Miya Pearson
Sleep disruption and insomnia are common issues for new mothers, and it is important to consider the safety of any medication taken while breastfeeding. While there are several over-the-counter sleep aids available, such as melatonin, zolpidem, and zopiclone, it is important to carefully consider the risks and benefits of taking any medication while breastfeeding. Melatonin, for example, is not recommended for children under three years old and may cause side effects such as agitation, sleepiness, and bed-wetting. Zolpidem and zopiclone are considered safer short-term options for breastfeeding mothers, although infant monitoring is required to watch for potential side effects such as drowsiness, slowed breathing rate, and dry mouth. Other alternatives to medication include cognitive-behavioral therapy for insomnia, although this may be difficult to adhere to when caring for a newborn.
| Characteristics | Values |
|---|---|
| Zolpidem | Can be used during breastfeeding, but infant monitoring is required. |
| Zopiclone | Can be used during breastfeeding, but infant monitoring is required. |
| Melatonin | Can be used with caution during breastfeeding, but infant monitoring is required. |
| Sedating antihistamines | Research is limited, but it is assumed that a transient reduction in serum prolactin levels will have no clinically significant effect on breast milk production. |
| Benzodiazepines | Research is limited but indicates a low risk of adverse events in nursing infants. |
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What You'll Learn
Zolpidem and Zopiclone are preferred for short-term management
Sleep disruption and insomnia are common issues for postpartum women, and it is important to carefully consider the treatment of sleep disorders with medication, taking into account the usual sleep deprivation associated with a newborn infant. While sedating antihistamines, benzodiazepines, and other medications are sometimes used to treat insomnia in breastfeeding women, "z-drugs" like zolpidem and zopiclone are preferred for short-term management.
Zolpidem and zopiclone are favoured due to their shorter half-lives and tendency to pass into breast milk in small amounts. The levels of zolpidem in breast milk are low and somewhat rapidly eliminated, so it is not expected to cause adverse effects in older infants who do not breastfeed during the night after the mother's dose. However, infant monitoring is required, as sedation, poor feeding, and poor weight gain may occur. Zolpidem use during breastfeeding is also generally not recommended due to minimal documentation.
Zopiclone is also considered safe for short-term use while breastfeeding, with infant monitoring recommended for the same reasons as zolpidem. Occasional use while breastfeeding an older infant is thought to pose little risk. However, an alternate hypnotic may be preferred while nursing a newborn or preterm infant.
In summary, while zolpidem and zopiclone are preferred for the short-term management of insomnia during breastfeeding, they should be used with caution and under medical supervision. Infant monitoring is crucial to ensure the child does not exhibit signs of sedation, poor feeding, or poor weight gain.
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Melatonin may be used with caution
Sleep disruption and insomnia are common among postpartum women, and it is understandable that new mothers may want to turn to sleeping pills to help them get a good night's rest. However, when it comes to taking sleeping pills while breastfeeding, caution is advised. While there are some over-the-counter (OTC) sleep aids that are generally considered safe and effective, such as melatonin, there has not been sufficient research to conclusively determine whether melatonin is safe for women who are breastfeeding.
Melatonin is a chemical naturally released by the brain to induce sleep as part of the sleep-wake cycle. It is also available as a supplement and can be purchased over the counter. Melatonin supplements are typically intended for short-term use to alleviate insomnia or difficulty sleeping. While melatonin has relatively few side effects, some people may experience headaches, dizziness, nausea, and drowsiness when taking it. These side effects are usually mild, and melatonin is not recommended for children under three years of age.
Although melatonin is a normal component of breast milk, there is limited research on its therapeutic use during breastfeeding. The low bioavailability of melatonin means that only a small amount is ingested by the infant. However, there is a possibility that an infant exposed to supplemental melatonin might experience increased sleepiness. As such, infant monitoring is recommended to watch for potential side effects, such as drowsiness, which may present as difficulty waking up to feed or falling asleep while feeding, potentially impacting weight gain.
While there is insufficient evidence to determine the safety of melatonin for breastfeeding mothers, it is important to note that each person's situation is unique. New mothers experiencing sleep difficulties should consult their healthcare provider to discuss the safest options for them and their babies. Healthcare providers can recommend treatments suitable for breastfeeding mothers and refer them to a sleep specialist if needed. Additionally, lifestyle changes, such as improving sleep habits, exercising regularly, and creating a sleep-conducive environment, can also help overcome insomnia.
