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For many, pregnancy is an exciting time, but it also comes with physical changes that can make it difficult to sleep. The majority of pregnant people experience sleep problems, particularly in late pregnancy. As a result, many wonder if it is safe to take over-the-counter or prescription sleep medication, melatonin supplements, or herbal sleep aids while pregnant.
Some health care providers opt not to recommend any sleep aids at all during pregnancy, given the limited research on their safety for pregnant people and fetuses. However, as sleep deprivation during pregnancy can have its own negative consequences, some pregnant people and their doctors may determine that the benefits of certain sleep aids outweigh the risks.
Sleep Aids People Take While Pregnant
Experts generally recommend that pregnant people address sleep difficulties without medication or supplements . However, if non-pharmacological measures fail to alleviate sleep problems, certain sleep aids may be an option. More than 90% of pregnant people report occasionally treating sleep difficulties with over-the-counter sleep aids. Some of the most common ones used during pregnancy are melatonin supplements and antihistamines.
The safety of many sleep aids for pregnant people and their fetuses has yet to be verified, as studies used to assess the safety of medications rarely include pregnant people. However, information collected from pregnant people and their physicians about medication use and subsequent pregnancy outcomes offers some insight into the safety of certain sleep aids.
The Food and Drug Administration (FDA) requires manufacturers to list information regarding the safety of a medication during pregnancy so that individuals and their doctors can make informed decisions. Pregnant people should always consult with a healthcare provider before starting any new medication or supplement.
The human body naturally produces melatonin, a hormone that helps people fall asleep and wake up at appropriate times. Taking melatonin supplements helps some people with sleep difficulties fall asleep more easily. Providers may suggest melatonin supplements during pregnancy for people who continue having trouble falling asleep even after trying non-medication alternatives. An estimated 4% of pregnant people take melatonin supplements .
While studies have found that melatonin use in pregnant animals has some risks, such as lower birth weights, there is currently no evidence that melatonin supplements are harmful to pregnant humans or their fetuses. That said, research has shown that melatonin supplements are capable of crossing the placenta and raising melatonin levels in fetuses. Some experts worry that if babies are exposed to melatonin supplements in the womb, they may struggle to establish healthy sleep-wake cycles once they are born.
Additionally, the FDA does not regulate melatonin supplements, so there is a risk that supplements may contain doses or ingredients inconsistent with their labels. Pregnant people should consult with their doctors before taking melatonin supplements.
Antihistamines are a type of medication commonly used to treat allergies. Known to induce drowsiness, antihistamines are also an ingredient in some over-the-counter sleep aids intended to treat occasional sleeplessness. Among pregnant people, antihistamines are used to alleviate morning sickness and indigestion. About 10 to 15 percent of pregnant people use an antihistamine at some point during pregnancy.
Most studies of antihistamine use during pregnancy have focused on their application as a treatment for nausea and vomiting. Within this context, a number of antihistamines appear to be both safe and effective. That said, existing research may not accurately represent the effects of taking antihistamines to induce sleep during pregnancy. More research is needed to understand how using antihistamines as sleep aids might affect pregnancy outcomes.
Additionally, a few studies have suggested links between particular antihistamines and birth defects , as well as other adverse events during pregnancy. A person planning to use antihistamines during pregnancy should consult with a medical provider about which options have the fewest associated risks.
One study has suggested that certain antidepressants improve sleep in pregnant people and also reduce the risk of postpartum depression. While the bulk of evidence suggests that antidepressants do not cause birth defects, most experts still advise against using these medications to treat sleep problems during pregnancy. More research is needed to assess whether antidepressants pose any risks to pregnant people and their fetuses.
Sleep Aids Known to Not Be Safe During Pregnancy
Much of the knowledge about using sleep aids during pregnancy comes from animal studies, so recommendations about which options are safe and which are not safe may change in the future. However, current evidence indicates that certain types of medications should be avoided.
Sedative hypnotics are a class of prescription drugs known to relieve anxiety and induce sleep . These medications are also sometimes called tranquilizers.This class of drug includes benzodiazepine receptor agonists (BZRAs), which are some of the most commonly prescribed insomnia medications . It also includes benzodiazepines and barbiturates, which are prescribed less often as sleep aids because of the risk of dependence and abuse. Currently, experts recommend against using sedative hypnotics during pregnancy.
