Insomnia in the perinatal period

Sleep is frequently impaired in the perinatal period.

The approach to assessing sleep problems in the perinatal period is the same as for the general population. However, during pregnancy, additional contributing factors include high concentrations of sex hormones, fetal movement and pregnancy-associated physical discomfort. Iron and folate deficiency may contribute to restless legs syndrome. Most causes of pregnancy-related insomnia are relieved by childbirth.

Sleeping less than 6 hours a night has been associated with a longer labour and higher risk of caesarean section—treating insomnia may improve obstetric outcomes.

The approach to treating insomnia in the perinatal period is the same as for other patients—address factors impacting sleep, ensure the patient has good sleep practices and use psychological and behavioural interventions. If the patient is experiencing sleeping problems because of their infant’s sleeping patterns, see the Raising Children website for advice. If a drug is considered necessary to treat insomnia and the patient is:

• pregnant, avoid suvorexant and discuss the potential harms and benefits of melatonin and hypnotic use—see Principles of psychotropic use during pregnancy, Benzodiazepine use in pregnancy and Zolpidem or zopiclone use in pregnancy
• breastfeeding, avoid melatonin and suvorexant and discuss the potential harms and benefits of hypnotic use—seePrinciples of psychotropic use while breastfeeding, Benzodiazepine use while breastfeeding and Zolpidem or zopiclone use while breastfeeding.