Insomnia

INFORMATION FOR WOMEN WHO HAVE INSOMNIA DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is insomnia?

Most people have trouble sleeping from time to time, and this qualifies as an episode of insomnia but, when it happens frequently and continues over time, thats an insomnia disorder. This term is applied to both if you have trouble falling asleep and if you have trouble staying asleep (including waking up too early). The definition also requires the events to have happened at least 3 nights in a week and for at least 3 months. Insomnia disorder occurs when you have adequate opportunity to sleep (that is, you do not have a job that forces you to work 100 hours per week, etc.) and there is no alternative explanation, such as generalized anxiety disorder (GAD), depression, drug use, or other sleep-related conditions (eg, a shifted daily sleep-wake rhythms, narcolepsy, and sleep breathing problems).

How common is insomnia during pregnancy?

Insomnia is very common during pregnancy. In fact, close to 80 percent of pregnant women suffer from insomnia. Furthermore, sleep disorders overall are common during pregnancy, so if you are pregnant and having sleep problems, insomnia disorder must be distinguished from other sleep conditions, plus the underlying reason for insomnia needs to be determined.

How is insomnia disorder diagnosed during pregnancy diagnosed?

Your doctor, or your therapist, go through your medical and sleep history and evaluate your sleep problem with respect to lists of criteria whose presence indicates insomnia disorder and criteria for other disorders affecting sleep. If the sleep trouble occurs at least 3 nights per week and has been happening for at least 3 months, if the problem occurs despite adequate opportunity to sleep, and if the problem cannot be attributed to some other condition, then insomnia disorder is diagnosed. Alternatively, you might meet the criteria for a different disorder, such as obstructive sleep apnea (you stop breathing momentarily, which wakes you for a few moments without you knowing), or a circadian clock shift (your body does want to sleep once per day, but you are shifted to match the light and darkness of a time zone different from the one in which you live). Another condition that must be distinguished from insomnia disorder that can affect pregnant women is restless legs syndrome.

Does insomnia cause problems during pregnancy?

Insomnia during pregnancy puts you are risk of developing depression in the late 3rd trimester and after delivery. It also increases the likelihood of preterm birth, longer labor, operative birth (cesarean section and instrument-assisted vaginal birth). Furthermore, insomnia at night makes you tired during the day with a tendency for day-time sleep (hypersomnia), which can lead to mood changes and interfere with your relationship with your partner.

Does insomnia during pregnancy cause problems for the baby?

Insomnia can affect the baby by increasing the chance of instrumented delivery and prolonged labor. Following birth, it may also impact mother-infant bonding. Furthermore, it can lead to depression during pregnancy, which has been shown to harm the developing baby independently of any anti-depressant medication the mother may require as treatment.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the insomnia
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat insomnia during pregnancy?

Medication is indicated for insomnia only after non-pharmacological strategies have been attempted and have failed. Once it is decided that medications are the best option, there are numerous choices as drugs vary greatly in their effectiveness and risks to the developing baby. Based on available studies to date, fairly safe sleep-inducing medications during pregnancy include chloral hydrate, eszopiclone, zaleplon, zolpidem, and diphenhydramine. A higher level of concern surrounds benzodiazepines, paroxetine, carbamazepine, lithium, and valproic acid. Therefore, these medications should be avoided. A host of other medications are useful for insomnia during pregnancy, but only if a different condition is the main reason for using the drug. Certain antidepressants fall into this category (used in a depressed pregnant patient who also has insomnia), as do drugs given for psychosis and bipolar disorder (mood stabilizers).

Who should NOT stop taking medication for insomnia during pregnancy?

If you are indicated a medication that is considered safe during pregnancy and, if it works for you, there is no reason to stop the treatment.

What should I know about choosing a medication for my insomnia during pregnancy?

A variety of medications are given for insomnia. The concern about possible birth defects varies among the different drugs. If you have been diagnosed with insomnia, and if non-drug therapies have not worked, your doctor can recommend and prescribe a drug that is thought to carry a low risk of complications for the developing baby.

You may find Pregistrys expert reports about the individual medications to treat insomnia here. Additional information can also be found in the sources listed at the end of the report.

What should I know about taking a medication for my insomnia when I am breastfeeding?

Potentially hazardous drugs to nursing infants include doxepin, which is given for depression combined with insomnia, and lithium, which is given when the insomnia is connected with bipolar disorder. Insomnia drugs that are fairly safe in lactating mothers include zaleplon, certain antidepressants, and some mood stabilizers, such as valproic acid and carbamazepine.

What alternative therapies besides medications can I use to treat my insomnia during pregnancy?

The first-line treatments for insomnia are sleep hygiene and sleep education, which means that you are taught about how to take control of your sleep-wake cycle and directed to habits that promote sleep. For instance, try using your bed only for sleep, as opposed to sitting/lying in bed to study and work or to watch television or videos, going to bed and waking up on a regular schedule, sleeping in dark, cool rooms, and avoiding blue, bright light prior to going to bed. Such light typically comes out from device screens, so if you must use a device at night, set the display to low intensity and comfort view that reduces or eliminates blue light that hits your eyes. Its also possible to find special glasses that filter out the blue components of light, but with or without the glasses you should avoid light that is very intens
e. If you cannot darken the room completely, a sleeping mask can be helpful too. Avoiding light is one aspect of stimulus control, which also involves avoiding caffeinated beverages in the latter part of the day.

Along with sleep hygiene and stimulus control, there are various behavioral therapies. These make use of relaxation, sleep restriction, cognitive therapy, and cognitive-behavioral therapy.

What can I do for myself and my baby when I have insomnia during pregnancy?

It is important to manage sleep conditions with the same seriousness as we approach other conditions. You must seek treatment because your insomnia can affect your mood, your labor, and even your child

Resources for insomnia in pregnancy:

For more information about insomnia during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


Medications for Insomnia


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