Safe Sleep Aids For Pregnancy: What To Take?

Sleep issues are common during pregnancy, with 77% of pregnant people experiencing sleep disturbances. While sleep aids can be helpful, it's important to proceed with caution as limited research exists on their safety for pregnant people and their fetuses. Here's an overview of some safe sleep aids to consider during pregnancy.

1. Melatonin: Melatonin is a natural hormone that helps regulate sleep. While research on its use during pregnancy is limited, most experts consider it likely safe for short-term use. However, it's important to consult a healthcare provider to determine the appropriate dosage.

2. Antihistamines: Antihistamines, such as Benadryl (diphenhydramine) and Unisom Sleep Tabs (doxylamine), are over-the-counter medications that can help treat insomnia during pregnancy. While they may have side effects and could be habit-forming, they are generally thought to be safe.

3. Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are typically used to treat depression and anxiety, but they can also help improve sleep. While not all antidepressants are considered safe during pregnancy, SSRIs are often recommended as a first-line treatment. Consult your healthcare provider to determine the best option for you.

4. Lifestyle and Natural Remedies: Before turning to pharmaceutical sleep aids, it's recommended to try natural remedies and lifestyle adjustments. This includes exercising, maintaining a consistent sleep schedule, reducing caffeine intake, limiting screen time before bed, and incorporating relaxation techniques such as meditation or warm baths.

While struggling with sleep during pregnancy is common, it's important to prioritize safe and effective solutions. Always consult your healthcare provider before taking any sleep aids or making significant changes to your routine.

Melatonin supplements

Melatonin is a hormone that is naturally produced by the human body to help people fall asleep and wake up at the appropriate times. Melatonin supplements are sold over the counter and are a popular natural remedy for sleep problems. Melatonin is not classified as a drug or hormone, so its production is not monitored by the Food and Drug Administration (FDA).

The dose of melatonin in supplements is typically higher than what the body normally produces. A typical dose of melatonin (1 to 3 mg) can elevate blood melatonin levels up to 20 times the normal amount. While melatonin is considered "natural", the amount delivered by over-the-counter preparations usually exceeds the quantities normally produced by the body.

There is limited research on the use of melatonin during pregnancy. While studies have found that melatonin use in pregnant animals carries some risks, such as lower birth weights, there is currently no evidence that melatonin supplements are harmful to pregnant humans or their fetuses. However, research has shown that melatonin supplements can cross the placenta and raise melatonin levels in fetuses. Some experts are concerned that if babies are exposed to melatonin supplements in the womb, they may struggle to establish healthy sleep-wake cycles once they are born.

Some studies suggest that melatonin may benefit the developing fetus. For example, a 2015 study in pregnant mice found that melatonin injections might reduce the risk of neural tube abnormalities. A 2011 review also reports evidence that short-term melatonin use may reduce the risk of pregnancy complications. Preliminary studies also suggest that melatonin supplementation may have a beneficial effect on fertilization rates and embryo quality.

While melatonin can be an effective sleep aid, there is not enough research to support its routine use during pregnancy. Doctors do not recommend taking melatonin during pregnancy unless sleep problems persist after trying non-medication alternatives. If you are interested in taking melatonin during pregnancy, you should speak to your healthcare provider for advice about whether it is a good idea and what amount of melatonin you can safely take.

Antihistamines

There are two generations of antihistamines. The first generation includes sedating antihistamines such as diphenhydramine (Benadryl), cyproheptadine, promethazine, chlorpheniramine, and hydroxyzine. These have a very potent effect, but they are short-acting and can cause side effects such as dryness of the mouth, blurred vision, constipation, and urinary retention.

The second generation includes non-sedating antihistamines such as loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec), and azelastine. These have a high therapeutic index and are long-acting, but they are poorly lipophilic, so they do not enter the central nervous system. Side effects include photosensitivity, tachycardia, and prolongation of the QT interval.

Most studies have not found a link between taking antihistamines during pregnancy and birth defects. However, there is a lack of well-controlled studies in pregnant women, and animal studies have shown some teratogenic effects. Isolated reports of antihistamines causing congenital malformations exist, but further investigation is needed.

The American College of Obstetricians and Gynecologists (ACOG) and the American College of Allergy, Asthma, and Immunology (ACAAI) recommend chlorpheniramine and tripelennamine as the antihistamines of choice for pregnant women. They also recommend cetirizine and loratadine after the first trimester for patients who do not respond to chlorpheniramine or tripelennamine.

