Pharmacological treatment of sleep disorders during pregnancy

How to cope with stress during pregnancy?

Worries and anxieties overcome every person. For a pregnant woman they have a special meaning, as she begins to feel responsible for two. As a result, the expectant mother experiences enormous stress, which can greatly ruin her mood and well-being. How to protect yourself from unnecessary worries and easily survive 9 months of waiting for a miracle?

Move

– take a walk, walk every day, this is especially useful to do in the evening.

Sleep more

– a daily full night’s sleep can be supplemented with an afternoon sleep if you feel the need for it. The closer the date of birth, the harder it is for a woman to get enough sleep: a growing belly, frequent urge to urinate and anxious thoughts about the baby keep her from falling asleep. A comfortable pillow for pregnant women, limiting fluid intake in the afternoon, and a calm, cozy home atmosphere will help you cope with this condition.

Treat yourself more carefully

– you shouldn’t hush up your emotions and accumulate them within yourself, only to eventually explode over a trifle and throw out an avalanche of feelings on your husband, mother, mother-in-law or cat. Worries, anxieties, and fears are completely normal when expecting a baby, and it is best to share them with your family. Your loved ones will support you and help dispel disturbing thoughts. An excellent way to calm down is breathing exercises, meditation, and journaling. You can channel your emotions into creativity - draw, sew, knit.

Get support from others

– not only relatives and friends, but also those who are in your position. Among pregnant women, you can easily discuss the most pressing issues (for example, choosing the color of a nursery or finding a suitable ultrasound specialist) without worrying that your interlocutors are not interested in such topics.

Seek help from a psychologist

. Sometimes it happens that a woman is unable to cope with the stress that has fallen on her. As a result, not only she suffers, but also her husband, parents, and loved ones, the situation in the family becomes tense, and the woman feels more and more unhappy. Don’t be embarrassed or afraid: the timely participation of a therapist will help you relieve anxiety and worries, regain lost peace of mind, enjoy the time you are waiting for your baby and prevent postpartum depression.

All information is for informational purposes only. If you have any health problems, you need to consult a specialist.

Treatment of primary and secondary insomnia

Benzodiazepines

. Benzodiazepines affect central nervous system levels in the limbic, lumbar, and hypothalamic regions and increase gamma-aminobutyric acid (GABA) neurotransmission. They act through the modulatory site of the GABAA receptor complex and have sedative, anxiolytic and antiepileptic effects.

Benzodiazepines are commonly used to treat insomnia, anxiety, and seizures. Although these medications are more suitable for short-term treatment of insomnia and anxiety, some patients take them long-term. It has been found to be associated with a high risk of addiction, drowsiness, cognitive impairment, falls and fractures.

Drowsiness when taking benzodiazepines

Benzodiazepines readily cross the placenta and enter fetal tissue, but studies indicate that these drugs are not teratogenic. Early case-control studies showed an increased incidence of abnormal growth of the lips (cleft lip) or palate (cleft palate) with benzodiazepines, but these results were not confirmed in subsequent studies.

However, there is evidence that benzodiazepines may increase the risk of preterm birth and low birth weight.

Hypnotic benzodiazepine receptor agonists

. Medicines belonging to the hypnotic benzodiazepine receptor agonists (HBRA) class, also known as Z drugs, include the imidazopyridine zolpidem, pyrazole and pyrimidine zaleplon, cyclopyrolone, zopiclone and eszopiclone.

This group of drugs is currently the most commonly prescribed sleeping pills in the world, including for pregnant women. Although they are not chemically related to benzodiazepines, they are GABA receptor agonists that reduce sleep time and improve sleep quality.

These drugs are believed to cause only minimal disruption of sleep architecture. The most common side effects associated with this group of drugs are memory impairment, daytime fatigue, hallucinations, physiological dependence, and so on.

HBRA, like benzodiazepines, crosses the placental barrier, but at standard therapeutic doses does not increase the risk of congenital malformations. However, a case of neural tube defect with high-dose zolpidem use in the first trimester of pregnancy has been studied. HBRA was then found to increase the likelihood of preterm birth because it is associated with low birth weight in infants. However, these data were obtained in studies on small samples.

