures that open the chest can help. However, if shortness of breath is severe or accompanied by chest pain, seek medical evaluation.

Key Takeaways

Sleep problems during pregnancy are normal and expected, resulting from the complex interplay of hormonal changes, physical discomfort, psychological factors, and physiological adaptations of gestation. While challenging, these sleep disturbances can be effectively managed through natural approaches including homeopathic remedies, Ayurvedic practices, sleep positioning strategies, relaxation techniques, and lifestyle modifications.

Natural treatment options for pregnancy sleep problems are extensive and effective, including homeopathic remedies tailored to individual symptom patterns, Ayurvedic practices that support natural sleep through diet and routine, positioning strategies that accommodate the pregnant body, and relaxation techniques that calm the nervous system. These approaches work with the body’s natural processes to support restorative rest during pregnancy.

Prevention and early intervention are key strategies for managing pregnancy sleep problems. Establishing healthy sleep habits early in pregnancy, proactively managing contributing factors, and developing a toolkit of effective strategies supports better sleep throughout gestation. Accepting that some sleep disruption is normal while taking active steps to minimize it helps women navigate this challenging aspect of pregnancy.

Your Next Steps

If sleep problems are significantly impacting your quality of life during pregnancy, our team at Healer’s Clinic is here to help you find effective relief. Our comprehensive approach combines multiple therapeutic modalities to address your specific situation.

Schedule a Prenatal Consultation to assess your sleep patterns and develop a personalized management plan. Our practitioners can identify contributing factors and recommend appropriate natural therapies alongside conventional strategies. Book your consultation today

Explore Our Homeopathic Pregnancy Care for individualized remedies that support healthy sleep during pregnancy. Our certified homeopathic practitioners provide personalized treatment throughout your pregnancy journey. Learn more about homeopathy for pregnancy

Discover Prenatal Yoga Classes that incorporate relaxation techniques, gentle movement, and yoga nidra practices designed to support restful sleep. Our classes provide community support while teaching practical tools for managing sleep challenges. Explore prenatal yoga

Consider Ayurvedic Prenatal Support for dietary guidance, lifestyle practices, and herbal support designed to balance doshas and promote natural sleep. Our Ayurvedic specialists provide personalized recommendations based on your constitution and symptoms. Explore Ayurvedic prenatal care

Remember that sleep challenges during pregnancy are temporary and manageable. With appropriate support and strategies, you can achieve the rest you need for your own health and your baby’s development.

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This article is for informational purposes only and should not replace professional medical advice. Always consult with your healthcare provider before starting any new treatment during pregnancy.