Herbie Murray
Sleep disruption and insomnia are common issues for postpartum women, and it is important to carefully consider any decision to treat a sleep disorder with medication. While over-the-counter sleep aids like melatonin can be effective, there is limited research on their safety for breastfeeding mothers and infants. Melatonin may be used with caution during breastfeeding, but infant monitoring is advised to ensure no adverse effects such as drowsiness. Other medications like zolpidem and zopiclone can also be used during breastfeeding but require similar monitoring for potential side effects. First-generation antihistamines are also used as sleep aids but may decrease breast milk production, although evidence is limited. Breastfeeding mothers should consult their healthcare provider for advice and consider non-medication alternatives to improve sleep.
| Characteristics | Values |
|---|---|
| Melatonin | There is limited research on the safety of melatonin for breastfeeding mothers. It is recommended that you consult your healthcare provider before taking melatonin. |
| Zolpidem | Can be used while breastfeeding, but infant monitoring is required. Possible side effects include drowsiness, slowed breathing rate, and dry mouth. |
| Zopiclone | Can be used while breastfeeding but monitor the infant for possible drowsiness. |
| Sedating Antihistamines | May decrease prolactin levels, which could reduce breast milk production. However, the impact on milk production is not well studied. |
| Benzodiazepines | Research indicates a low risk of adverse events in nursing infants. Short-acting benzodiazepines, such as lorazepam, may be preferred as they promote sleep without interfering with waking hours. |
| Non-medication alternatives | Improving sleep hygiene, such as avoiding food and electronics before bed and sticking to a routine sleep schedule. Cognitive-behavioral therapy for insomnia is also an option. |
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What You'll Learn
- Melatonin may be safe in small amounts, but there is little research on its effects
- Zolpidem and Zopiclone can be used, but require infant monitoring
- Sedating antihistamines may decrease milk production
- Benzodiazepines have a low risk of adverse events in nursing infants
- Non-medication methods include improving sleep hygiene and cognitive-behavioural therapy
Melatonin may be safe in small amounts, but there is little research on its effects
Sleep disruption and insomnia are common issues for breastfeeding mothers. While melatonin is a popular over-the-counter sleep aid, there is limited research on its effects on breastfeeding mothers and infants. Melatonin is a chemical released by the brain to induce sleep as part of the sleep-wake cycle. While it has relatively few side effects, with mild symptoms such as headaches, dizziness, nausea, and drowsiness, there is insufficient data on its long-term effects.
Although melatonin supplements can help some people fall asleep faster and sleep longer, they do not work for everyone, and their effectiveness tends to decrease over time. As a result, melatonin is intended for short-term relief from insomnia rather than ongoing use. Due to the lack of research on its effects during breastfeeding, experts generally recommend that breastfeeding mothers avoid taking melatonin until their babies are weaned. However, each person's situation is unique, and some healthcare providers may approve the use of small amounts of melatonin for a short period while breastfeeding.
The UK Drugs in Lactation Advisory Service (UKDILAS) advises that decisions regarding the use of medications during breastfeeding should be based on published evidence, pharmacodynamic and pharmacokinetic principles, risk assessments, expert advice, and simulated data. While there is very limited evidence on the use of melatonin in breastfeeding, small amounts have been detected in breast milk. However, no side effects have been observed in infants exposed to melatonin through breast milk, and the low bioavailability of melatonin minimizes the amount ingested by the infant.
Breastfeeding mothers experiencing sleep difficulties should consult their healthcare providers for personalized advice and explore non-medication alternatives, such as improving sleep hygiene by creating sleep-fostering routines and environments, avoiding food and electronics before bed, and maintaining a consistent sleep schedule. Additionally, it is important to identify and address any underlying factors contributing to sleep issues, such as post-pregnancy conditions like heartburn, leg cramps, or shortness of breath.
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Zolpidem and Zopiclone can be used, but require infant monitoring
Sleep disruption and insomnia are common issues for postpartum women, and it is understandable that medication may be considered as a solution. However, it is important to carefully consider the decision to treat sleep disorders with medication, taking into account the usual sleep deprivation associated with a newborn infant.
Zolpidem and Zopiclone can be used by breastfeeding mothers, but require infant monitoring. Very small amounts of these drugs have been found in breast milk, but no side effects have been observed in infants after exposure. As a precaution, the infant should be monitored for possible drowsiness, which may present as not waking up to feed or falling asleep while feeding, which may affect weight gain. Additionally, monitor for a slowed breathing rate and dry mouth. Monitoring the infant will quickly pick up any potential issues, but further investigation is usually required before any effects can be attributed to the medication.
It is recommended that an individual risk assessment is completed for each patient, taking into account the available information and making treatment decisions based on the principles of prescribing in breastfeeding. The cause of insomnia should be identified before medication is prescribed, and underlying factors should be treated where possible.
It is important to note that there is very limited evidence on the safety of medications for breastfeeding mothers, and assessments are often based on case reports, pharmacodynamic and pharmacokinetic principles, risk assessments, expert advice, and unpublished data. As such, it is always best to consult a healthcare provider for advice on the safest options for you and your baby.
