Colin Snow
Sleep is a common issue during pregnancy, with insomnia affecting 5% to 38% of women in early pregnancy, and up to 60% in late pregnancy. While taking sleeping pills during pregnancy is a personal choice, it is important to note that there is limited research on the safety of these medications for pregnant people and their fetuses. Some healthcare providers opt not to recommend any sleep aids during pregnancy, while others may suggest trying non-medication alternatives first. It is always advisable to consult with a healthcare provider before starting any new medication or supplement, especially during pregnancy, to weigh the risks and benefits.
| Characteristics | Values |
|---|---|
| Prevalence of insomnia in pregnancy | 5% to 38% in early pregnancy, up to 60% in late pregnancy |
| Prevalence of RLS in pregnancy | 1 in 5 pregnant women in Western countries |
| Prevalence of snoring in pregnancy | Up to 1/3 of pregnant women by the third trimester |
| Prevalence of sleep-disordered breathing in pregnancy | 4% to 70% |
| Natural sleep aids | Melatonin supplements, herbal sleep aids |
| Prescription sleep aids | Zolpidem, Trazodone, Ambien, Nortriptyline, Amitriptyline, Benzodiazepines |
| Over-the-counter sleep aids | Tylenol PM, Unisom, Benadryl, Doxylamine, Antihistamines |
| Non-pharmacological interventions | Relaxation techniques, deep breathing, guided imagery, progressive muscle relaxation, yoga, exercise, caffeine reduction, avoiding screens before bed, blackout curtains, nightlights, pregnancy pillows |
| Risks of sleep deprivation during pregnancy | Negative impact on the health and safety of the pregnant person and the baby, increased anxiety |
| Risks of sleep aids during pregnancy | Increased risk of miscarriage, low birth weight, preterm birth, birth defects, infant withdrawal symptoms, sleep problems, abnormal muscle tone, respiratory problems |
| Recommendations from healthcare providers | Generally recommend addressing sleep difficulties without medication or supplements, melatonin is controversial due to lack of research, benzodiazepines generally not recommended |
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What You'll Learn
Melatonin supplements
Sleep problems are common during pregnancy, particularly in the later stages. Many pregnant people wonder if it is safe to take over-the-counter or prescription sleep medication, melatonin supplements, or herbal sleep aids.
Some healthcare providers opt not to recommend any sleep aids during pregnancy due to limited research on their safety for pregnant people and fetuses. However, as sleep deprivation during pregnancy can have negative consequences, some pregnant people and their doctors may decide that the benefits of certain sleep aids outweigh the risks.
Melatonin is a hormone naturally produced by the human body that helps regulate sleep. Taking melatonin supplements can help some people fall asleep more easily. While melatonin supplements may be suggested by healthcare providers for pregnant people who continue having trouble sleeping even after trying non-medication alternatives, it is important to note that there is limited research on the impact of high levels of this hormone on the developing fetus.
Some studies suggest that melatonin supplementation in pregnant animals is associated with risks such as lower birth weights. However, clinical trials in humans have not indicated major safety concerns. Preliminary studies suggest that melatonin supplementation may even have beneficial effects on fertilization rates, embryo quality, and fetal development.
While melatonin use during pregnancy and breastfeeding is likely safe, it is always recommended to consult with a healthcare provider before starting any new medication or supplement to make an informed decision regarding your specific circumstances.
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Prescription sleep medication
Sleep disturbances are common during pregnancy, affecting 77% of pregnant individuals, with issues peaking in the third trimester due to bodily discomforts such as frequent urination, nausea, and heartburn. While non-pharmacological interventions are likely the safest approach, they are often ineffective, leaving patients dealing with the frustrations of sleep disturbances and the negative outcomes of poor sleep.