Some studies have suggested that taking certain BZRAs or benzodiazepines during pregnancy may elevate the risk of giving birth early or delivering a baby that is too small or too light. There is also evidence that BZRAs and benzodiazepines can cross the placenta, potentially contributing to breathing problems and withdrawal symptoms in newborns. More research is needed to confirm these findings.
Benzodiazepines were previously thought to cause birth defects, but more recent research indicates this may not be the case . However, certain types of barbiturates have been linked to birth defects, and infants exposed to barbiturates in the womb may experience withdrawal symptoms when they are born.
Herbal Products and Natural Sleep Aids
Some of these products have a record of problematic side-effects in the general population. For example, the kava plant is associated with liver damage, and the amino acid L-tryptophan has been linked to a rare white blood cell disorder. Pregnant people should avoid such products.
Pregnant people may also wish to avoid certain herbal teas that are marketed as sleep aids. For instance, one study found that ingesting chamomile in the final months of pregnancy increased the risk of preterm birth and decreased the size of newborns, but these findings need to be confirmed by further research. Not enough is known about other herbs, such as valerian and lavender, to determine whether they are safe to take during pregnancy.
Dietary supplements and herbal remedies are not regulated as strictly as medication by the FDA, so the labels may be misleading, and there may be unknown side effects. While it is usually better not to use them at all, be sure to talk to a doctor before trying these products.
Alcohol and Cannabinoids
Causes of Insomnia During Pregnancy
People with insomnia have trouble falling asleep, sleeping soundly through the night, or sleeping until their desired wake-up time. These sleep problems make it hard to function in the daytime. Insomnia is common during pregnancy, especially in the third term.
There are many reasons why people may have trouble sleeping during pregnancy, including:
- Stress and vivid dreams related to the pregnancy
- Movement of the fetus
- Leg cramps
- Difficulty finding a comfortable position
- Frequent nighttime urination
- Shortness of breath and increased heart rate
- Leg and back pain
Lack of sleep during pregnancy not only can be frustrating but also can impact the health and safety of the pregnant person and the baby . Poor sleep may increase the risk of developing pregnancy-related diabetes, high blood pressure, and depression. It also might increase the likelihood of giving birth prematurely, having a difficult labor, or needing a cesarean section.
How to Improve Sleep During Pregnancy
- Sleep on your left side: Left side sleeping enhances blood flow and prevents the uterus from placing too much weight on the liver. It may feel more comfortable to use a pressure-relieving mattress topper and place pillows beneath the lower back, between the legs, or under the midsection.
- Keep the bedroom dark and quiet: Consider using a dim nightlight instead of bright overhead lights during nighttime bathroom visits. This may make it easier to fall back asleep.
- Establish a regular bedtime routine: Maintain similar sleep and wake times from day to day and carry out a relaxing, consistent bedtime routine, so your body knows it is time to sleep.
- Eat and drink mindfully: Avoid eating heavy meals or drinking too much liquid in the leadup to bedtime, and be sure not to consume caffeine later in the day. If nausea keeps you up at night, a light, bland snack might help.
- Manage leg cramps: If severe and regular leg cramps keep you up at night, your doctor might be able to prescribe a medication that prevents them from happening so frequently.
- Exercise earlier: Regular exercise can help with sleep, but exercising too close to bedtime may make it hard to wind down for sleep.
- Take naps: Napping may be a convenient way to recover from missed sleep, but take naps early in the day so they don’t interfere with bedtime.
- Try cognitive behavioral therapy for insomnia (CBT-I): This therapy aims to improve sleep by changing mental and behavioral habits, without the need for medication.
- Ask for help: It is natural to have strong emotions surrounding pregnancy and childbirth. Consider reaching out to friends, family, or your healthcare provider for support.
Although it is common to have trouble sleeping during pregnancy, some pregnant people may have a condition that requires medical treatment, such as obstructive sleep apnea or restless legs syndrome. Talk to your medical provider if you experience symptoms that interfere with your ability to get a good night’s sleep.