What is insomnia?

Insomnia is a sleep disorder where you may find it hard to fall or stay asleep. Sleep issues, including insomnia, affect more than 1 in every 2 pregnancies and can get worse as your pregnancy progresses. It is also common after birth when breastfeeding.

Insomnia can become long term (called chronic insomnia disorder). This is when you have trouble falling asleep or staying asleep at least 3 nights per week, for at least 3 months, along with not functioning well during the day.

What are symptoms of insomnia?

Key symptoms of insomnia include:

• difficulty falling asleep
• waking up a lot during the night
• waking up too early and not being able to go back to sleep
• not feeling refreshed when you wake up

Insomnia can cause other symptoms during the day, including:

• tension headaches
• low energy, feeling tired or being too sleepy to do normal activities
• poor memory and concentration
• worrying about sleeping
• feeling irritable, moody or losing motivation and interest in doing things you usually enjoy
• feeling restless, being aggressive or impulsive
• feeling sleepy when sitting quietly

People experience insomnia differently, and you might only have some of these symptoms.

Why might I have insomnia during pregnancy?

You may develop insomnia during pregnancy because of many physical, emotional and hormonal changes your body is going through or because of general, non-pregnancy causes.

Pregnancy causes for insomnia:

• hormone changes in your body
• nausea and vomiting
• heartburn
• backaches, restless legs or leg cramps
• needing to urinate during the night
• struggling to get comfortable in bed as your baby grows and moves

General causes of insomnia:

• medical issues — conditions causing chronic pain and breathing, urinary or digestive problems
• sleep disorders— obstructive sleep apnoea, circadian rhythm disorders, restless leg syndrome and periodic leg movement
• poor sleep habits, known as sleep hygiene
• mental health problems — anxiety, depression or other disorders
• stress — caused by work or financial problems, relationship issues or grief
• substances — caffeine, nicotine, alcohol, amphetamines and some medicines

How is insomnia treated during pregnancy?

Your doctor or midwife can help you manage your insomnia. They will likely recommend a non-medicine treatment first, for example, behavioural and psychological interventions.

Treating an underlying condition causing insomnia

Before you try to treat the symptoms of insomnia, tell your doctor if you have any underlying conditions that may cause insomnia such as:

• pain
• digestive problems
• mental health problems
• other sleep disorders such as sleep apnoea

Sleep hygiene

Your health professional may recommend you improve your sleep hygiene. Try these good sleep habits to help you sleep better:

• Keep regular sleep patterns. Go to bed and wake up at around the same time every day, and avoid napping for more than 20 minutes in the day.
• Don’t spend too long in bed. Most people should not stay in bed for more than 8½ hours. Staying in bed for longer can lead to broken sleep.
• Cut out nicotine, reduce or cut out alcohol and limit caffeine to mornings only.
• Exercise regularly, but not in the evening.
• Do something relaxing before bed. If you don’t feel sleepy, or wake in the night, go to another room and do a relaxing activity (such as reading) until you feel sleepy, and then try again.
• Try to manage anything that is worrying you earlier in the day, rather than at bedtime.
• Make sure your bedroom is comfortable. It should be quiet and dark, not too hot or too cold. Consider removing clocks from your bedroom, so you don’t keep checking the time. Avoid screens in your bedroom and don’t use screens for one hour before going to bed.

Cognitive behaviour therapy (CBT)

Research shows that cognitive behaviour therapy (CBT) is a treatment of choice for many pregnant females with insomnia. CBT can help reduce your insomnia symptoms while pregnant. CBT is based on the idea that how you think and act affects how you feel.

Medicines

Your doctor will discuss which medicines you can safely take during pregnancy. Many sleep medicines are not considered safe for you and your baby, so be sure your doctor knows you’re pregnant or breastfeeding.

Sedating antihistamines such as doxylamine can be used in all stages of pregnancy. They are not associated with any increased risk to your baby and are not habit forming, but speak with your doctor before you take these in pregnancy.

Melatonin is sometimes used to treat insomnia, but it’s not recommended if you are pregnant. There is little research investigating how safe it is to use during pregnancy. Doctors prefer that you take a medicine with more evidence of being safe for you and your baby.

Benzodiazepines, including temazepam, are habit forming and not recommended. They may be associated with your baby having withdrawal symptoms after birth. If necessary, your doctor may prescribe these at the lowest effective dose for the shortest period of time.

Are there any alternative ways to treat insomnia?

Acupuncture is a popular alternative therapy for insomnia, and is recommended during pregnancy. Research shows that it can improve your sleep quality.

Herbal medicines and infusions, another common alternative treatment, are not recommended to treat insomnia while pregnant or breastfeeding, as there is not enough research investigating their safety. Always check with your doctor or pharmacist before taking an alternative or herbal medicine.

How is insomnia treated while breastfeeding?

If you are breastfeeding and experiencing insomnia, your doctor will first treat insomnia by addressing your sleep hygiene, as well as any underlying causes of poor sleep.

Some medicines can pass into your breastmilk and make your baby drowsy. It is not recommended to take any medicines or herbal infusions without first checking with your doctor. If your doctor does prescribe you with a sleeping medicine, they may prescribe the lowest dose for the shortest amount of time possible.

Temazepam, a short acting medicine, is unlikely to be a problem, especially with older babies. It can be prescribed on a one-off occasion. This medicine is used in preference to over-the-counter antihistamine — doxylamine, which can affect your milk production.

There is not much research studying the effect of melatonin on your breastmilk. It is unlikely to be of concern if you are breastfeeding an older baby, but check with your doctor or pharmacist before you take any medicine while you are breastfeeding.

Can insomnia affect my or my baby’s health?

Insomnia during pregnancy can affect your and you baby’s health. It can negatively affect your quality of life and cause anxiety and stress during pregnancy. It is also be associated with premature birth, postnatal depression and anxiety, gestational diabetes and pre-eclampsia. This is why if you have problems with experiencing insomnia, you should seek appropriate medical advice and treatment.

How can I improve my sleep during pregnancy?

You can improve your sleep during pregnancy by following these tips to help treat pregnancy related sleep problems:

• Indigestion and heartburn — raise the head of your bed or sleep with more pillows. Take antacids in moderation.
• Physical discomfort — sleep on your side and try a pregnancy pillow.
• Frequent urination — avoid drinking too much in the evening and try to go to the toilet before bed.
• Restless leg movements — reduce the amount of tea, coffee and other sources of caffeine.

See your doctor or midwife if you still have problems sleeping after trying these tips.

Resources and support

• The Sleep Health Foundation provides information about insomnia and links to online resources and programs.
• The Health Resource Directory has sleep hygiene information, as well as advice on good sleep habits in Chinese, Arabic and Vietnamese.
• Visit the Australian Psychological Association for more information on seeking help and treatment for insomnia.
• THIS WAY UP is a free online program which provides practical strategies to help deal with ongoing insomnia, based on cognitive behavioural therapy (CBT).