Miya Pearson
Sleep disruption and insomnia are common issues for postpartum women, who often seek advice on medications compatible with breastfeeding. Melatonin is a hormone that regulates sleep and is naturally present in breast milk. While melatonin can be taken while breastfeeding, it is important to monitor infants for drowsiness, which may impact their weight gain. Zolpidem and zopiclone can also be used during breastfeeding but require infant monitoring for possible drowsiness. The UK Drugs in Lactation Advisory Service (UKDILAS) provides advice on medicines during breastfeeding, with decisions based on published evidence, pharmacodynamic and pharmacokinetic principles, risk assessments, and expert advice. While sedating antihistamines may be used as sleep aids, there are concerns about their impact on milk production due to prolactin secretion. However, research on this topic is limited, and the prohibition on first-generation antihistamines during breastfeeding stems from a single paper published in 1985.
| 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 | Limited research, but may decrease breast milk production. |
| Mirtazapine | May be used during breastfeeding. |
| Olanzapine | May be used during breastfeeding. |
| Quetiapine | May be used during breastfeeding. |
| Doxylamine | May be used during breastfeeding. |
| Diphenhydramine | May be used during breastfeeding. |
| Hydroxyzine | May be used during breastfeeding. |
| Doxepin | May be used during breastfeeding. |
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What You'll Learn
- Zolpidem and Zopiclone may be used, but infant monitoring is required
- Melatonin can be used with caution, but may cause drowsiness in infants
- Sedating antihistamines may reduce breast milk production
- Sleep aids may be unnecessary if the cause of insomnia is treated
- There is limited evidence on the safety of sleep aids for breastfeeding mothers
Zolpidem and Zopiclone may be used, but infant monitoring is required
While breastfeeding, it is important to carefully consider any decision to treat a sleep disorder with medication, taking into account the usual sleep deprivation associated with having a newborn. The cause of the insomnia should be identified, and underlying factors should be treated where possible. Good sleep hygiene should also be established to raise awareness of behavioural, environmental, and temporal factors that may be beneficial or detrimental to sleep.
Zolpidem and Zopiclone may be used while breastfeeding, but infant monitoring is required. Zolpidem is a sedative-hypnotic with unpredictable behaviour and has been associated with sleepwalking and other sleep-related activities. While very limited published evidence shows that only very small amounts of zolpidem are found in breast milk, and no side effects have been observed in infants exposed to zolpidem through breast milk, it is still recommended to monitor the infant for possible drowsiness, which may present as not waking up to feed or falling asleep while feeding, potentially affecting weight gain. It is also important to monitor the infant for slowed breathing rate and dry mouth.
Similarly, while there is very limited published evidence of zopiclone use while breastfeeding, with no observed side effects in infants exposed to zopiclone through breast milk, infant monitoring is still required as a precaution. As with zolpidem, monitor the infant for possible drowsiness, which may present as not waking up to feed or falling asleep while feeding, which may in turn affect weight gain.
If you are experiencing sleep issues while breastfeeding, it is important to consult with a healthcare professional to discuss your individual risk assessment and the most suitable treatment options. The UK Drugs In Lactation Advisory Service (UKDILAS) is a specialist breastfeeding medicines advice service that can provide support and recommendations based on the available evidence.
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Melatonin can be used with caution, but may cause drowsiness in infants
Breastfeeding mothers often experience sleep disruption and insomnia, and it is understandable that they may want to take medication to help them sleep. However, it is important to carefully consider the risks of taking any medication while breastfeeding. Melatonin is a hormone that plays a role in regulating sleep and is a normal component of breast milk, with higher concentrations at night. While melatonin can be taken while breastfeeding, it should be used with caution.
Melatonin is not recommended for breastfeeding mothers due to a lack of data on its effects. There is limited evidence on the use of melatonin in breastfeeding mothers, and it is not known how much melatonin passes into the breast milk when taken as a supplement. While it is thought that only a small amount is transferred to the infant, there is a risk of drowsiness in the baby if melatonin is taken for extended periods. This may present as the infant not waking up to feed or falling asleep while feeding, which could affect their weight gain. Therefore, it is important to monitor the infant for any signs of drowsiness and seek advice from a healthcare professional if concerned.
Some sources suggest that breastfeeding mothers should avoid sedating antihistamines as they may reduce breast milk production. However, other sources indicate that while first-generation antihistamines may transiently decrease prolactin levels, standard doses are unlikely to have a significant impact on breastfeeding. Nonetheless, some mothers may not feel comfortable taking this class of medications while breastfeeding. Other alternatives, such as sedating antidepressants or atypical antipsychotics, may be considered in certain situations.
It is always advisable to consult a healthcare professional before taking any medication while breastfeeding. The UK Drugs in Lactation Advisory Service (UKDILAS) can provide specialist advice on the use of specific medicines during breastfeeding. An individual risk assessment should be conducted, and the underlying cause of insomnia should be addressed before prescribing medication. Good sleep hygiene practices should also be established to improve sleep quality.