Other studies suggest that there is insufficient evidence to support the first-line use of cetirizine and loratadine during pregnancy and recommend first considering chlorpheniramine, tripelennamine, or hydroxyzine.

Overall, antihistamines are thought to be safe during pregnancy, but it is important to consult a healthcare provider before taking any medication.

Lifestyle changes

• Exercise and activity: Staying active during the day can help ease muscle aches and stiffness. Try yoga, swimming, or going for a walk. Just make sure to avoid exercising too close to bedtime, as it may interfere with your ability to wind down.
• Caffeine and diet: Limit your caffeine intake, especially in the evening. Avoid heavy meals, spicy foods, and caffeine before bedtime to prevent heartburn and indigestion. Opt for a light snack before bed, such as a healthy carb-protein pair, to keep your blood sugar stable.
• Fluid intake: While staying hydrated is important, try to drink less in the evening to reduce the need for frequent urination during the night.
• Napping: Taking short naps (30-60 minutes) during the day can help you catch up on lost sleep. Just be sure to nap early enough so that they don't interfere with your bedtime.
• Screen time: Avoid screens at least an hour before bedtime, as the bright light can disrupt your sleep.
• Bedtime routine: Establish a relaxing bedtime routine to signal to your body that it's time to wind down. This could include reading a book, listening to soothing music, practising relaxation techniques, or taking a warm bath.
• Sleep environment: Keep your bedroom dark, cool, and quiet. Consider using blackout curtains, earplugs, or a white noise machine to create a comfortable sleep environment.
• Pillows and mattress: Use pillows to support your body and relieve discomfort. For example, placing a pillow between your knees when sleeping on your side can help support your bump. Additionally, consider using an extra pillow under your head to help relieve heartburn. An egg-crate foam mattress pad may also help relieve hip discomfort.
• Stress and anxiety: Pregnancy can be a stressful time, and anxiety can contribute to insomnia. Try to address any underlying worries or concerns by talking to a friend or partner, or consider seeking professional support. Relaxation techniques, meditation, and mindfulness apps can also help ease stress and improve sleep.
• Work and childcare: If possible, adjust your work schedule or work from home to allow for more rest. If you have other children, see if someone can help with childcare or school runs to free up some time for yourself.

Prescription medications

Pregnant women are generally advised to avoid medications, including sleep medications, during pregnancy. Most drugs are not tested on pregnant women, and the effects on the unborn baby are unknown. However, sleep problems are very common during pregnancy, and severe sleep disorders or other medical conditions can cause sleeping problems. Therefore, doctors may recommend prescription medications to help pregnant women sleep.

Prescription sleep medications should be avoided during late pregnancy as they may cause breathing and muscle tone problems in infants exposed to these medications.

Benzodiazepines

• Temazepam (Restoril)
• Estazolam (ProSom)
• Flurazepam (Dalmane)
• Quazepam (Doral)
• Triazolam (Halcion)

Nonbenzodiazepine sleep aids

• Zolpidem (Ambien)
• Zopiclone (Imovane)
• Eszopiclone (Lunesta)
• Zaleplon (Sonata)

Barbiturates

• Amobarbital
• Pentobarbital
• Secobarbital

Other prescription sleep medicines

• Chloral hydrate (Chloralum)
• Etomidate (Amidate)
• Ramelteon (Rozerem)
• Suvorexant (Belsomra)
• Tasimelteon (Hetlioz)

The risks of these drugs during pregnancy are unknown but may be similar to those of benzodiazepines, non-benzodiazepines, and barbiturates.

Herbal remedies

While herbal remedies can be a great way to aid sleep, it is important to note that there is limited research on the safety of herbal remedies as sleep aids during pregnancy. It is always best to consult a doctor before taking any new medication or supplement.

Ginseng

Ginseng is one of the herbal remedies that may be safe for use during pregnancy.

Honey

Honey is another option that is likely safe for pregnant people to consume.

Nutmeg

Nutmeg is also considered a safe herbal remedy during pregnancy.

Oats

Oats may be a suitable option for aiding sleep during pregnancy.

Chamomile

Chamomile is a herb that should be avoided during pregnancy. One study found that ingesting chamomile in the final months of pregnancy increased the risk of preterm birth and decreased the size of newborns. However, further research is needed to confirm these findings.

Lavender

There is not enough research to determine whether lavender is safe to take during pregnancy.

Valerian

Like lavender, there is insufficient evidence to conclude whether valerian is safe to consume as a sleep aid during pregnancy.

Frequently asked questions