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Sedating antihistamines may decrease prolactin levels
Sleep disruption and insomnia are common among postpartum women, and many wonder what medications are safe to use while breastfeeding. While sedating antihistamines may transiently decrease prolactin levels, this is unlikely to have a clinically significant impact on breastfeeding. Prolactin stimulates milk production, and levels of this hormone rise during pregnancy, peak at the time of delivery, and continue to be elevated in lactating women.
First-generation antihistamine medications are often used as sleep medications due to their ability to promote sedation by binding to histamine receptors in the brain. While second-generation antihistamines, like loratadine (Claritin), are not sedating, first-generation antihistamines, such as diphenhydramine (Benadryl), hydroxyzine (Atarax), and doxylamine, exhibit sedative effects through antagonism at H1 histamine receptors in the brain. Doxepin, a tricycline antidepressant, also binds to H1 histamine receptors at low doses and is sometimes used to promote sleep.
Research on the use of sedating antihistamines in breastfeeding women is limited. While avoiding medications that may decrease milk production is understandable, the effects of untreated insomnia in the mother must also be considered. Sleep deprivation can significantly affect a person's well-being and capacity to function effectively. Additionally, there is a growing body of literature indicating that insomnia and poor sleep quality may increase the risk for postpartum depression.
If sedating antihistamines are not an option, other alternatives should be considered. Cognitive-behavioral therapy for insomnia is a non-pharmacologic option, although adhering to this type of therapy may be challenging when caring for a newborn. Other pharmacologic options include benzodiazepines, which have a low risk of adverse events in nursing infants. Short-acting benzodiazepines, such as lorazepam, may be preferable as they promote sleep but have diminishing effects over the next few hours and are less likely to interfere with waking.
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Benzodiazepines are another option
The Motherisk program conducted the largest study on the risks associated with benzodiazepines in breastfeeding mothers, which included a total of 124 exposed infants. The study found that adverse events, specifically sedation, were observed in only 1.6% (2 out of 124) of infants exposed. The most commonly used benzodiazepines were lorazepam (52%), clonazepam (18%), and midazolam (15%). It is worth noting that about half of the women in the study were also taking other medications, most commonly antidepressants and opioids, in addition to benzodiazepines.
While the risk of adverse events in nursing infants exposed to benzodiazepines in breast milk is considered low, it is still recommended to monitor the infant closely for side effects such as drowsiness, especially if the mother is taking higher doses of benzodiazepines or other sedating medications.
Zolpidem and zopiclone, known as 'z-drugs', are also options for the short-term management of insomnia during breastfeeding. They have shorter half-lives than benzodiazepines and appear to pass into breast milk in smaller amounts. However, it is important to monitor infants for possible drowsiness, which may affect their weight gain. Melatonin can also be used with caution during breastfeeding, although infant monitoring is required to watch for the same side effects as zolpidem and zopiclone.
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Lack of research on melatonin's safety
While melatonin is a naturally occurring hormone that helps regulate sleep and circadian rhythm, and is normally found in breast milk, there is a lack of research on its safety for mothers who are breastfeeding. Melatonin has no specific use during breastfeeding, and there is no data on the safety of maternal use of melatonin supplements during breastfeeding.
Some sources suggest that melatonin can be used cautiously by breastfeeding mothers, recommending that infants be monitored for drowsiness, which may affect weight gain. However, it is important to note that there is limited published evidence in this area, and the long-term effects of melatonin use while breastfeeding are unknown.
The National Center for Complementary and Integrative Health (NCCIH) states that there is insufficient evidence to recommend melatonin for chronic insomnia treatment, and there is not enough data to determine its safety for breastfeeding mothers. While some sources suggest that short-term use of melatonin is generally considered safe, others caution against its use due to the lack of data and the relatively long half-life in preterm neonates.
Until more research is conducted, it is advisable for breastfeeding mothers to consult their healthcare providers before taking melatonin supplements.
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Frequently asked questions
There is very limited research on the safety of sleeping pills during breastfeeding. While some sources claim that melatonin can be used while breastfeeding, it is recommended that you consult your healthcare provider before taking it. Zolpidem and zopiclone are preferred for the short-term management of insomnia during breastfeeding.
There is very limited published evidence of the use of sleeping pills during breastfeeding. However, it has been observed that very small amounts of zolpidem and zopiclone are found in breast milk. While no side effects have been observed in infants after exposure to these drugs through breast milk, infant monitoring is required. As a precaution, monitor the infant for possible drowsiness, which may present as not waking up to feed/falling asleep while feeding, affecting weight gain.
Some alternatives to sleeping pills while breastfeeding include cognitive-behavioral therapy for insomnia, improving your sleep habits, exercising routinely, and creating a bedroom environment that fosters sleep. There are also some breastfeeding-safe anti-anxiety medications that can be taken to improve sleep.