Antidepressants

. Regardless of class, all antidepressants currently on the market act by modulating the neurotransmitters monoamines, serotonin, norepinephrine, dopamine and thus treat depression and anxiety. Because of the sedative effects of some antidepressants, this group of drugs is often used to treat insomnia during pregnancy.

The most commonly prescribed tricyclic antidepressants (TCAs), piperazinoazepine (mirtazapine), serotonin-2 receptor antagonists, and the serotonin reuptake inhibitor trazodone. Doxepin and amitriptyline are TCAs most often used in low doses for sleep disorders. Their sleep-inducing effects are thought to be due to their antihistamine properties.

Doxepin

Side effects of TCA include confusion, constipation, blurred vision, weight gain, tachycardia, cardiac arrhythmia, and death in case of overdose. Adults usually tolerate low doses of doxepin to treat insomnia. Serious side effects of mirtazapine may occur, such as drowsiness, loss of appetite, and weight gain.

Trazodone, which was originally developed as an antidepressant, is now used almost exclusively to treat insomnia. It is generally well tolerated, improves sleep quality and reduces sleep time.

Studies have found no association between perinatal antidepressant use and an increased risk of birth defects. The likelihood of having a low birth weight baby and preterm birth was slightly increased, but the underlying medical condition may have influenced the study results.

Studies have shown that use of antidepressants in late pregnancy slightly increases the risk of respiratory symptoms, including persistent neonatal pulmonary hypertension, but the absolute risk is very low.

A systematic review of mirtazapine in pregnant women suggested that there may be an increased risk of miscarriage, but these findings could be related to the underlying medical condition. No association was found between prenatal use of mirtazapine and congenital malformations.

Antidepressant use during pregnancy has been associated with adverse neurophysiological effects in newborns - irritability, tremors, nervousness, and sleep disturbances - known as neonatal adjustment syndrome, but these symptoms are usually transient. Additional neurological effects—abnormal gross movements—were observed in the newborns, but these results should be taken with extreme caution because in many of the same studies the mothers had a history of untreated depression.

Untreated depression

Antipsychotic drugs.

Antipsychotic drugs act primarily as dopamine receptor antagonists. First generation antipsychotics (characterized by D2 receptors) work essentially the same way (strength varies). Second-generation antipsychotics do not have such a uniform effect and have an inhibitory effect on serotonin receptors.

The use of antipsychotic drugs to treat insomnia has become common, but due to side effects, pregnant women should not take them if the primary indication is only insomnia. The sedative effects of many antipsychotic drugs may be useful in the treatment of psychosis and mood disorders.

Second-generation sedative antipsychotics include clozapine, olanzapine, quetiapine, and risperidone. Olanzapine and clozapine cross the placenta more quickly than quetiapine and risperidone due to differences in protein binding. In vivo studies have shown that maternal blood levels of antipsychotic drugs decrease during the third trimester of pregnancy.

Recent studies of second-generation antipsychotics have shown that these medications can be used in the perinatal period. No association with congenital malformations or gestational diabetes was found.

A study by Sorensen and colleagues found no increased risk of miscarriage in pregnant women who took and subsequently discontinued antipsychotic medications, but it was associated with an increased risk of stillbirth (1.2% vs. 0.6%). In 2011, the US Federal Drug Administration issued a warning about this class of drugs for the treatment of withdrawal symptoms and extrapyramidal symptoms in newborns.

Melatonin and melatonin receptor agonists.

Melatonin is a natural neurotransmitter that modulates the circadian rhythm of all mammals. Melatonin is known to influence fetal puberty and increase endogenous melatonin secretion during pregnancy. Melatonin is also produced in the placenta. It protects against molecular damage and cell dysfunction that develops due to oxidative stress.

There are no adequate data on the use of exogenous melatonin in pregnant women. Studies analyzing the effects of melatonin on newborns were conducted on mice. Their results are contradictory. Some suggest that melatonin has a neuroprotective effect under the influence of toxins, and others point to disruption of reproductive hormone secretion and circadian rhythm after childbirth.