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Sedating antihistamines may decrease milk production
Sleep disruption and insomnia are common among postpartum women, and it is understandable that they would want to turn to medication to help them sleep. However, it is important to consider the effects of the medication on breast milk production.
Sedating antihistamines are often used as sleep medications due to their ability to promote sedation by binding to histamine receptors in the brain. While these medications can help with sleep, they may also transiently decrease prolactin levels. Prolactin stimulates milk production in postpartum women, and levels of this hormone rise during pregnancy, peak at the time of delivery, and continue to be elevated in lactating women.
The prohibition on the use of first-generation antihistamines by breastfeeding women comes from a single paper published in 1985. This study focused on the effects of first-generation antihistamines on prolactin secretion. However, no studies have actually investigated the effects of these medications on breast milk production directly. While it is assumed that a transient reduction in serum prolactin levels will have no clinically significant effect on breast milk production, there is not enough evidence to be certain.
Some sources suggest that sedating antihistamines are unlikely to have a clinically significant impact on breastfeeding. However, others recommend avoiding these medications, especially long-term, as they may reduce breast milk production. Non-sedating antihistamines are generally considered a safer option for breastfeeding mothers.
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Benzodiazepines have a low risk of adverse events in nursing infants
Sleep disruption and insomnia are common among postpartum women, and many wonder what medications are compatible with breastfeeding. While many doctors advise expecting mothers to stop taking prescription medications such as benzodiazepines during pregnancy, they may continue their doses after giving birth.
Benzodiazepines are synthetic drugs that are often prescribed to treat nerve-related conditions, including seizures and anxiety. They are also used to manage severe symptoms of anxiety or insomnia. While benzodiazepines can be beneficial for treating certain conditions, they may affect other bodily functions such as breastfeeding and lactation. Benzodiazepines have been shown to be transferred into breast milk, but the amount transferred is small and compatible with breastfeeding.
Research indicates that benzodiazepines pose a low risk of adverse events in nursing infants. The largest study from the Motherisk program examined the risks associated with benzodiazepines in breastfeeding mothers, including a total of 124 exposed infants. Adverse events, specifically sedation, were observed in only 2 infants (1.6%). Additionally, studies that have quantified benzodiazepine levels in infants' serum have found low or undetectable levels, suggesting that drug exposure through breast milk is minimal.
While the risk of adverse events is low, it is important to note that substances ingested while breastfeeding can contaminate breast milk, which could be harmful to the baby. A study reported that taking benzodiazepines while breastfeeding can cause lethargy, sedation, and even weight loss in infants. Therefore, exposed infants should be monitored for sedation, especially if the mother is taking higher doses of benzodiazepines or other sedating medications.
It is important to consult with a healthcare provider before taking any medication while breastfeeding, as individual risk assessments and the underlying causes of insomnia should be considered. Non-medication alternatives, such as improving sleep hygiene and making lifestyle changes, can also be explored to address sleep problems.
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Non-medication methods include improving sleep hygiene and cognitive-behavioural therapy
While melatonin may be an option for treating insomnia during breastfeeding, there is limited evidence of its safety for infants. Therefore, non-medication methods are recommended to improve sleep while breastfeeding. These include improving sleep hygiene and cognitive-behavioural therapy.
Sleep hygiene refers to the practices and routines that promote better sleep. This includes setting a strict sleep schedule, following a bedtime routine, forming healthy habits, and optimising your bedroom environment. For example, it is recommended to avoid food and electronics for an hour or so before bed, stick to a routine sleep schedule, and ensure your bedroom is cool, dark, quiet, and free from distractions. Improving sleep hygiene can be a simple and low-cost way to improve sleep quality without the need for medication.
In addition to sleep hygiene, cognitive-behavioural therapy (CBT-I) can be an effective treatment for insomnia during breastfeeding. CBT-I is a short, structured approach that focuses on the connection between thoughts, feelings, and behaviours that contribute to insomnia symptoms. During treatment, a trained CBT-I provider helps to identify and challenge thoughts, feelings, and behaviours that interfere with sleep. They then work with the individual to reframe these thoughts and behaviours in a way that promotes restful sleep. CBT-I typically involves 6-8 sessions and can be an effective way to break the cycle of insomnia without medication.
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Frequently asked questions
There is very limited evidence on the safety of sleeping pills for breastfeeding mothers and infants. Melatonin, for example, can be used with caution during breastfeeding, but infant monitoring is required. It is important to consult a healthcare provider for advice on the safest options for you and your baby.
There are non-medication alternatives to address sleep problems, such as improving sleep hygiene by creating routines and environments that promote sleep. This includes avoiding food and electronics for an hour or so before bed and sticking to a routine sleep schedule. Cognitive-behavioral therapy for insomnia is another non-pharmacologic option.
Zolpidem and Zopiclone can be used during breastfeeding, but infant monitoring is required. No side effects have been observed in infants after exposure to these drugs through breast milk. However, as with all medications, it is important to consult a healthcare provider before taking any sleeping pills while breastfeeding.
