Dealing With Insomnia In Pregnancy

Pregnancy insomnia

During your pregnancy, especially toward the end, you’ll probably receive the advice, “Sleep while you can!”   This well-meaning recommendation can be extremely frustrating, however, as virtually all women experience some sort of sleep disturbance due to pregnancy.   Couple existing sleeping issues with added anxiety surrounding the anticipation of sleepless nights once baby arrives, and you have a recipe for staying awake all night!

One way that sleep disruptions can manifest is insomnia.  Clinically defined as difficulty falling asleep, difficulty staying asleep, waking too early from sleep, and/or experiencing non-restorative sleep, insomnia affects the majority of expecting mothers.  The causes of insomnia often change throughout pregnancy.  For example, ailments such as nausea and vomiting are more likely to lead to sleep deprivation during the first trimester, while discomforts like tingling legs and fetal movements are more likely to negatively impact sleep in the third trimester.  Studies have shown that the symptoms of insomnia tend to worsen as pregnancy progresses.  In addition to the near-universal overall physical discomfort and frequent middle of the night bathroom trips at the end of pregnancy, impending anxiety surrounding delivery and motherhood and hormonal fluctuations also affect sleep quality.

It’s important to recognize your insomnia and develop treatment strategies.  Sleep disturbances during pregnancy are related to a higher likelihood of preterm labor, longer labor, cesarean delivery, and depression during pregnancy, along with postpartum depression and anxiety.  Therefore, it’s incredibly important to recognize insomnia and develop treatment strategies with your doctor.  Below are some approaches you might consider.

 Behavioral Strategies

Healthcare professionals recommend behavioral modifications as a first-line treatment for insomnia.  Small changes to your routine can make a big impact, so consider the following behavioral strategies to help get a more restful night’s sleep:

  • Bring back bedtimes. Bedtimes aren’t just for kids!  Although it might be tempting to stay up later and sleep in later on the weekends, changing your sleep and wake times by more than an hour can throw off your internal clock, or circadian rhythm. This will mess with your brain’s production of melatonin, a hormone responsible for causing sleepiness, making it more difficult to fall asleep earlier on weeknights.
  • Ditch the screen. Electronic devices such as TVs, tablets, and phones, emit blue light that sends a signal to your brain that it’s time to be awake.  Try to turn off your devices at least an hour before bedtime.
  • Develop rituals. Establishing a relaxing bedtime routine, like taking a warm bath or sipping a mug of decaffeinated tea, will help you wind-down after a long day and send your body cues that it’s time for some shut-eye.
  • Avoid large meals. The incidence of indigestion and heartburn increases during pregnancy, and consuming large meals before bed will only exacerbate these sleep-disrupting conditions.
  • Cut the caffeine. Caffeine levels should be limited during pregnancy, as the substance can cross the placenta and your developing baby can’t metabolize is as effectively as you can.  ACOG recommends that pregnant women limit daily caffeine intake to less than 200 mg per day, but if you are experiencing sleep difficulties then you might consider abstaining completely.
  • Exercise! It might seem counterintuitive because you are so tired from not sleeping well at night, but exercise is a proven strategy for treating sleep issues like insomnia.  Exercise is recommended during pregnancy for all women (provided there are no serious complications), and establishing an exercise routine will not only help you sleep but also improve you and your baby’s overall health.  Consider exercising in the morning or early afternoon, as the rush of adrenaline that can accompany exercise might interfere with your ability to fall asleep if it occurs too close to bedtime.
  • Just say no. Alcohol and cigarettes are always to be avoided during pregnancy. These substances not only cause harm to your developing baby, but they also interfere with the quality of your sleep.
  • Catch some daytime ZZZ’s. When possible, take a nap during the day. Research has shown that daytime napping can help compensate for reduced sleep duration or quality at night. Read more about this here.

Medication

When behavioral changes aren’t effective, some pregnant women might consider taking medication to treat their insomnia.  The risk to benefit ratio must be considered carefully by you and your doctor before taking any medication during pregnancy that hasn’t been fully evaluated in a clinical trial.

Benzodiazepines, such as Ativan, and hypnotic benzodiazepines, such as Ambien, are the most commonly prescribed medications for insomnia during pregnancy.  Very few studies have been conducted in order to systematically evaluate the safety of these drugs in pregnancy, but both classes of medications have been associated with an increased risk of preterm labor and low birth weight.  Therefore, it’s critical to talk about these medications with your doctor if you are considering taking them during your pregnancy.  Diphenhydramine, an antihistamine found in medications such as Benadryl, can be prescribed or obtained over-the-counter.  Although antihistamines are most commonly prescribed during pregnancy for the treatment of hyperemesis gravidarum, colds, or allergies, many women seek them out because of their sleep-inducing properties.  Antihistamines are largely deemed safe by the medical community, but discuss specific brand and dosing information with your doctor before taking any medication.

Alternative Medicine

A small study of 22 pregnant women experiencing insomnia showed that acupuncture and sleep hygiene education significantly reduced self-reported signs on insomnia as compared to education alone.   Meditation and hypnotherapy are proven effective treatments for chronic insomnia in the general population, but no studies have been conducted examining their effects in pregnant populations.

Pregnancy is a time when women actually need more sleep to sustain the tremendous effort of generating new life.  Therefore, if you believe you are suffering from insomnia, it’s critical to talk to your doctor about treatment strategies.  Managing your insomnia through one or more of the factors above will help you have the healthiest pregnancy possible.

Please share any tips that you have for managing insomnia during pregnancy in the comments below!

References:

da Silva JB, Nakamura MU, Cordeiro JA, Kulay L.  Acupuncture for Insomnia in Pregnancy – a Prospective, Quasi-Randomized, Controlled Study.  Acupuncture in Medicine.  23(2): 47-51, 2005.

Juric S, Newport DJ, Ritchie JC, Galanti M, Stowe ZN.  Zolpidem (Ambien) in Pregnancy: Placental Passage and Outcome.  Archives of Women’s Mental Health.  12:441, 2009.

Mindell JA, Cook RA, Nikolovski J.  Sleep Patterns and Sleep Disturbances Across Pregnancy. Sleep Med. 16(4): 483-488, 2015.

Reichner CA.  Insomnia and Sleep Deficiency in Pregnancy.  Obstet Med. 8(4): 168-171, 2015.

Sedov I, Goodman SH, and Tomfohr-Madsen.  Insomnia Treatment Preferences During Pregnancy.  J Obstetrics, Gynecologic, and Neonatal Nursing.  46(3): 95-104, 2017.

Kristen Hollinger

Dr. Kristen Hollinger has a Ph.D. in molecular and cellular biology from Pennsylvania State University. She currently resides in Maryland and works as an Instructor in the Departments of Psychiatry and Neurology at Johns Hopkins University School of Medicine. Her research focuses on neurological diseases including depression and multiple sclerosis.


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