Pregnant people should always consult with a healthcare provider before starting any new medication or supplement. The human body naturally produces melatonin, a hormone that helps people fall asleep and wake up at appropriate times. Taking melatonin supplements helps some people with sleep difficulties fall asleep more easily. Providers may suggest melatonin supplements during pregnancy for people who continue having trouble falling asleep even after trying non-medication alternatives. An estimated 4% of pregnant people take melatonin supplements. While studies have found that melatonin use in pregnant animals has some risks, such as lower birth weights, there is currently no evidence that melatonin is unsafe for pregnant humans. However, many healthcare providers recommend against it because it crosses the placenta, and there isn't extensive research on its use in pregnancy.
There are several prescription sleep medications that are generally not recommended for use during pregnancy due to insufficient data on their safety profiles. Benzodiazepines, for example, haven't been proven safe for pregnant women, so it's best to avoid them. While one study of more than 6,000 women found no increased risk of problems such as preterm birth or low birth weight associated with benzodiazepine use during pregnancy, another nationwide study of more than 3 million pregnancies found an increased risk of miscarriage. There are also reports of withdrawal or toxicity symptoms (such as sleepiness, abnormal muscle tone, and respiratory or sleep problems) in newborns whose mothers took benzodiazepines during pregnancy.
Nonbenzodiazepines, such as zolpidem, should also be avoided during pregnancy. A study of 2,497 pregnant women who used zolpidem showed an increase in low birth weight, small-for-gestational age infants, preterm delivery, and C-sections compared to pregnant women who didn't use the drug. While another study of more than 39,000 birth defect cases found no large increase in risk with zolpidem use, the researchers concluded that smaller increases in risk for certain defects couldn't be ruled out.
It's important to note that, while insomnia is common during pregnancy, it's not the only sleep disorder that can occur. Snoring, for example, affects up to one-third of pregnant women by the third trimester, and sleep-disordered breathing affects 4-70% of pregnant women. These conditions further complicate the decision-making process regarding pharmacotherapy during pregnancy.
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Non-medication alternatives
Sleep disturbances and disorders are common during pregnancy, with insomnia affecting 5% to 38% of women in early pregnancy and up to 60% in late pregnancy. While sleep aids may be considered, healthcare providers often recommend addressing sleep difficulties without medication or supplements due to limited research on their safety for pregnant individuals and fetuses. Here are some non-medication alternatives to promote sleep during pregnancy:
Establish Regular Sleep-Wake Cycles
Maintaining a consistent sleep schedule can help regulate your body's internal clock, making it easier to fall asleep at night and wake up in the morning. Try to go to bed and wake up at the same time each day, even on weekends.
Stimulus Control
Associating specific stimuli with sleep can help condition your body to prepare for rest. Establish a relaxing bedtime routine by dimming the lights, listening to soothing music, or practicing deep breathing exercises. Avoid bright screens and stimulating activities before sleep.
Minimize Fluid Intake Before Bed
Decrease your fluid intake a few hours before bedtime to reduce nocturia (the need to urinate during the night). This can help you sleep for longer stretches without interruptions.
Avoid Caffeine Close to Bedtime
Caffeine is a stimulant that can keep you alert and make it difficult to fall asleep. Refrain from consuming caffeine close to bedtime, and if possible, limit your overall caffeine intake during the day.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is a specialized form of therapy that can help you identify and change negative thoughts and behaviors that affect your sleep. It involves learning relaxation techniques, improving sleep hygiene, and developing coping strategies to manage insomnia.
Exercise and Meditation
Regular physical activity and meditation can help reduce stress, improve mood, and promote better sleep. Find forms of exercise that you enjoy and that are comfortable during pregnancy, such as walking, swimming, or prenatal yoga. Meditation and deep breathing exercises can also be practiced anytime, anywhere, to help calm your mind and body.
Acupuncture
Acupuncture involves stimulating specific points on the body to alleviate various conditions, including insomnia. It is generally considered safe during pregnancy when performed by a licensed and experienced practitioner. Always consult with your healthcare provider before starting any new treatment.
