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Treatment of Insomnia During Pregnancy

Treatment of Insomnia During Pregnancy

Most women experience some degree of sleep disturbance during pregnancy, and for a significant number of women sleep disruption may be quite severe. There are many different causes for sleep disturbance during pregnancy, and choosing the appropriate intervention relies on an accurate diagnosis of the problem.

Certain sleep disorders, such as restless leg syndrome and sleep apnea, are more common during pregnancy and may cause significant sleep disruption.

Sleep disturbance may also be a symptom of depression or an anxiety disorder, thus it is important to screen for these problems. Many women with depression or anxiety have difficulty falling asleep or they wake early and are unable to return to sleep. Treating the underlying disorder may improve sleep quality. (More information on the treatment of depression and anxiety during pregnancy can be found here.) Typically antidepressants, including fluoxetine (Prozac) and the older tricyclic agents (including nortriptyline and amitriptyline) are used in this setting.

While certain strategies may help to improve sleep quality, some women may require some type of pharmacologic intervention. Although Ambien (zolpidem) and other sedative-hypnotic agents, including Lunesta (eszopiclone) and Sonata (zalepion), are commonly prescribed to women with sleep disturbance, the data regarding their reproductive safety is limited and generally we try to avoid their use during pregnancy.

Sedating tricyclic antidepressants, such as amitriptyline or nortriptyline, may be a better choice for women with sleep disturbance and have not been associated been associated with an increase in risk of congenital malformation. Benzodiazepines, including Ativan (lorazepam) and Klonopin (clonazepam) may also be useful. There is some controversy regarding the use of benzodiazepines during pregnancy. Although initial reports suggested that there may be an increased risk of cleft lip and cleft palate, more recent reports have shown no association between exposure to benzodiazepines and risk for cleft lip or palate. Pooling the data suggests that this risk– if it exists — is estimated to be 0.7%. The risk of malformation is confined to the first trimester when lip and palate formation take place; thus, benzodiazepines when used later in pregnancy do not carry this tertogentic risk.

Ruta Nonacs, MD PhD

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My wife and I are TTC. It’s taking longer than we hoped, though the outlook right now is pretty positive.

The problem is that she’s suffered from anxiety and depression in the past, and went off of Prozac (20 mg) because we’re TTC.

Due to the stress of it taking awhile to conceive, plus other things (job-related, etc) she’s having quite a bit of insomnia. Her symptoms certainly don’t fall in the “severely/extremely depressed” category, but having been depressed myself in the past, I think in a relative sense that she’s suffering quite a bit.

Looking at the literature, I think it might be reasonable for her to go back on Prozac.

Will she be able to discuss the pros and cons off that treatment option rationally with her providers (gyn, etc), or will she be repeatedly met with “no, you can’t take SSRIs during pregnancy”?

The information regarding antidepressant use during pregnancy is growing and is actually a little conflicting. But I think it is really important for you and your wife to develop a relationship with an OB and psychiatrist who are familiar with this area and know the available info re: the safety of these medicines. Also, a great resource is our Perinatal Information Resource Center at ; see the extensive library and columns across the website, including our most recent newsletter.

I am 24 weeks pregnant and prior to pregnancy have taken Ambien. I held off taking it during my first trimester, but just can not fall asleep at night. Is is safe to take Ambien again?

I’ve had primary insomnia (idiopathic) since childhood. I have worked with my doctors for 15+ years on proper medications for sleep. I’ve spent years of my life on Ambien and other sleep medications, but about five years ago was able to go off all of those and simply stay on Trazodone. I have also spent years refining my sleep hygiene, doing biofeedback and behavioral therapy to do everything possible to try and ensure good sleep (which I am generally able to do now, though it’s still hard). My husband and I are now trying to get pregnant and my OB says no to Trazodone. I have gone off of it and gone back to my horrible insomnia of 2-3 hours of sleep a night. I can’t live like this – I can’t take care of myself properly in this state and can’t imagine nurturing a baby in my womb when I am like this. But over the counter sleep medication (Tylenol PM, Unisom, Benadryl) simply keeps me awake and prescription sleep medication is off limits, according to my doc. What are my choices if I want to have a baby? For all those suffering out there, I hear you!

Ditto Shannon! My doc just took me off the trazodone yesterday after I found out I was pregnant last week. I just spent a horrible night of tossing and turning, and don’t know how I can do this for a prolonged period. Before trazodone I never slept, and if I missed a pill, I didn’t sleep… and now I have 9 months to look forward to of this? There has to be something that I can take. I can’t do the benadryl thing either… it gives me restless leg syndrome and makes me extremely anxious.

@Rebecca, what did you do? was there anything safe to take for sleep during pregnancy?

