Colin Snow
Sleep is a common issue during pregnancy, with many pregnant people experiencing insomnia or other sleep disturbances. While some sleep aids may be dangerous during pregnancy, there are a variety of strategies and medications that can help. Sleep aids and medications are a complicated issue for pregnant people, as there is limited research on their safety for both the pregnant person and the fetus. However, sleep deprivation during pregnancy can have negative consequences, so it is important to explore options for improving sleep. Some lifestyle adjustments, such as limiting caffeine intake, avoiding heavy meals and spicy foods before bed, and establishing a relaxing bedtime routine, can help alleviate pregnancy insomnia without the use of sleep aids. Additionally, some over-the-counter antihistamines like doxylamine and diphenhydramine are considered safe during pregnancy and can be recommended by doctors for occasional use. Herbal teas and remedies can also be soothing, but it is important to consult a healthcare provider, as not all herbs are safe during pregnancy.
| Characteristics | Values |
|---|---|
| Prevalence of sleep disturbances and disorders | Very common, affecting 25% of women in the first trimester, 27% in the second trimester, and over 40% in the third trimester |
| Risks of sleep deprivation during pregnancy | Gestational hypertension, preeclampsia, preterm birth, and increased rates of C-sections |
| Risks of taking sleeping pills during pregnancy | Potential toxicity to the fetus, alterations in pharmacokinetic parameters, congenital abnormalities, and other complications |
| Safety of taking sleeping pills during pregnancy | Limited research and clinical trials on the effects of sleeping pills on the long-term health of infants and mothers |
| Recommended sleep aids during pregnancy | Lifestyle adjustments, magnesium supplement, melatonin (probably safe but lacking studies on effectiveness and safety), antihistamines (e.g. doxylamine and diphenhydramine), herbal remedies (e.g. ginseng, honey, nutmeg) |
| Alternative approaches to improve sleep during pregnancy | Sleep hygiene practices, pregnancy-specific adjustments (e.g. sleeping on the left side, using a pregnancy pillow), regular bedtime routine, mindful eating and drinking (e.g. limiting caffeine and heavy meals), regular exercise |
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What You'll Learn
Sleep aids vs natural remedies
Sleep is a basic necessity in life, and getting a good night's sleep is critical for optimal health, especially during pregnancy. However, hormonal shifts, physical discomfort, and other factors can make it difficult for pregnant people to get the sleep they need. While sleep aids and natural remedies can help alleviate pregnancy-related insomnia, it is important to carefully consider the potential risks and benefits of each option.
Sleep Aids
The use of sleep aids during pregnancy is a complex issue due to limited research on their safety for both pregnant individuals and fetuses. While some medications may be recommended by doctors, it is important to note that the potential risks are not yet fully understood. The Food and Drug Administration (FDA) requires manufacturers to provide information on the safety of medications during pregnancy, but the ultimate decision should be made in consultation with a healthcare provider.
Natural Remedies
Natural remedies can be a safer alternative to sleep aids during pregnancy. Aromatherapy, for example, has been used for centuries to promote restorative health and wellness. However, it is important to consult with a healthcare provider before using essential oils, as some may be unsafe during pregnancy. Herbal teas can also help promote sleep, but it is important to avoid certain herbs, such as chamomile, which has been linked to an increased risk of preterm birth and decreased newborn size.
Lifestyle Adjustments
Making pregnancy-specific adjustments to sleep habits and lifestyle choices can also help improve sleep during pregnancy. Sleeping on the left side, for example, enhances blood flow and prevents the uterus from placing too much weight on the liver. Establishing a regular bedtime routine, avoiding heavy meals and caffeine later in the day, and keeping the bedroom dark and quiet can also promote better sleep. Cognitive behavioral therapy for insomnia (CBT-I) is another drug-free option that aims to improve sleep by changing mental and behavioral habits.
In conclusion, while sleep aids may be necessary for some pregnant individuals, natural remedies and lifestyle adjustments should be considered first due to the limited understanding of the potential risks associated with sleep aids. Pregnant people should always consult with a healthcare provider before starting any new medication, supplement, or natural remedy to ensure the best possible outcome for both themselves and their baby.
