Did you take medication for sleep while pregnant, and if so, what?
January 28, 2010 2:23 PM   Subscribe

Did you take medication for sleep while pregnant, and if so, what? YANMD. Many more details inside.

For the last five years I've been taking .25 mg of clonazepam every night for sleep. I have a diagnosis of bipolar II and more often than not, when I don't take it I have racing thoughts and a general feeling of tension that keeps me from falling asleep for hours. Without it I also generally wake several times during the night and wake up with sore muscles in my shoulders, neck and hands. I assume this is from tensing those muscles during sleep. I believe that this is due to my bipolar - not a clonazepam addiction. I've been off the drug for 3-4 days in the past without typical withdrawal symptoms.

Last week, I found out I'm pregnant. First trimester. Information on clonazepam during pregnancy indicates that it falls somewhere between 'probably safe' and 'probably not safe' on the caution spectrum (depending on the source). I am going to see my psychiatrist about this next week. I am pretty certain she's going to present a balanced viewpoint on the possible risks to the baby vs. possible risks to me and then let me decide.

I don't know what to do. The general consensus seems to be that Benedryl is safe for pregnant women as a sleep-aid, but does that mean you can take it every night? And does it lose efficacy after a few weeks?

Are there other options that are 'safer' than clonazepam? Like Ativan, or Lunesta? Barbituates? Did you take anything and if so, what was it and how did you make your decision?

I also take Lamical and Celexa. Might a different antidepressant help on the sleeping end of things? I think this is something my psychiatrist might suggest.

During the last week, I managed to get to sleep without pills on only 1 day of of the 7. I've been switching back and forth between clonazepam and benedryl, not knowing what else to do. I work a full day and then go to night class every weekday evening. Living without sleep is simply not an option. They say women come to be exhausted in the first trimester and that would certainly solve the problem temporarily, but this hasn't happened to me yet.

Sorry this is so long. My main question remains: did you take anything for sleep when you were pregant? What was it?
However, any info you can give me is appreciated and will help prepare me to talk with my doctor.
posted by kitcat to Health & Fitness (19 answers total) 2 users marked this as a favorite
Response by poster: Maybe I should have mentioned as well - I am definitely not stopping my Lamictal, but I may consider slowly going of the Celexa in the third semester. Just in case you were going to mention something contraindicated with antidepressants.
posted by kitcat at 2:27 PM on January 28, 2010

Obviously, you need to talk to your doctor about daily use. The train of thought I've heard most often with these meds and pregnancy is that you and your doctor need to do a risk/benefit analysis, individualized to your own needs.

That said, my doctor told me Unisom (same active ingredient in benadryl) was okay every day during pregnancy, and that a low dose of xanax (alprazolam) or ambien was okay from time to time (and I interpreted that as 1-2 times a week, but not daily). I was taking xanax and ambien every day before I got pregnant, and the first few weeks were horrible because I stopped both the moment I found out I was pregnant - I don't think I slept for 3 weeks straight. After awhile, I did adjust. That is, the exhaustion you mention did kick in, but it took awhile.

The way you mention going off of Celexa toward the end of the pregnancy, you seem to be aware that antidepressants are actually apparently said to be more troublesome during the third trimester than first. At any rate, I think your doc can and really will help you with this - sleep, rest and maintenance of low stress during pregnancy are important, valid goals.
posted by bunnycup at 2:34 PM on January 28, 2010

Um, you might want to stop the Lamictal. Recent studies have indicated an increased risk of cleft palate associate with Lamictal use. Also I am not sure why you are augmenting with anti-depressant with bipolar 2, I'm sure there is a good reason but many times anti-depressants are counter-indicated in bipolar because they are too activating. I think you need to start over with your entire med regime, and you should bump up your appointment if possible.

In the meantime, Unisom is OK as a sleep aid while pregnant, but it's not intended to be used every night and yes it does lose efficacy rapidly.
posted by crazycanuck at 2:35 PM on January 28, 2010

First, congratulations!

Second, yes, talk with your doctor about all of this.

