Sleep Disorders Treatment Safety of Medications Used to Treat Sleep Disorders in Pregnancy By Brandon Peters, MD Brandon Peters, MD Facebook Twitter Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist. Learn about our editorial process Updated on May 10, 2022 Medically reviewed by Rochelle Collins, DO Medically reviewed by Rochelle Collins, DO LinkedIn Rochelle Collins, DO, is board-certified in family medicine. She is an assistant clinical professor of family medicine at Quinnipiac University and works in private practice in Hartford, Connecticut. Learn about our Medical Expert Board Print If you have difficulty sleeping during pregnancy, you may want to learn about treatment options. Certain conditions such as insomnia and restless legs syndrome (RLS) may occur more frequently during pregnancy. Other sleep disorders such as narcolepsy and sleep behaviors known as parasomnias may persist through pregnancy and require treatment. It is important to understand how the safe use of medications during pregnancy is determined. Then, you can consider what options your healthcare provider might have to treat your condition and help you to sleep better. Discover what medications are safest to use to treat sleep disorders in pregnancy. Alter_photo/Getty Images Categorizing Drug Safety The first choice to treat a sleep disorder in a pregnant woman is to use lifestyle changes to help relieve the condition and avoid all medications. For those suffering from insomnia, a treatment with cognitive behavioral therapy for insomnia (CBTi) may be effective. Even in RLS, a variety of changes can lead to relief without resorting to medication. In severe conditions, some medication must be used with caution. The concern is that many medications have not been tested in large numbers of women. No one wants to cause a birth defect. Drugs that do so are called teratogenic (literal translation is "monster forming"). Therefore, many studies are not done in pregnant women because even a small risk is not deemed to be acceptable. Nevertheless, experience and studies in animals have given us some guidance on medication safety in pregnancy. Categories of Medications for Use in Pregnancy The following classification of the effects of medications during pregnancy is used:Category B: Animal studies have not indicated a fetal risk but no controlled studies in pregnant women exist, or animal studies have shown an adverse fetal effect that is not confirmed in controlled studies in women in the first trimester. There is no evidence in later trimesters.Category C: Animal studies have shown adverse fetal events, but no controlled studies in pregnant women exist, or studies in humans and animals are not available; thus, the medication is given if the potential benefit outweighs the risk.Category D: Risk to fetus is present, but benefits may outweigh the risk if a life-threatening or serious disease exists.Category X: Studies in animals or humans show fetal abnormalities; the drug is contraindicated for pregnant women. Therefore, medications are deemed to be safer when additional research supporting safety in humans is available. However, an individual’s risk with the use of any drug may still result in unacceptable consequences. Medication Use for Sleep Disorders Using the categories outlined above, medications for the treatment of the most common sleep disorders during pregnancy can be grouped. These conditions include insomnia, RLS, narcolepsy, and parasomnias. The safety of drugs decreases as you move from Category B to Category C to Category D and, finally, to Category X. According to published research, hypnotic benzodiazepine receptor agonists (zaleplon, zolpidem and eszopiclone) are the most commonly prescribed drugs for insomnia in pregnant women, but other medications are also sometimes prescribed. Consider the sleeping medications available during pregnancy for each of the following conditions: Insomnia Category B Sedatives and Hypnotics (Benzodiazepines): Zolpidem, Diphenhydramine Category C Sedatives and Hypnotics (Benzodiazepines): Zaleplon Anticonvulsants: Gabapentin Antidepressants and Depressants: Amitriptyline, Doxepin, Trazodone Category D Sedatives and Hypnotics (Benzodiazepines): Alcohol, Alprazolam, Diazepam, Lorazepam, Midazolam, Secobarbital Category X Sedatives and Hypnotics (Benzodiazepines): Alcohol (if used in large amounts or for prolonged periods), Estazolam, Flurazepam, Quazepam, Temazepam, Triazolam Restless Legs Syndrome or Willis-Ekbom Disease Category B Antiparkinsonian Agents (Dopaminergics): Bromocriptine, Cabergoline Narcotic Agonist Analgesics (Opioids) (see D): Meperidine, Oxymorphone, Methadone, Oxycodone Category C Central Analgesics: ClonidineAnticonvulsants: Gabapentin, LamotrigineAntiparkinsonian Agents (Dopaminergics): Carbidopa, Levodopa, Pramipexole, RopiniroleNarcotic Agonist Analgesics (Opioids) (see D): Codeine, Morphine, Propoxyphene, HydrocodoneAntidepressants and Depressants: Amitriptyline, Doxepin, Trazodone Category D Anticonvulsants: Clonazepam, CarbamazepineNarcotic Agonist Analgesics (Opioids) (if used for prolonged periods or in high doses at term): Meperidine, Oxymorphone, Methadone, Oxycodone, Codeine, Morphine, Propoxyphene, Hydrocodone Category X Sedatives and Hypnotics (Benzodiazepines): Estazolam, Flurazepam, Quazepam, Temazepam, Triazolam Narcolepsy Category B Stimulants: Caffeine, PermolineAntidepressants and Depressants: Sodium oxybate (Xyrem) Category C Antidepressants and Depressants: Fluoxetine, Paroxetine, Protriptyline, VenlafaxineStimulants: Dextroamphetamine, Mazindol, Methamphetamine, Methylphenidate, Modafinil Category D None Category X None Parasomnias (Sleep Behaviors) Category B None Category C Antidepressants and Depressants: Imipramine, Paroxetine, Sertraline, Trazodone Category D Sedatives and Hypnotics (Benzodiazepines): DiazepamAnticonvulsants: Clonazepam, Carbamazepine Category X None How to Choose a Medication After considering the list of medications available for the treatment of sleep disorders during pregnancy, you should have a candid discussion of your situation with your healthcare provider. You will want to consider the severity of your symptoms. Do you even require treatment or will the condition pass on its own? If possible, you should first try non-pharmacological treatments including lifestyle changes. If you can address stress, alter your diet, or improve your condition with exercise, you may not need to consider a potentially risky medication. If you do decide to choose to take a medication during pregnancy, discuss the potential risks with your healthcare provider and pharmacist to ensure you are fully informed of the potential consequences. You can be your best advocate, both for yourself and your unborn child. 4 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Gupta R, Dhyani M, Kendzerska T, et al. Restless legs syndrome and pregnancy: prevalence, possible pathophysiological mechanisms and treatment. Acta Neurol Scand. 2016;133(5):320–329. doi:10.1111/ane.12520 Haynes J, Talbert M, Fox S, Close E. Cognitive Behavioral Therapy in the Treatment of Insomnia. South Med J. 2018;111(2):75-80. doi: 10.14423/SMJ.0000000000000769 Alwan S, Chambers CD. Identifying Human Teratogens: An Update. J Pediatr Genet. 2015;4(2):39–41. doi:10.1055/s-0035-1556745 Reichner CA. Insomnia and sleep deficiency in pregnancy. Obstet Med. 2015;8(4):168–171. doi:10.1177/1753495X15600572 Additional Reading Kryger, MH et al. "Principles and Practice of Sleep Medicine." ExpertConsult, 5th edition, 2011, p. 1581. By Brandon Peters, MD Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit