Around 78% of women report disturbed sleep during pregnancy, with up to 80% experiencing insomnia symptoms by the third trimester. Adequate sleep is important for maternal and fetal health, helping to avoid complications like hypertension, gestational diabetes, and low birth weight. This article provides guidance on safely addressing sleep issues during pregnancy, particularly concerning medication.
Why Sleep is Challenging in Pregnancy
Pregnancy brings physiological and physical changes that disrupt sleep. Hormonal shifts, particularly increases in progesterone and estrogen, contribute to sleep disturbances, sometimes as early as the first trimester. Progesterone, essential for maintaining pregnancy, acts as a sedative but can also lead to fragmented sleep. Estrogen fluctuations can affect temperature regulation, causing hot flashes and night sweats that interfere with comfort.
Physical discomforts also play a role as pregnancy progresses. The growing uterus can cause back pain, frequent nighttime urination, and difficulty finding a comfortable sleeping position. Restless legs syndrome, heartburn, and anxiety about birth can further contribute to sleeplessness.
Non-Medicinal Sleep Strategies
Before considering medication, non-pharmacological approaches can help improve sleep during pregnancy. Establishing a consistent sleep schedule by going to bed and waking up at the same time daily regulates the body’s internal clock. Creating a comfortable sleep environment involves keeping the bedroom dark, cool, and quiet. Using pillows to support the growing belly and placing one between the knees alleviates physical discomfort and optimizes sleeping positions. Side sleeping, especially on the left, is often recommended to improve blood flow to the baby.
Dietary adjustments support better sleep. Avoiding caffeine and heavy, spicy meals close to bedtime prevents indigestion and overstimulation. Limiting fluid intake in the evening reduces nighttime bathroom trips. Incorporating light, regular exercise earlier in the day, about four to six hours before bedtime, promotes sleep without overstimulating the body. Relaxation techniques such as deep breathing, meditation, or a warm bath before bed help calm the mind and prepare the body for rest.
How Medication Safety is Assessed
Evaluating medication safety during pregnancy involves weighing potential benefits against risks to both mother and fetus. No medication is without risk during pregnancy. The U.S. Food and Drug Administration (FDA) revised its medication safety labeling in 2015 with the Pregnancy and Lactation Labeling Rule (PLLR). This rule replaced the older letter categorization system (A, B, C, D, X) with a detailed narrative summary.
The PLLR provides comprehensive information on a drug’s effects during pregnancy, including a risk summary, clinical considerations, and data from human and animal studies. It also includes information about pregnancy exposure registries, which collect data on outcomes when pregnant individuals use specific medications. This detailed approach helps healthcare providers make informed decisions, considering how risks might change throughout pregnancy.
Common Medications Considered for Pregnancy Sleep
Certain over-the-counter medications, particularly some antihistamines, may be considered by healthcare providers for sleep issues during pregnancy, always under medical guidance. Diphenhydramine (Benadryl) and doxylamine (Unisom) are antihistamines that cause drowsiness and are sometimes used as sleep aids. These medications are generally recognized as having a lower risk profile when used intermittently for sleep in pregnancy. While some studies suggest a potential, though inconsistent, association between first-trimester diphenhydramine use and birth defects, many studies report no increased chance.
In severe cases, under strict medical supervision, a healthcare provider might consider other options. Some antidepressants with sedating effects, such as certain tricyclic antidepressants, may address sleep disturbances, particularly if underlying mood disorders are present. Benzodiazepines, a class of prescription sedatives, are sometimes considered for severe insomnia, though their use is generally limited due to concerns about potential neonatal withdrawal symptoms if taken close to delivery.
Medications to Avoid During Pregnancy
Sleep aids and medications are generally discouraged or contraindicated during pregnancy due to known or suspected risks. Sedative-hypnotics, such as zolpidem (Ambien) and eszopiclone (Lunesta), are typically not recommended because limited data exists on their reproductive safety. Some studies suggest zolpidem use might be associated with a higher chance of preterm delivery and lower birth weight, and it can cause withdrawal symptoms or respiratory depression in newborns if taken late in pregnancy.
Many herbal remedies and dietary supplements, including melatonin, lack sufficient safety data for use during pregnancy. While melatonin is naturally produced by the body and plays a role in pregnancy, supplemental doses can significantly exceed natural levels, and its impact on the developing fetus is not fully understood. Experts advise caution with such products as they are not regulated with the same strictness as prescription medications; their purity, dosage, and effects may be inconsistent or unknown. All medication decisions during pregnancy should involve a healthcare provider to ensure safety for both the mother and baby.