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Zolpidem and other nonbenzodiazepines
Zolpidem is a sedative-hypnotic drug commonly used for the short-term treatment of insomnia. It is also known by the brand name Ambien. While Zolpidem is frequently prescribed to pregnant women, there is limited information on its reproductive safety.
Some studies have shown that the use of Zolpidem during pregnancy may be associated with an increased risk of adverse pregnancy outcomes, including low birth weight, small for gestational age, preterm birth, caesarean section, and NICU admission. Additionally, there is a risk of neonatal respiratory depression, especially when the drug is used with other central nervous system (CNS) depressants during the latter stages of pregnancy. Infants born to mothers who took Zolpidem during pregnancy may also be at risk for developing physical dependence and withdrawal symptoms, such as agitation, in the postnatal period.
Due to the limited research on the safety of sleep aids for pregnant people and fetuses, healthcare providers may opt not to recommend any sleep aids during pregnancy. However, as sleep deprivation during pregnancy can negatively impact the health and safety of both the pregnant person and the baby, some pregnant individuals and their doctors may decide that the benefits of certain sleep aids outweigh the risks.
It is important to note that non-pharmacologic interventions are generally considered the safest approach for treating sleep disturbances during pregnancy, but they are often ineffective. Therefore, the decision to use sleep aids during pregnancy should be made in consultation with a healthcare provider, carefully weighing the risks and benefits of each option.
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Doxylamine and other antihistamines
Sleep problems are common during pregnancy, particularly in the third term, and many pregnant people experience insomnia. Doxylamine is a first-generation histamine H1 receptor antagonist that is used to treat insomnia, allergic rhinitis, and nausea and vomiting during pregnancy. It is available over the counter in the US and as a prescription medication. Doxylamine is highly lipophilic and has a half-life of 11.9 hours. It undergoes hepatic metabolism and is excreted by the kidneys.
Doxylamine is considered relatively safe for use during pregnancy. In the early 1980s, lawsuits alleged that Bendectin, which included doxylamine, caused birth defects, but extensive studies found no evidence to support this. The US FDA approved Diclegis, which has the same ingredients as Bendectin, for treating nausea and vomiting in pregnant women in 2013. However, some studies have identified associations between doxylamine and specific birth defects, such as oral clefts, pyloric stenosis, hypoplastic left heart syndrome, spina bifida, and neural tube defects.
When taking doxylamine, individuals should be aware of potential adverse effects, such as dry mouth, and drug interactions, especially with alcohol and other central nervous system depressants, which can increase sedation. It is important to consult with a healthcare provider before taking doxylamine or any other medication or supplement during pregnancy to weigh the risks and benefits and monitor for any unwanted effects.
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Frequently asked questions
It is recommended that you consult a healthcare provider before taking any medication or supplement while pregnant. There is limited research on the safety of sleep aids for pregnant people and foetuses, and some studies have found that certain sleep aids can contribute to breathing problems and withdrawal symptoms in newborns. However, sleep deprivation during pregnancy can also have negative consequences, so some doctors may determine that the benefits of certain sleep aids outweigh the risks.
There are several alternatives to sleeping tablets that can help you get a good night's sleep while pregnant. These include:
- Avoiding caffeine and alcohol
- Reducing screen time before bed
- Establishing a relaxing bedtime routine
- Staying active during the day
- Using blackout curtains
- Trying different sleeping positions and pregnancy pillows
- Taking natural supplements, such as folic acid or iron, to address underlying pregnancy discomforts
Unisom, an over-the-counter sleep aid, is considered safe to take during pregnancy by some healthcare professionals. The active ingredient in Unisom is doxylamine, an antihistamine that is thought to be safe for pregnant women and their babies. However, it is important to consult with a healthcare provider before taking any medication or supplement while pregnant, as the research on the safety of sleep aids during pregnancy is limited.
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