It was so refreshing to read your post and know that I’m not alone. I am barely pregnant (5 weeks) and up until this point took a Klonopin and a Seroquel every night to sleep. Since I am not taking them now, I am not sleeping. Did anyone resopnd with helpful suggestions? My OB said that Ambien from time to time wasn’t necessarily a bad thing, but I only sleep “okay” with Ambien.

Any help you could provide would be greatly appreciate. Thanks so much.

Thank you, I really needed it, almost did the wrong thing.

I really wish someone had replied to the above two posts… I also don’t get more than 2-3 hours of sleep without Trazodone. I’m going to want to be pregnant soon, and my husband (a doctor) wants me to try nortriptyline or amytriptyline. I guess I’ll just have to see how it goes…

I too am thinking about having a baby soon and I take trazodone. I have recently consulted with a couple of psychiatrists/OBGYNs who have indicated that it is safe to take trazodone during pregnancy – it has been around since the 1960s.

While it is reassuring to know that a medication has been around since the 1960s, this does not necessarily mean that a particular medication is safe when used during pregnancy. Many of these older medications have never been systematically studied in pregnant populations.

There is nothing to suggest that Trazodone is unsafe; however, the data is limited. There has been one small study including 58 women taking Trazodone. This study detected no increase in the risk of malformation, but the study was too small to rule out small increases in risk.

Are you suggesting that trazodone is not safe during pregnancy? Do you recommend that I consult further with the physicians who told me it was ok?

My MGH OB consulted with perinatal psych who told her it was okay for me to stay on trazodone. Thank goodness!

I too had dreadful insomnia both before and during pregnancy. It became unbearable during pregnancy because I couldn’t take anything. In the end I ended up crying at the doctor’s and he prescribed me valium (diazepam) and it was a godsend. I just used it occasionally when I couldn’t bear another day of feeling shattered. (About once a week). I went through two pregnancies, was really tired and stressed throughout both, but both babies were fine, and unaffected by my stress. Being told that the babies were unaffected by my stress helped me a lot, as that would have just added to my stress and insomnia.

I have suffered a genetic form of chronic insomnia all my life and have been on Trazodone for the past 10 years – and like some of you, I don’t sleep without it. This is my second pregnancy and doctors have all agreed (in my case) that the benefits outweigh the risks and I have continued to take the medication throughout both pregnancies. If you are able to go off of it or at least cut back then you probably should, but if you’re like me and are unable to sleep without it then staying on it may be the only option. I believe it’s a personal choice but you may be doing more harm to the baby by not sleeping. Your doctor may suggest trying something safer like Unisom or even Ambien but for me they don’t have any effect (I have literally tried everything). Good luck!

@Meghan, I appreciated your post and am wondering how your babies did since you took the Trazodone throughout both pregnancies. It would be so helpful to know if either of them suffered withdrawal or otherwise had any negative effects which could be attributed to the Trazodone. Thanks so much for sharing your experience. -Betsy

My gym trainer told me that she takes Melatonin to help her fall asleep. I’m 8 weeks preg and haven’t slept in a week. I’m thinking about melatonin because it’s natural but I want to check with my OB first. I will let everyone know what he says.

I was on trazodone sine last 1 year. Just found out two days ago that I am 4 weeks pregnant. I have stopped taking the medication. Just worried if there are any risks to baby… Please comment, if any mom was on Trazodone and before the start of pregnancy and had successful pregnancy with no harm to the baby.

I took 100mg of Trazadone my entire pregnancy and I have a beautiful, perfect baby boy. I was seeing a fetal maternal medicine specialist who told me it was just fine to stay on Trazadone !

If sedating tricyclic antodepressant e.g. amitryptaline is safe during pregnancy how about trazodone. I know that Trazodone is class C by the FDA. Is Amitryptaline is class C too?
Please let me know

Assuming that amitryptaline is safe during pregnancy, how about trazodone? I know that Trazodone is class C. Is Amitryptaline is class C too.

Did anybody ever answer your question about trazodone?
I would also like to know.

Just found out I was pregnant and have been on Trazodone for years for insomnia. I was also recently put on amitriptyline because I was still not sleeping well. When I found out I was pregnant my doctor said to immediately stop taking both medications cold turkey as they were harmful to the fetus. The doctor is a regular MD as well as an ND. He looked up Amitriptyline in a medical book directly in front of me and this medication was listed as a class D drug. This means it is proven to be harmful to a fetus.

The current system used to classify the safety of medications during pregnancy is often confusing. You can read more about it in this post.

Neither Trazodone nor amitriptyline have been proven to harm the developing fetus, if you look at all of the data in the literature.