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Doxylamine and diphenhydramine
Sleep disturbances and disorders are common during pregnancy, affecting up to 80% of expecting mothers. While sleep deprivation during pregnancy can have negative consequences, the lack of clinical trials and limited understanding of the effects of medications on the long-term health of infants and mothers make discontinuing medication seem like the safest course. However, some pregnant people and their doctors may determine that the benefits of certain sleep aids outweigh the risks.
Doxylamine is a medication used to manage and treat nausea and vomiting during pregnancy, allergic rhinitis, and insomnia. It is often co-administered with pyridoxine (vitamin B6) as an extended-release oral tablet. The tablets should not be crushed, chewed, or split to maintain the extended-release effects. The recommended dose is two tablets before bed on an empty stomach, and if symptoms continue, one tablet after waking up and two at night. Doxylamine is generally safe and effective, with minimal adverse events, and is available over the counter in the USA.
The combination of doxylamine and pyridoxine was previously discontinued due to concerns about congenital disabilities. However, the newer formulation received approval in 2013 for treating nausea and vomiting during pregnancy. The fetal safety of this combination has been proven by numerous studies, and it is the only FDA-approved medication for this indication. The maternal safety of this combination is still an important public health question, and further evaluation is needed.
Diphenhydramine is another antihistamine medication that has been shown to ease morning sickness symptoms by suppressing the pathways that trigger nausea and vomiting. It is also generally considered safe to take during pregnancy, and the American College of Obstetricians and Gynecologists (ACOG) supports its use with vitamin B6 to treat nausea and vomiting.
While doxylamine, diphenhydramine, and vitamin B6 can be helpful during pregnancy, it is always advisable to consult a healthcare provider before taking any medication. They can provide guidance on appropriate medications, doses, and potential side effects or interactions.
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Melatonin's effectiveness
Melatonin is a hormone that is naturally produced by the body and helps promote sleep. It is also sold over the counter as a dietary supplement to aid sleep. Melatonin does not make you fall asleep but rather lets your body know that it is time for bed so that you can fall asleep more easily.
Research shows that melatonin supplements may help people with insomnia fall asleep faster. They may also have bigger benefits for those with delayed sleep phase syndrome, helping them fall asleep very late and wake up late the next day. Melatonin supplements are also used to help people who work rotating or night shifts fall asleep more easily during the day. However, some experts warn against taking melatonin for this purpose as it can be difficult for shift workers to effectively time its administration or predict its effects.
The typical dose of melatonin (1 to 3 mg) elevates blood melatonin levels up to 20 times the normal levels. While melatonin is considered safe and non-toxic for most adults, the dose should be kept to a minimum. Taking melatonin in excess of 5 mg is unlikely to help you fall asleep faster.
While melatonin is indeed “natural”, the amount delivered by various over-the-counter preparations typically exceeds the quantities normally produced by the body. As is the case with most supplements, there is limited knowledge about the impact of high levels of melatonin on the developing fetus. Melatonin crosses the placenta and blood-brain barrier from the maternal circulation to the fetus in the third trimester of pregnancy. Melatonin receptors are widespread in the fetus in both central and peripheral tissue from early fetal development.
Animal studies have shown that melatonin supplementation during pregnancy decreases the risk of pre-eclampsia, preterm birth, and intrauterine growth retardation (IUGR). Preliminary studies also suggest that melatonin supplementation may have a beneficial effect on fertilization rates and embryo quality, likely due to a reduction in oxidative damage.
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Insomnia's impact on pregnancy
Sleep disturbances are common during pregnancy, with insomnia affecting most pregnant women at some point. About 25% of women experience insomnia in their first trimester, with this number rising to 66% by the end of the third trimester. The causes of insomnia during pregnancy include hormonal changes, physical discomfort, frequent urination, stress, nausea, vomiting, back pain, leg cramps, and a growing fetus placing pressure on the body.
The impact of insomnia during pregnancy can be significant. Women who don't get enough sleep while pregnant have higher risks of developing preeclampsia and gestational diabetes, as well as increased rates of C-sections. Insomnia can also contribute to anxiety and depression in late pregnancy and postpartum. It can negatively impact the partner relationship and interfere with mother-infant bonding. Sleep disturbances in the third trimester are associated with increased perception of labour pain, longer labour, and increased operative births.
