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Why we must recognize and treat sleep disorders during pregnancy

This article was first published on February 17, 2023. It was last reviewed/ updated on February 18, 2023.


Sleep problems are common during pregnancy—and why that is

Sleep problems occur in more than half of all pregnancies and their prevalence increases as the pregnancy progresses (Facco et al., 2022).

A pregnant woman’s sleep can be disturbed by many different factors. Here are just a few of them (Facco et al., 2022; McLafferty et al., 2022):

– Acid reflux

– Nausea/ vomiting in the first trimester

– Having to get up at night to urinate

– Positional discomfort

– Fetal movements at night

– Uterine contractions at night (in the third trimester)


Commonest sleep disorders during pregnancy

Diagnosable sleep disorders are also common during pregnancy (Facco et al., 2022).

The 3 most common ones are

1. Obstructive sleep apnea

2. Insomnia

3. Restless legs syndrome.


Sleep disorders during pregnancy are associated with negative outcomes

Sleep disorders during pregnancy are associated with (but don’t necessarily “cause”) an increased risk of several problems for the pregnant woman and her fetus, including:

– Impaired quality of life for the pregnant woman.

– Depression during the pregnancy and post-partum period (meta-analysis by Fu et al., 2023; meta-analysis by Li et al., 2023).

– Gestational diabetes (strongly associated with short sleep duration during pregnancy; Facco et al., 2022).

– Preterm birth (associated with insomnia; Felder et al., 2017).


Insomnia during pregnancy

Regarding insomnia (meta-analysis by Sedov et al., 2021):

– It is present in about 38% of pregnant women.

– Its prevalence increases as the pregnancy progresses and is greatest in the third trimester.

Treatment of the insomnia does make a difference!

We should be motivated to treat insomnia in pregnant women because a randomized, controlled trial found that the treatment of insomnia in pregnant women with cognitive-behavior therapy was associated with (Felder et al., 2022):

– Reduction in depression and anxiety symptoms

– Lower prevalence of probable major depression 3 months after delivery.


Is it safe for us to recommend an antihistamine like diphenhydramine (Benadryl®), doxylamine (Unisom®), or hydroxyzine (Vistaril®)—the medications most commonly used to treat moderate to severe insomnia during pregnancy that has not responded to non-pharmacological interventions?

For our answer to this question, please see the following article on this website:

Is it safe to recommend an antihistamine for insomnia during pregnancy?


And, for other articles on this website related to psychopharmacology during pregnancy or lactation/ breastfeeding, please see Related Pages below.


Related Pages

Pregnancy: General articles

General approach to treating women during pregnancy and lactation

Pregnancy registries

Pregnancy and psychotropic medications: Online resources

Does this medication increase the risk of bad outcomes in pregnancy?

Why we must recognize and treat sleep disorders during pregnancy


Pregnancy: Specific treatments 

Potential risks of second-generation (atypical) antipsychotics in pregnancy

Tips on using lithium during pregnancy

Is the use of lamotrigine during pregnancy safe?

Does methylphenidate during pregnancy increase the risk of congenital malformations?

Is it safe to recommend an antihistamine for insomnia during pregnancy?

Bright light therapy for depressive disorders during pregnancy?

Repetitive transcranial magnetic stimulation (rTMS) for depressive disorders during pregnancy?

How to manage agitation in a pregnant woman

Serious dangers to avoid if it is essential to physically restrain a pregnant woman


Lactation/ breastfeeding: General articles

General approach to treating women during pregnancy and lactation

Tips on psychotropic medications during breastfeeding

Lactation and psychotropic medications: Resources


Lactation/ breasfeeding: Specific treatments

Is sertraline safe in lactation?


References

Facco FL, Chan M, Patel SR. Common Sleep Disorders in Pregnancy. Obstet Gynecol. 2022 Aug 1;140(2):321-339. doi: 10.1097/AOG.0000000000004866. Epub 2022 Jul 6. PMID: 35852285.

Felder JN, Baer RJ, Rand L, Jelliffe-Pawlowski LL, Prather AA. Sleep Disorder Diagnosis During Pregnancy and Risk of Preterm Birth. Obstet Gynecol. 2017 Sep;130(3):573-581. doi: 10.1097/AOG.0000000000002132. PMID: 28796676.

Felder JN, Epel ES, Neuhaus J, Krystal AD, Prather AA. Randomized controlled trial of digital cognitive behavior therapy for prenatal insomnia symptoms: effects on postpartum insomnia and mental health. Sleep. 2022 Feb 14;45(2):zsab280. doi: 10.1093/sleep/zsab280. PMID: 34850238; PMCID: PMC8842335.

Fu T, Wang C, Yan J, Zeng Q, Ma C. Relationship between antenatal sleep quality and depression in perinatal women: A comprehensive meta-analysis of observational studies. J Affect Disord. 2023 Feb 3;327:38-45. doi: 10.1016/j.jad.2023.01.125. Epub ahead of print. PMID: 36739002.

Li H, Li H, Zhong J, Wu Q, Shen L, Tao Z, Zhang H, Song S. Association between sleep disorders during pregnancy and risk of postpartum depression: a systematic review and meta-analysis. Arch Womens Ment Health. 2023 Feb 4. doi: 10.1007/s00737-023-01295-3. Epub ahead of print. PMID: 36738337.

Meers JM, Nowakowski S. Sleep During Pregnancy. Curr Psychiatry Rep. 2022 Aug;24(8):353-357. doi: 10.1007/s11920-022-01343-2. Epub 2022 Jun 11. PMID: 35689720.

Palagini L, Bramante A, Baglioni C, Tang N, Grassi L, Altena E, Johann AF, Geoffroy PA, Biggio G, Mencacci C, Sharma V, Riemann D. Insomnia evaluation and treatment during peripartum: a joint position paper from the European Insomnia Network task force “Sleep and Women,” the Italian Marcè Society and international experts task force for perinatal mental health. Arch Womens Ment Health. 2022 Jun;25(3):561-575. doi: 10.1007/s00737-022-01226-8. Epub 2022 Apr 13. PMID: 35419652; PMCID: PMC9072480.

Sedov ID, Anderson NJ, Dhillon AK, Tomfohr-Madsen LM. Insomnia symptoms during pregnancy: A meta-analysis. J Sleep Res. 2021 Feb;30(1):e13207. doi: 10.1111/jsr.13207. Epub 2020 Nov 2. PMID: 33140514.


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