I’m so glad I found this site. My husband and I have been TTC for a few months now. I have clinical insomnia and have to take ambian, but now we think I may be and am desperately trying to ween off for the baby. I need to know alternatives. All my doctor told me was to come off it. I’m desperate, for my health and our babies health.

Since writing that post, we have seen a few more studies focusing on the reproductive safety of sleep medications. Yo might find this recent post more helpful in terms of making a decision.

Is trazodone safe while breastfeeding?

I am wondering if anyone has any information on the medication Doxepin. It is a tricyclic agent, used for anxiety and insomnia. I am 21 weeks pregnant and suffer from severe anxiety and insomnia and have a PTSD, and have been prescribed this medication. I have had chronic insomnia since I was 10 years old, and for the past 5 years, the only way I have been able to sleep was from taking Remeron combined with smoking marijuana. No sleep medications on their own have ever worked for me, and I have tried many over the last 10 years. Since I found out I was pregnant in February I gave up my medicating cold turkey. Like many women on this site, I have been unable to sleep more than 2-3 hrs a night. I haven’t had one full nights sleep in 5months, and am barely surviving. My heart races all day long, and all night long, preventing me from being able to relax and sleep. If I do dose off my heart racing wakes me up. I have tried my absolute best to make it through this pregnancy unmedicated, but I feel as if I am barely surviving. I have tried anything and everything natural: warm baths/epsom salts, essential oils, deep breathing, meditation, CBT, acupuncture and herbal chinese medicine, melatonin, as well as flotation therapy. My heart continues to race and I can not sleep. The last 5 months have been an absolute nightmare, and I can’t imagine how I will get through labor and raising an infant. I am thankful to have found this site and hear of other women who have suffered similar to me. If anyone has any information on what is the best/safest medication to take for severe anxiety/insomnia or specific info on Doxepin I truly appreciate it.

I have had idiopathic insomnia for 9 years and now pregnant with my fourth and haven’t fallen asleep For TEN NIGHTS. I think I am going insane and no one understands and there is nothing that makes me sleep. I have tried everything….CBT, warm milk, eating oatmeal before bed, chamomile tea, sleep hygiene suggestions, meditation, etc. I have tried literally every medication out there solo and in combo with other medications and even mixed them up with alcohol. I am sleep deprived and I am pregnant and have three children s husband and a house to care for and literally I feel I am going me insane from sleep deprivation. Please help me with any suggestions you may have! I have tried Xanax, Doxepin, Ametriptelyne, ambien, lunesta, remeron, trazadone, seroquel, Vicodin, percocete, etc. one time I even took all f these and a whole bottle of wine and still NO SLEEP! I have tried Benadryl and things like it (unisom, zzzquil, melatonin,)…I just have adverse reactions where my heart races and races and I can’t sleep for anything. I have the opposite reaction to antihistamines and pain killers…they totally WIRE me up. PLEASE HELP ME.

It sounds like you have tried the medications we typically use to manage sleep problems during pregnancy. The only thing I would recommend is making sure that you were taking adequate dosages of these medications.

Thankyou all for sharing your stories… I would love to hear where some of you are now, as well as the health of your baby. I am hoping to get pregnant in the next few months and am taking celexa and trazodone to be able to sleep. I am weaning myself from clonazepam in which my psychiatrist told me that I should not take during pregnancy. It helps to read that other people have, and are going through a tough time balancing medications with the best outcomes for baby.

I just met with my OB who said that I should not take Trazadone. I can see that there are several post about this, but no one seems to have an answer as to if it is safe or not. My Psychiatrist keeps saying its safe, but my OB is absolutely against it. Is there a site admin who has some professional advice on this?

According to the data we have, there is nothing to suggest that Trazodone carries any risk when used in pregnancy. However, we don’t have a lot of data on this particular compound. In that case, one might use something for which there is more data regarding reproductive safety data. However, every case is difference.

Well yea . I was using trazodone and had to stop taking it after 2 weeks because the side effects kicked in. CBT helped me a lot. People avoid it because they are lazy and want to get instant relief. I used self help guide but that might not be the best for everyone so you might want to consider visiting a certified CBT expert.(might be very expensive)

This web site definitely has all the info I needed
concerning this subject and didn’t know who to ask.

Don’t you think you should update this info with more current practices. Leaving a 2007 outdated post is not helpful for pregnant desperate for sleep mothers.

Ever since I became pregnant( am 5 weeks) I have been having sleep problems, so my doctor prescribed for me amitriptyline but the side effects are severe. I have severe diarrhea and lose of appetite. Has anyone had this problem before?

Stay tuned. We are working on an update.

Iam 30 weeks pregnant having anxiety can I take medicine

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Sedating tricyclic antidepressants may be better for women with sleep disturbance (not associated with an increase in risk of congenital malformation) ]]>