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Sedating antihistamines may reduce breast milk production
Sleep disruption and insomnia are common issues for postpartum women. While sedating antihistamines are often used as sleep medications, there are concerns about their impact on breast milk production.
Sedating antihistamines, also known as first-generation antihistamines, work by binding to histamine receptors in the brain. Examples include diphenhydramine (Benadryl), hydroxyzine (Atarax), and doxylamine. While these medications can help with sleep, there are concerns that they may reduce breast milk production. This is because they can lower prolactin levels, which is the hormone responsible for stimulating milk production in postpartum women.
The advice to avoid sedating antihistamines while breastfeeding stems from a single paper published in 1985. This study focused on the effects of first-generation antihistamines on prolactin secretion. However, it is important to note that no studies have directly investigated the effects of these medications on breast milk production.
While the impact of sedating antihistamines on milk production is not definitively known, it is generally recommended to avoid them when establishing breastfeeding. This is because, even though prolactin levels increase once lactation is established, there is a concern that reducing them could negatively impact milk production. Additionally, there are other risks to consider when taking sedating medications while breastfeeding, such as infant drowsiness and potential weight gain issues.
If you are experiencing sleep issues while breastfeeding, it is important to consult a healthcare professional for advice. They can help assess your individual situation and provide guidance on the best course of action. While avoiding sedating antihistamines may be recommended, untreated insomnia can also carry risks, including negative impacts on well-being and an increased risk for postpartum depression.
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Sleep aids may be unnecessary if the cause of insomnia is treated
Treating the underlying cause of insomnia can help improve your sleep without the need for sleep aids. For example, if anxiety is causing your insomnia, addressing the anxiety through medication or therapy may be more effective than taking a sleep aid. Establishing good sleep hygiene and a relaxing bedtime routine can also help treat insomnia without medication. This includes practices such as reading, listening to soothing music, taking a hot bath, massage therapy, meditation, or yoga. Acupuncture has also been shown to improve insomnia, especially in older adults.
Additionally, stimulus control therapy can help regulate your sleep-wake cycle by associating your bed with sleep. This involves going to bed only when you are sleepy, getting out of bed if you cannot sleep, and using your bed only for sleep and sexual activity. Identifying and addressing the cause of insomnia through these non-pharmacological methods may eliminate the need for sleep aids.
However, if additional aid is required, certain medications can be used during breastfeeding with infant monitoring, such as zolpidem, zopiclone, and melatonin. Melatonin is a normal component of breast milk, and while it is recommended to monitor infants for drowsiness, no side effects have been observed. It is important to note that research has not proven melatonin to be an effective treatment for insomnia, and side effects may include daytime sleepiness, headaches, upset stomach, and worsening depression.
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There is limited evidence on the safety of sleep aids for breastfeeding mothers
Sleep disruption and insomnia are common issues for postpartum women. While it is understandable that new mothers want to avoid medications that may decrease milk production, it is also important to consider the effects of untreated insomnia on the mother. Sleep deprivation can significantly impact a mother's well-being and functioning. Additionally, research suggests that insomnia and poor sleep quality may increase the risk of postpartum depression.
When considering the use of sleep aids while breastfeeding, it is crucial to acknowledge that evidence regarding their safety is limited. The available evidence is often based on case reports, which can be conflicting and lack detail. Recommendations are made based on pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessments, expert advice, and unpublished or simulated data.
For example, melatonin is a hormone that regulates sleep and is naturally present in breast milk, with higher concentrations at night. While melatonin can be used cautiously while breastfeeding, infant monitoring is crucial. Healthcare professionals advise monitoring infants for drowsiness, which may manifest as difficulty waking up to feed or falling asleep while feeding, potentially impacting weight gain. However, it is important to note that no side effects have been observed in infants exposed to melatonin through breast milk.
Zolpidem and zopiclone are other sleep aids that can be used during breastfeeding with infant monitoring. Again, monitoring is essential to detect any signs of drowsiness in the infant. While small amounts of these medications have been detected in breast milk, no side effects have been observed in infants.
Sedating antihistamines are another option for treating insomnia, but the evidence regarding their safety during breastfeeding is limited. While they may transiently decrease prolactin levels, the clinical impact on breastfeeding is thought to be insignificant. However, some women may not feel comfortable using this class of medications while breastfeeding due to concerns about milk production.
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Frequently asked questions
Melatonin is a normal component of breast milk, with higher concentrations at night. It is thought that taking melatonin while breastfeeding will not cause any side effects in your baby, but it might make them sleepy if taken for long periods. Melatonin can be used with caution during breastfeeding, but infant monitoring is required.
First-generation antihistamines may reduce breast milk production and are typically avoided by breastfeeding mothers. These include diphenhydramine (Benadryl), hydroxyzine (Atarax), and doxylamine.
Yes, it is important to complete an individual risk assessment and consider the underlying causes of insomnia before taking medication. The UK Drugs In Lactation Advisory Service (UKDILAS) provides advice on the use of specific medicines while breastfeeding.
