Drugs in Pregnancy Part 5: Sleep Medication

Last updated:February 10, 2024

In Part 5 of our 7-part Drugs in Pregnancy series, we’re talking about the issue of sleep meds during pregnancy. Being pregnant makes sleep problematic for many women, for a whole host of reasons: You have to get up to pee more frequently earlier in your pregnancy, you’re uncomfortable in the later stages — and worrying about impending childbirth (not to mention motherhood!) has the potential to keep you wide-eyed for all 40-something weeks. Hormonal fluctuations play a role, too. Progesterone, which increases during pregnancy, interferes with sleep rhythms.

For more on pregnancy and drugs, see the other chapters in our series, and check out our Drug Classification of Prescriptions Medicines During Pregnancy. And always ask your doctor or other healthcare provider what course of treatment is best for you and your baby.

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Are Meds Safe?

Getting a good night’s sleep often gets more difficult as a pregnancy progresses. The National Institutes of Health urges pregnant women to avoid sleep medication entirely, and to rely on behavioral techniques to fall asleep and stay asleep, as no prescription sleep aid has a safe A rating for use during pregnancy. Antihistamine-based OTC sleep medications, those containing diphenhdrydramine (Unisom, Benadryl) are considered the safest option, in the B category, for short-term use during pregnancy. Decongestant-based sleep medications should be avoided entirely. (Sleep medications should also be avoided while breastfeeding, as they pass into your milk and affect the baby.)

A big concern, however, is developing a dependency on the medication to help induce sleep. “You don’t want to get to a point where you can’t fall asleep without them,” says Lori Wolfe, a certified genetic counselor and president of MotherToBaby, a free, national informational service of the nonprofit Organization of Teratology Information Specialists

Melatonin supplements, which help regulate our sleep cycle, should also be limited, as they may interfere with the baby’s natural melatonin.

Getting Good Zzzzz’s

So what can you do to improve sleep during pregnancy? Here are some tips for a better night in bed:

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Drink less fluid closer to bedtime: You may have already eliminated or greatly cut down caffeine consumption, but pay some attention to how much ligquid you’re guzzling generally in the last hours before bedtime. Try to “front load” your fluids earlier in the day, so you’re less apt to be awoken by a full bladder several times during the night.
Get more exercise: Timing physical activity for later in the day helps many people naturally wind down by bedtime. But exercise in general is a good way not just to tire yourself out, but to release stress that might be keeping you awake at night.
Get comfortable: Invest in a pregnancy-friendly body pillow, or use regular pillows to support your growing belly. Experiment to find your most relaxing, cozy position.
Treat underlying issues that disrupt sleep: If leg cramps or restless leg syndrome (RLS) are keeping you awake, be sure you’re getting enough folate and iron (both from diet and in the form of prenatal vitamins); women whose diets are low in folate and iron are more prone to RLS.
Acid reflux might also be interfering with sleep. Find relief by avoiding heavy, greasy, spicy foods, and elevating your upper body when you sleep.