Managing insomnia during pregnancy is crucial for the health of both the mother and the pregnancy. While sleep aids and medication are options, they should be approached with caution due to the limited research on their safety for pregnant people and fetuses. The potential toxicity of drugs to the fetus and breastfeeding infant is a significant concern. Healthcare providers often recommend addressing sleep difficulties through non-pharmacological measures such as lifestyle changes, sleep hygiene practices, and therapy. Cognitive behavioural therapy for insomnia (CBT-I) has been shown to help ease insomnia symptoms and improve feelings of fatigue, anxiety, and depression.
Some non-pharmacological strategies for managing insomnia during pregnancy include sleeping on the left side, which enhances blood flow and reduces pressure on the liver, keeping the bedroom dark and quiet, establishing a regular bedtime routine, and eating and drinking mindfully, such as avoiding heavy meals, caffeine, and excessive liquids before bedtime. Light exercise during the day and short naps can also help improve sleep quality. If these measures fail to alleviate sleep problems, healthcare providers may consider pharmacological treatments, carefully weighing the risks and benefits for the mother and fetus. Antihistamines like doxylamine, which is safe during pregnancy, can be used for moderate insomnia. In more severe cases, sedating antidepressants or sedative-hypnotics may be necessary, although limited reproductive safety data is available for these medications.
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Drug toxicity risks
Sleep disturbances are common in pregnancy, and sleep disorders may worsen or present during gestation. Managing a pregnant patient is complicated by the risk of teratogenicity, pharmacokinetic changes, and the dynamic nature of pregnancy. There is a significant lack of clinical trials and limited understanding of the effects of medications on the long-term health of infants and mothers.
Prescribing medications to pregnant and lactating women poses a unique challenge for clinicians due to concerns about the potential toxicity of drugs to the foetus and breastfeeding infant. During the earliest postpartum days, more medication penetrates into the breast milk due to wide paracellular pathways between mammary epithelial cells. However, the newborn’s low volume of milk intake typically results in a small medication dose exposure.
Medications are more likely to be transferred into breast milk if they have high concentrations in the maternal plasma, are lipophilic, have a smaller molecular weight, and are less protein-bound. Further concerns for potential infant toxicity include specific infant characteristics, including age, size, and health.
Benzodiazepines, for example, have not been proven safe for pregnant women, and there are links between their use and preterm labour and C-section deliveries. 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. Nonbenzodiazepines should also be avoided during pregnancy, as they have been associated with an increased risk of low birth weight, preterm delivery, and C-sections.
Prescription sleeping pills are stronger than over-the-counter ones, and providers do not typically recommend using them long-term due to the risk of dependence and addiction. Sleeping pills can cause a range of side effects, including constipation, diarrhoea, and muscle weakness. Approximately 8 out of 10 people experience a hangover effect the day after taking sleep medicine, with symptoms such as drowsiness, muddled thinking, and dizziness, which can negatively impact daily tasks.
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Frequently asked questions
Research on the safety of sleeping pills during pregnancy is limited. However, certain over-the-counter sleep aids, such as Unisom and Benadryl, are generally considered safe. The active ingredients in these medications, doxylamine and diphenhydramine, are antihistamines that can help with sleep and are considered safe during pregnancy.
There are several natural alternatives to sleeping pills that can help improve sleep quality during pregnancy. These include reducing caffeine intake, limiting screen time before bed, taking warm baths, listening to relaxing music, and practising relaxation techniques such as deep breathing and progressive muscle relaxation.
Prescription sleeping pills are generally stronger than over-the-counter options and should be used with caution during pregnancy. While some healthcare providers may recommend certain prescription sleep aids, it's important to consult your doctor before taking any prescription medications while pregnant.
The true safety of taking sleep medications during pregnancy is difficult to determine since studies often exclude pregnant individuals. However, certain medications, such as benzodiazepines, have been linked to an increased risk of miscarriage, preterm labour, and C-section delivery. It's crucial to weigh the pros and cons before using any sleeping aids during pregnancy and to consult a healthcare provider to assess the benefits against the potential risks.
