What is insomnia?

Insomnia is a sleep disorder where you may find it hard to fall or stay asleep. This can make it difficult to function during the day.

Sleep issues affect around 1 in every 2 pregnancies. They may get worse as your pregnancy progresses. Sleep issues are also common after birth, especially if you are breastfeeding.

Insomnia can become ongoing. It is called chronic insomnia 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.

Acute (short-term) insomnia may happen during short periods of stress, such as when you're feeling emotional pressure, dealing with money worries or recovering from childbirth. It usually gets better once the stressful situation passes.

What are the 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, especially in the morning
• 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, aggressive or impulsive
• feeling sleepy when sitting quietly

People experience insomnia differently. You might only have some of these symptoms.

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What causes insomnia during pregnancy and breastfeeding?

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

Pregnancy-related causes of insomnia:

• hormone changes in your body
• nausea and vomiting
• heartburn
• backaches, restless legs or leg cramps
• needing to urinate (wee) 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 insomnia. They will likely recommend a non-medicine treatment first. This includes behavioural and psychological interventions. There are some treatments for insomnia that are not appropriate if you're pregnant or breastfeeding.

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Treating an underlying condition causing insomnia

Before you treat the symptoms of insomnia, you should 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
• any other conditions that cause pain or discomfort

Sleep hygiene

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

• Do not spend too long in bed without sleeping. Staying in bed for longer without sleeping can worsen insomnia.
• Cut out nicotine, reduce or cut out alcohol and limit caffeine to mornings.
• Exercise regularly, but not vigorously (with lots of effort) in the evening.
• Do something relaxing before bed. If you don't feel sleepy, or if you wake up 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 deal with 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 try not to use technology for one hour before going to bed.

General sleep hygiene habits include going to bed and wake up around the same time every day, and avoiding long naps, especially later in the day. These habits can be hard to keep after having a baby or when you are breastfeeding at night. Talk to your midwife, child and family health nurse or lactation consultant about how to adjust sleep hygiene goals when you're pregnant or breastfeeding.

Cognitive behaviour therapy (CBT)

Cognitive behaviour therapy (CBT) is a treatment of choice for insomnia during pregnancy and can help reduce your symptoms. It is a well-researched treatment with low risks to you and your baby. 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 connected with any increased risk to your baby and are not addictive. There is little evidence that they help to treat insomnia.

Melatonin is sometimes used to treat insomnia. It is not recommended if you are pregnant. There is little research about how safe it is to use during pregnancy. Your doctor may prefer a medicine with more safety evidence.

Benzodiazepines, including temazepam, are often prescribed to treat insomnia in non-pregnant people. They are generally not recommended during pregnancy. Your baby may have withdrawal symptoms after birth, especially if you take them in your third pregnancy trimester. If necessary, your doctor may prescribe these at the lowest effective dose for a short time.

Suvorexant is prescribed for people with chronic insomnia. It is not recommended during pregnancy.

Speak with your doctor before taking any medicines during your pregnancy.

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How is insomnia treated while breastfeeding?

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 breast milk and make your baby sleepy. They can also affect your milk supply. Do not take any medicines or herbal infusions without first checking with your doctor. If your doctor does prescribe you a sleeping medicine that's safe for you and your baby, they may prescribe the lowest dose for the shortest amount of time possible.

Benzodiazepines belong to a class of medicines that are not recommended during breastfeeding. One medicine in this class, temazepam, is short acting (works for a short amount of time). It is unlikely to be a problem, especially if your baby is older. Your doctor may prescribe this for a one-off occasion. Temazepam is preferred to the over-the-counter antihistamine doxylamine. This is because doxylamine can affect your milk production if taken in large doses.

There is not much research studying the effect of taking melatonin on your breast milk. It may pass into your breast milk, but is unlikely to be of concern if you are breastfeeding an older baby.

Suvorexant is prescribed for people with chronic insomnia. It is not recommended while breastfeeding.

Always check with your doctor or pharmacist before you take any new medicine or supplement while you are breastfeeding.

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.

Other alternative treatments include:

• yoga
• tai chi
• aromatherapy or massage
• music

Herbal medicines and infusions are other common alternative treatments for insomnia. These treatments are not recommended during pregnancy or breastfeeding. There is not enough research looking into their safety. Always check with your doctor or pharmacist before taking an alternative or herbal medicine.

Can insomnia affect my or my baby’s health?

Insomnia during pregnancy can affect your and your baby's health. It can cause anxiety and stress during pregnancy. Insomnia can affect your quality of life. It is also associated with:

• premature birth
• postnatal depression and anxiety
• gestational diabetes
• pre-eclampsia

If you have problems with insomnia, seek medical advice and treatment.

How can I improve my sleep during pregnancy?

You can improve your sleep during pregnancy by following these tips:

• Indigestion and heartburn — raise the head of your bed or sleep with more pillows. Do not take too many antacids.
• Physical discomfort — sleep on your side and try a pregnancy pillow.
• Frequent urination — avoid drinking too much liquid in the evening and go to the toilet before bed.
• Restless leg movements — reduce the amount of tea, coffee and other sources of caffeine. Stop smoking and try gentle exercise.

See your doctor or midwife if you still have trouble 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 information on sleep hygiene and advice on good sleep habits.
• Visit the Australian Psychological Society for more information on seeking help and treatment for insomnia.
• THIS WAY UP is a free online program which provides practical ways to help you deal with ongoing insomnia, based on cognitive behavioural therapy (CBT).
• MindSpot's Sleep Course is a free online program assisted by therapists designed to help you improve your sleep.

Languages other than English

Read about sleep hygiene and healthy sleep habits in Chinese, Arabic and Vietnamese through the Health Resource Directory.