Third, I took Unisom from time to time when I was pregnant, on my OB's advice. Sometimes it would be half a Unisom tablet and a B6 to help with pregnancy sickness (before it got bad enough that I had to move on to Reglan and Zofran). But sometimes, it was a whole tablet at bedtime for sleeping. It seems to be a common suggestion - definitely ask the doctor about this as well, if it will help you.
posted by Lulu's Pink Converse at 2:39 PM on January 28, 2010

I occasionally took Melatonin to fall asleep during pregnancy. Again doctor/midwife's call, but if your doctor doesn't know or isn't familiar with melatonin, you might ask around.
posted by kch at 2:44 PM on January 28, 2010

Response by poster: crazycanuck: thank you for that info. I didn't know about the cleft palate risk, but I don't think that I can go without the Lamictal. And yes, antidepressants can cause hypomania in bipolar patients, but I've been taking one with the Lamictal almost from the beginning because my mood remained on the low end. On the other hand, my 'trouble getting to sleep' issues could be a hypomania thing. So yes, of course, we will review the whole regime.
posted by kitcat at 2:45 PM on January 28, 2010

I think the best thing would be for you to talk to a doctor about this sooner than next week. Your OB-GYN could help you in two ways: (1) she'd know which sleep aids are better than others -- maybe something that's given for morning sickness, as I know one side effect of those can be sleepiness! and (2) she might be able to call up your psychiatrist and get your appointment moved up, as a professional courtesy. That's the avenue I'd take, first thing tomorrow morning, and see if you can get seen tomorrow. You at least need to know whether you could be switching from the clonazepam to something equally effective but generally thought to be safer.

First trimester exhaustion generally kicks in at 6-8 weeks (from your last menstrual period). So that may work toward your advantage, since for the rest of us, it has us in bed at 8!

Good luck, and congratulations!
posted by palliser at 3:02 PM on January 28, 2010

I have depression and anxiety. I took Ambien with my last pregnancy. It was two years ago, so my memory might be a little fuzzy, but I'm pretty sure I took it every night. It was regular Ambien, not Ambien CR. I also took Effexor XR, weaning off of it did not work for me.

My doctor was extremely cautious about medications during pregnancy, but gave me the Ambien to use every day with no hesitation.
posted by TooFewShoes at 3:18 PM on January 28, 2010

Seconding Ambian. Took it with both.
posted by pearlybob at 3:25 PM on January 28, 2010

I took Benadryl daily through both my pregnancies, because my allergies are so bad I simply could not do without it. I vaguely remember reading about some slightly increased risk of cleft palette from Benadryl, but it wasn't a big enough risk to make me try to do without it. I always took it at bedtime because it put me to sleep.
posted by not that girl at 4:17 PM on January 28, 2010

I took Benadryl to go to sleep while pregnant, not every night, because it makes me groggy in the morning. If you can get Phenergan from your doctor, it's an anti-nausea pill that I had while pregnant that makes you sleepy.
posted by artychoke at 4:21 PM on January 28, 2010

Unisom = doxylamine, not benadryl and this is safe in pregnancy. Benzodiazepines are controversial. There's very little data on all of this.
posted by Maias at 4:24 PM on January 28, 2010

I used benadryl but it lost its effectiveness rapidly. Going to the chiropractor and doing Shiva Rea's prenatal yoga ended up being significantly more effective anyway. In general, I'd say 'What baby needs the most is for Mom to be okay.'
posted by debbie_ann at 4:55 PM on January 28, 2010

During my pregnancies, I only took Welbutrin regularly. I'd take melatonin to help me sleep occasionally, which is a natural supplement that your body makes normally. Not sure if it would help in your case.

I also sometimes tend to have something approaching restless leg syndrome, which can make it tough to fall asleep. Not sure if this is something you feel or not, but I thought I'd mention that a weighted blanket can help a lot, sometimes more than drugs.

