What sleep medications are safe for use during pregnancy?

Safe Sleep Medications During Pregnancy

Non-pharmacological approaches should be the first-line treatment for sleep disorders during pregnancy due to potential risks associated with medications to the developing fetus.

First-Line Approach: Non-Pharmacological Interventions

• Implement sleep hygiene measures as the primary treatment strategy, including maintaining a regular sleep schedule, creating a comfortable sleep environment, avoiding heavy meals near bedtime, and limiting screen exposure before sleep 1
• Engage in regular physical activity to improve sleep quality during pregnancy 1
• Consider cognitive behavioral therapy (CBT) for sleep disturbances, which has shown effectiveness without medication risks 1
• Use relaxation techniques and mind-body interventions such as mindfulness meditation to improve sleep 1

Pharmacological Options (When Non-Pharmacological Approaches Fail)

Relatively Safer Options

• Doxylamine may be used with caution for short-term insomnia:

  • FDA labeling indicates pregnant women should consult a healthcare professional before use 2
  • Should only be used when benefits outweigh potential risks 2

• Diphenhydramine may be considered with caution:

  • FDA labeling requires pregnant women to consult a healthcare professional before use 3
  • Marked drowsiness may occur, and caution is advised when driving or operating machinery 3

• Sertraline may be considered for sleep disturbances associated with depression:

  • One of the preferred antidepressants during pregnancy due to its favorable safety profile 1
  • Should be used at the lowest effective dose with close monitoring 1
  • Arrange early follow-up after hospital discharge for infants exposed in the third trimester to monitor for neonatal adaptation syndrome 1

Medications to Avoid During Pregnancy

• Sodium oxybate has insufficient safety data for use during pregnancy and may cause fetal harm based on animal data 1, 4
• Pitolisant may cause fetal harm based on animal data and may reduce the effectiveness of oral contraceptives 1, 4
• Methylphenidate may cause fetal harm based on animal data 1, 4
• Modafinil/armodafinil may cause fetal harm based on animal data and may reduce the effectiveness of hormonal contraception 5, 1

Special Considerations

• Sleep disturbances are common during pregnancy, affecting more than half of all pregnancies and increasing as gestation progresses 6
• Sleep disruption in pregnancy can substantially worsen maternal quality of life and may be a risk factor for adverse pregnancy outcomes 6
• For pregnant women with pre-existing sleep disorders, a multidisciplinary approach involving maternal-fetal medicine specialists is beneficial 1
• The risks of pharmacotherapy must be weighed against their benefits due to the possible risk of teratogenicity associated with some medications 7

Common Pitfalls and Caveats

• Sleep disturbances are often dismissed as normal during pregnancy, which may impede accurate diagnosis of treatable sleep disorders 6
• Limited research exists on sleep medications during pregnancy, making definitive recommendations difficult 5
• SSRIs in the third trimester may be associated with neonatal adaptation syndrome, including irritability, tremors, feeding difficulties, and respiratory distress 1
• When considering any medication during pregnancy, the risk of the untreated condition must be weighed against the risk of medication exposure 8