Insomnia in pregnant women – risk factors, diagnosis, and treatment

Insomnia is a common problem reported by pregnant women. Data on the prevalence of insomnia in both the general population and the subpopulation of pregnant women vary depending on the methodology. Pregnancy-associated insomnia has a complex aetiology and can significantly affect pregnant women’s quality of life and the course of pregnancy. The most important factors predisposing pregnant women to sleep disorders include hormonal changes, physical complaints related to pregnancy (e.g. back pain, frequent urination), stress, and comorbidities such as obstructive sleep apnoea or restless legs syndrome. Some changes in sleep architecture are physiological. Typically, the first trimester of pregnancy is characterised by increased sleepiness, which subsides as the body adapts to new hormone concentrations in the second trimester. The greatest severity of sleep disorder symptoms usually occurs in the last trimester of pregnancy. Consequences of untreated insomnia during pregnancy include an increased risk of preterm labour, low birth weight, pre-eclampsia, and postpartum depression. Diagnostic methods for sleep disorders vary in the quality of data obtained. The most commonly used tool is a sleep diary kept by the patient, which can be supplemented by objective data obtained from an actigraph. Treatment of insomnia during pregnancy should be tailored to the individual needs of each woman. Non-pharmacological therapy, which is now considered first-line treatment, primarily includes improved sleep hygiene and cognitive behavioural therapy for insomnia. In some cases, following a thorough risk-benefit assessment, short-term use of medication at low doses may be recommended. Doxylamine and some antidepressants have the best safety profiles.