Getting a good night's sleep is one of the many challenges of pregnancy. Maybe nausea is keeping you up, or anxiety , or frequent trips to the bathroom . Or maybe you have leg cramps or restless legs syndrome . Or maybe you're just unable to get into a comfy sleeping position now that you have a big belly.
You're not alone. According to an analysis of 24 studies including more than 15,500 women, 25% of moms-to-be experience insomnia in the first trimester of pregnancy, 27% in the second trimester, and more than 40% in the third trimester.
When you're tossing and turning, it's natural to wonder whether it's okay to reach for prescription sleeping pills or an over-the-counter sleep aid such as Unisom.
Can you take Unisom during pregnancy?
Yes. The active ingredient in Unisom is the antihistamine doxylamine, which is considered safe during pregnancy. In fact, doxylamine is probably the safest option when it comes to sleep medications during pregnancy, says Layan Alrahmani, M.D., a board-certified ob-gyn, maternal-fetal medicine specialist, and member of the BabyCenter Medical Advisory Board .
"I tell my patients it's okay to use Unisom occasionally if they're struggling to sleep," says Dr. Alrahmani.
Along with doxylamine, the antihistamine diphenhydramine is okay to take in recommended doses during pregnancy, even for extended periods. Doxylamine and diphenhydramine are the active ingredients found in over-the-counter medications including Unisom, Decapryn, Aldex, Advil PM, Aleve PM, Excedrin PM, and Sominex.
Doxylamine – in tandem with vitamin B6 – is sometimes prescribed for morning sickness (the combination drug is called Diclegis). According to the American College of Obstetricians and Gynecologists , "both drugs, taken alone or together, have been found to be safe to take during pregnancy and have no harmful effects on the fetus."
According to Mother to Baby , a non-profit teratology information organization, occasional use of the antihistamine diphenhydramine isn't expected to increase the risk of pregnancy-related problems
But as with any drug, you may experience side effects. The possible side effects of Unisom include:
If you have any serious effects, such as vision problems or difficulty urinating, contact your doctor right away.
Are sleeping pills safe during pregnancy?
There's not a lot of data to help decide if many of the available prescription sleeping pills are safe during pregnancy. According to the Centers for Disease Control and Prevention , fewer than 1% of medicines approved since 1980 have enough information to determine their safety during pregnancy. That's because it's difficult to safely test medications on pregnant women.
Here's what we know about some of the ingredients in sleeping pills:
Benzodiazepines
Benzodiazepines haven't been proven safe for pregnant women, so it's best to avoid them.
On one hand, a study of more than 6,000 women found no increased risk of problems such as preterm birth, low birth weight , or other adverse pregnancy outcomes in those who used sedative drugs such as benzodiazepines during pregnancy.
But one nationwide study of more than 3 million pregnancies found an increased risk of miscarriage associated with benzodiazepine use. Another study of more than 82,000 pregnancies found weak links between benzodiazepine use and decreased birth weight and preterm birth. Links have also been found between benzodiazepines and preterm labor and C-section delivery .
There are also reports of withdrawal or toxicity symptoms (such as sleepiness, abnormal muscle tone, and respiratory or sleep problems) in newborns whose mothers took benzodiazepines during pregnancy.
"I wouldn't recommend using a benzodiazepine as first- or second-line treatment for insomnia in pregnancy," says Dr. Alrahmani.
Nonbenzodiazepines
Nonbenzodiazepines should also be avoided during pregnancy. One study of 2,497 pregnant women who used the nonbenzodiazepine zolpidem showed an increase in low birth weight, small-for-gestational age infants, preterm delivery, and C-sections compared with pregnant women who didn't use the drug.
Another study of more than 39,000 birth defect cases found no large increase in risk with the use of zolpidem, though the researchers concluded that "smaller increases in risk for certain defects cannot be ruled out."
Nonbenzodiazepines can also cause withdrawal symptoms (such as breathing problems and difficulty sleeping) in newborns.
Barbiturates
Barbiturates aren't safe to take during pregnancy. They may increase the risk of birth defects and brain tumors and may result in bleeding problems and withdrawal side effects in newborns.
Other drugs
There aren't good studies on whether it's safe to use the prescription medications ramelteon, tasimelteon, or suvorexant in pregnancy. There are some concerning animal studies, however, and doctors recommend only using products containing these ingredients if the potential benefits outweigh the potential risks.
What are safe alternatives to sleeping pills during pregnancy?
In many cases, "sleep disorders can be relieved by improving sleep hygiene, such as avoiding caffeine, having a consistent bedtime, and avoiding screens before bed," says Dr. Alrahmani.
Here are some safe alternatives to sleep medication:
- Set regular bedtimes and waking times.
- Limit your fluid intake in the evening to reduce trips to the bathroom.
- Avoid foods that might give you heartburn .
- Avoid caffeine , especially in the afternoon and evening.
- Take naps early in the day, if needed, rather than in the afternoon.
- Establish a soothing bedtime ritual. Take a warm bath or shower before bed, for example, and put on some quiet music.
- Have a warm bedtime drink, such as milk (dairy or oat milk, for example). Some people find a dash of honey and nutmeg soothing. Some herbal teas are also soothing, but not all herbs used for sleep issues are safe during pregnancy, so talk with your doctor or midwife about which to use.
- Make sure your bedroom is dark. Use blackout curtains, if needed, and put a nightlight in the bathroom so you can find your way without turning on the light. Avoid bright screens (such as your laptop, tablet, television, and smartphone) before bed, too. Artificial light prevents your body from making melatonin because it thinks it's still daytime.
- Don't use your bed for eating, watching television, or scrolling on your phone. Use it only for sleeping and sex .
- Try relaxation techniques, such as deep breathing, guided imagery, and progressive muscle relaxation.
- Do some gentle stretches or prenatal yoga before bedtime to relax your muscles.
- Try different sleeping positions and a pregnancy pillow to get comfortable.
When it comes to taking melatonin during pregnancy , the jury is out. Many healthcare providers recommend against it because it crosses the placenta, and there isn't extensive research on its use in pregnancy.
Others, however, recommend it for pregnant women who find it hard to fall asleep. One review of 15 studies concluded that using melatonin during pregnancy and breastfeeding is probably safe, but that studies on effectiveness and safety are lacking.
Read more about natural remedies for pregnancy insomnia .
When to talk to your provider about sleep issues
If you consistently have trouble sleeping during pregnancy, ask your doctor or midwife about your options.
They can help you sort out and address any underlying problems, such as sleep apnea, restless leg syndrome, or heartburn. You can also talk about feelings of anxiety or depression that may be affecting your sleep. (Treating your insomnia can decrease your risk of postpartum depression – so it's important to bring this up with your provider.)
If needed, your doctor or midwife can help you choose an appropriate sleeping medication and advise you on how to use it (how often and for how long, for example). To be safe, always talk to your provider before taking any supplement or medication during pregnancy .
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