Treatment Options for Insomnia in Pregnancy
Authored by:
Anna Glezer, M.D.
Sleep in pregnancy can be a challenge and poor sleep leads to various emotional and physical consequences (See: Sleep Disturbance in Pregnancy). Before seeking treatment for sleep, it is important to evaluate the potential reasons why you might be having difficulty with sleep, whether it is a medical reason such as sleep apnea, or a mental health condition such as anxiety.
This article will focus on the various ways that sleep problems can be treated with and without medication.
Psychotherapeutic Treatments
Cognitive-behavioral therapy for insomnia is highly effective and can be adapted to the pregnant woman. This therapy involves providing the woman with information about sleep, behavioral strategies and skills, changing unhelpful believes and thoughts about sleep, and relaxation techniques. It can be done with a trained clinician, or on your own with a workbook (see my Resources page for suggestions).
Sleep hygiene is essential. Good sleep hygiene refers to all the specific interventions one uses to ensure a good sleep. This includes:
A consistent bedtime weekly and weekends
Avoiding naps late in the day
Ensuring the bed is used only for sleep (and sex) – that means no electronics, no television, etc. so that the mind and body learn to associate the bed with only sleep
Avoiding substances that can impact sleep such as caffeine late in the day
Giving yourself 15-20 minutes to fall asleep, and if that is not working, leaving the bed to do something else and then returning. Again, this is so the body associates the bed with just sleep.
Having comfortable pillows, blankets, and also ensuring the room is a good temperature, as body temperature needs change during pregnancy
Finally, many women find mindfulness based relaxation exercises, meditation, and yoga to be helpful. These can both help immediately to induce a calm state prior to bedtime and in the long term allow for the development of a mental and physical state that is better adapted to good sleep.
Medication Treatments
Because the majority of women experience difficulty with sleep in pregnancy, the number of women who take medication for sleep while pregnant is high. Studies report about 1 in 25 women taking medication several times per week and 1 in 10 taking medication at least monthly.
There are prescription-strength medication options as well as those available over the counter. The most common nonprescription medications that can help with sleep in pregnancy are antihistamines such as Benadryl (diphenhydramine) and Unisom (doxylamine), and melatonin.
Antihistamines like Benadryl (diphenhydramine) have been used extensively in pregnancy and are not associated with birth defects. The main side effect patients note is some morning grogginess. Melatonin is a substance naturally produced by the body, but as a supplement it has much less data, and is still being researched. Initial studies in animals suggest it is important for fetal development and essential processes of pregnancy. However, like all supplements, it is not regulated by the FDA and it is therefore important to make sure you are purchasing from a trustworthy company.
Among prescription medications, the ones used most often both during and outside of pregnancy include Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon). Other prescription medications that can help with sleep in pregnancy or postpartum include those in the category of benzodiazepines/anti-anxiety agents such as Ativan (lorazepam) and in the category of antidepressants such as trazodone. As these all require a prescription, you will need to speak with your obstetrician, primary care physician, or psychiatrist.
Postpartum-Specific Treatments
In the postpartum period, one intervention that has successfully led to improved sleep and therefore decreased symptoms of depression is reducing infant sleep problems. There is research and many opinions on how to improve infant sleep, and I recommend being in touch with your pediatrician about the strategy that is right for you.
Selected References:
Ibrahim, S., Foldvary-Schaefer, N. Sleep disorders in pregnancy: Implications, evaluation and Treatment. Neurol Clin 30 (2012) 925–936.
Okun, M., Ebert, R., Saini, B. Overview of sleep-promoting medications used in pregnancy. American Journal of Obstetrics and Gynecology (2015) 428-441.