Best of luck to you, and congratulations!
posted by wwartorff at 5:31 PM on January 28, 2010

While I can't help with the prescription during pregnancy part of your question, could yoga help? At the very least, it may ease the tension.
posted by Chuckles McLaughy du Haha, the depressed clown at 6:34 PM on January 28, 2010

Best answer: For these and other drug in pregnancy questions, check out Safe Fetus, the awesome website with the horrible name! I think I kept a tab open to SafeFetus for my entire pregnancy. I'm getting conflicting information now about whether doxylamine succinate, which is the active ingredient in Unisom, is considered pregnancy category A or pregnancy category B; my OB, however, told me it was in category A, which is the same category as, like, Tums and oranges. It's given for morning sickness and nausea all the time, for decades, and there have never been any problems reported with it.
posted by KathrynT at 11:36 PM on January 28, 2010

My OB recommended both Unisom (which was evidently developed for morning sickness originally) and Tylenol PM (same stuff as Benadryl). She did not give me any restrictions on how often I could take them. I went through periods of using one or the other daily for a few weeks at a time and never had trouble with either. But you should definitely clear anything with your OB and/or psychiatrist to make sure there aren't conflicts with your other meds.
posted by Dojie at 5:07 AM on January 29, 2010

Obviously the final answer will lie with your physicians. If you haven't already done this, please coordinate your care with your psychiatrist and OB. (Don't rely on them to talk with each other--they hardly ever do!)

When I was pregnant I had a bout of bedrest in the hospital. After a few days, I couldn't sleep. My sense of timing was all off; I was laying in bed all day with nothing to do and wasn't getting very tired. So, I was prescribed Ambien, which I know is given routinely to women in the third trimester and in situations like mine.

Honestly, I was so dog-tired my first trimester I wouldn't have needed anything.

Would some light exercise, such as walking for up to an hour a day, be feasible for you? I find that when I have a daily walk, I feel a lot better and am able to get a lot of rest. This worked for me when I was going through a period of anxiety. I wasn't formally treated for it, but I had a lot of insomnia because of it. Just a thought.

Best of luck and congratulations!!!!
posted by FergieBelle at 6:07 AM on January 29, 2010

Best answer: The answers to these kind of questions are all risk-benefit based. In term of risk to the fetus, Lamictal>clonazepam>Celexa however, I have seen all of these used in pregnancy, and used safely and effectively under the guidance of good medical care. In fact, I just had a conversation with an OB in a doctor's lounge complaining about her patient that kept wanting to stop her Lamictal during her pregnancy and kept winding up it the hospital because of it. You need to have an honest conversation with your psychiatrist about how much you need these medicines: did you start them 2 years ago when you had some family stress that has largely passed or are you a raving lunatic whenever you go off your meds? Most people don't think twice about Celexa because the risk is low enough that it usually weighs the risk/benefit equation towards taking it. With Lamictal, and the people who really need it, the benefit is so great that it weighs the risk/benefit equation towards taking it. Clonazepam is a bit tricky because the "medical" benefits are very marginal as are the "medical" risks (I'm talking about hard, experimental outcome data) but the patient perceived benefits are often great. And Benedryl or Ambien haven't been demonstrated as 100% safe either, although they are safe enough to get prescribed all the time.

If you are purely using it for sleep (and not as an adjunctive mood stabilizer, and you maybe need to clarify this with your psychiatrist), my advice is to try whatever sleeping agent your trusted OB is comfortable with that also works (this is the doctor that is going to deal with any adverse consequences of medicines you take, and you want them to be familiar with the adverse consequences that can develop) and know that the risk you take is probably small. If you end up taking clonazepam, it's not the end of the world. A good parent always wants to know that they are doing the best they can *within their abilities* for their child and it starts now.

As I'm sure you are aware, hormones and pregnancy can have big effects on the mood and sleep, so be prepared for a roller coaster. *No one* sleeps in the last month.

Oh and finally, yes yes yes you need to involve both your psychiatrist and OB in the conversation.
posted by Slarty Bartfast at 5:43 AM on January 30, 2010

« Older Looking for musical role models   |   Help me choose a verb Newer »
This thread is closed to new comments.