So you’ve probably heard about insomnia during pregnancy but what about if you have chronic insomnia even before you get pregnant? Insomnia is one of the most commonly reported sleep problems, with chronic insomnia affecting up to one in seven adults. Insomnia tends to occur more often in women than men and in fact, up to one in four women reports experiencing symptoms of insomnia such as trouble falling asleep, waking up during the night or waking up early. Although insomnia tends to affect older people, it is still an important health issue for those who are younger.1
If you have had insomnia for a while you may be taking medication to help you sleep. There are several types of drugs on the market to help treat insomnia but are these safe to take while pregnant?
Some antidepressant drugs are used to treat insomnia as drowsiness is one of their side effects. Drugs in this group include trazodone, nortriptyline and doxepine.2 Trazodone should be used with caution during pregnancy and it should be avoided during the first trimester. Animal studies have shown conflicting results with respect to fetal harm.3 Similarly, with nortriptyline, animal studies have shown inconclusive fetal harm results. Nortriptyline should only be used during pregnancy if the benefit outweighs the risk to the fetus.4 Doxepine is usually prescribed for people who have trouble staying asleep. Animal studies have not shown evidence of fetal harm with the capsule or liquid formulation but have with the tablet formulation5 For all three of these drugs, withdrawal symptoms have been observed in newborn babies following long-term use by the mother.3-5 However, these drugs are usually given at a dose which is substantially below that which would give an antidepressant effect and therefore may be safe to take during pregnancy. This is something you should discuss with your healthcare provider.
Benzodiazepines are an older class of drugs, of which several are prescribed for insomnia: quazepam, triazolam, estazolam, temazepam, flurazepam, and lorazepam. Most of these drugs should not be taken at all during pregnancy under any circumstances and alternatives should be considered. Lorazepam may be taken; however there may be potential risk to the fetus.6
Eszopiclone helps you to fall asleep quickly although it can make you feel somewhat groggy the next day.2 Animal studies have failed to show an effect on fetus development, although reduced fetal weight and skeletal abnormalities have been reported at higher doses. Animal studies have also shown increased rates of miscarriage and sperm abnormalities.7
This sleep medication works differently to other sleeping pills as it targets the sleep wake cycle. It is taken by people who have trouble falling asleep and can be used over the long term.2 Animal studies have shown evidence of developmental abnormalities; however these were at doses far higher than the recommended human dose. Ramelteon has also been associated with effects on reproductive hormones, such as increased prolactin levels and decreased testosterone levels, and it is not known what effect chronic use of this drug may have on development of the reproductive system in humans.8
Suvorexant works by blocking a hormone that promotes wakefulness and causes insomnia; it helps you both get to sleep and once asleep to stay asleep. At doses 25 times higher than that found in humans, suvorexant resulted in decreased fetal body weight in rats and at doses 40 times that found in humans, suvorexant resulted in the premature death of pregnant animals.9
Of all the newer sleeping pills, zaleplon remains in the body for the shortest amount of time so therefore it is used by people who want to try to get to sleep without the use of drugs. If they still can’t sleep after a few hours, they can take it and they won’t feel drowsy in the morning. Although animal studies showed no evidence of abnormal physiological development, increased rates of stillbirths and postnatal deaths have been observed as have impaired female fertility and decreased physical development.10
Zolpidem (also called zopiclone)
This drug is often prescribed for insomnia and is effective in helping people get to sleep although some people may still wake up in the middle of the night. As a result there is now an extended-release formulation available that stays in your body for longer. Cases of severe neonatal respiratory depression a have been reported when this drug was used towards the end of pregnancy, and especially when used with other central nervous system depressants. In addition, newborns may be at risk of withdrawal effects. This class of drugs is also associated with neonatal flaccidity.11
Over-the-counter sleep aids
Most over-the-counter sleeping pills are antihistamines and due to their safety, some women take them for pregnancy-related insomnia. Oral antihistamines such as cetirizine (Zyrtec), chlorphenamine (Chlor-Trimeton), diphenhydramine (Benadryl), fexofenadine (Allegra), and loratadine (Claritin) seem to be safe.2,12
So as you can see, there are many options available regarding sleeping pills and if you are taking one that might not be suitable during pregnancy, you should discuss switching medications with your healthcare provider.