Antihistamines.

Diphenhydramine and hydroxyzine are widely used during pregnancy, but little research has been done on the safety profile of these drugs in humans.

A study by Khazaie and colleagues assessed the effects of antihistamine treatment for insomnia in the third trimester of pregnancy on sleep and postpartum depressive symptoms. The study included 54 pregnant women who were randomized to receive trazodone 50 mg/day and diphenhydramine 25 mg/day or placebo treatment. Trazodone and diphenhydramine significantly improved sleep duration and efficiency compared with placebo. Both drugs reduced symptoms of depression.

Einarson and colleagues compared 53 pregnant women taking hydroxyzine with 23 women taking cetirizine and a control group, but they found no significant differences in the risk of spontaneous abortion, therapeutic abortion, or stillbirth.

Hydroxyzine

In 2005, a case of neonatal abstinence syndrome was reported in association with the use of hydroxyzine (150 mg/day). The Israeli Teratogenicity Information Service looked at 37 pregnant women taking hydroxyzine and found no increased risk of birth defects.

A study by Lee and colleagues found no significant association between diphenhydramine and doxylamine with birth defects. Another study, in contrast, found a possible link between diphenhydramine, doxylamine and developmental defects, but was criticized for bias and a relatively small sample.

sedatives during pregnancy

Pregnancy, of course, is not a disease. However, this condition often requires the use of certain medications. In addition, the usual means of combating the disease may now turn out to be undesirable for you. Therefore, the usual composition of your home first aid kit should be replenished with the following components.

A pregnant woman needs more vitamins, and even a balanced diet during this period cannot fully satisfy the body’s need for vitamins and microelements. It is best to take multivitamin preparations designed specifically for pregnant women. A doctor will help you choose such a drug. However, if various complications occur during pregnancy, your doctor may prescribe the following medications in addition to your multivitamins:

• folic acid
  - vitamin B9, which is recommended to be taken before the 12th week of pregnancy, because its deficiency can lead to anemia, blood clotting disorders, and fetal malnutrition. A sufficient amount of folic acid will ensure the correct formation of the fetal neural tube, from which the baby’s nervous system will then be formed;
• Vitamin E
  performs an important protective function in the body, fighting free radicals - metabolic products that destroy cells; in addition, it helps to relax the muscles of the uterus during pregnancy, thereby preventing its interruption;
• During pregnancy, the need for iron
  , because this microelement is part of hemoglobin, which ensures the delivery of oxygen to the body not only of the mother, but also of the fetus. It is quite difficult to satisfy this need by simply adjusting the diet;
• calcium
  ensures proper growth and formation of fetal bone tissue. If calcium is supplied in insufficient quantities from food, it is “taken” from the mother’s bones, which leads to a disruption of their structure - osteoporosis, deterioration of the condition of the teeth. Therefore, in some cases, pregnant women are recommended to take calcium supplements. Often such preparations also contain vitamin D, which helps improve the absorption of incoming calcium.

Your doctor will determine the right dosage and duration of taking these medications, because they are individual for each woman and depend on the severity of pregnancy complications.

E

This is an antispasmodic drug that is used during pregnancy to increase the tone of the uterus. The effect of the drug is based on relaxation of the muscle muscles of the uterus. Clinical studies have proven that no-spa does not have an adverse effect on the fetus. Doctors recommend having this drug with you and using it if there are signs of increased uterine tone (painful sensations in the abdominal area, when the uterus becomes hard and dense and does not relax for a long time). It is recommended to take no more than 6 tablets of no-shpa per day. Before you start taking no-shpa, you should consult your doctor, since this drug cannot be taken if you have symptoms of isthmic-cervical insufficiency.

They have an effect similar to no-shpe and are used to enhance its effect, since both of these drugs interact, increasing the duration of each other’s therapeutic effect. Suppositories with papaverine are rectal, i.e. are inserted into the rectum, the frequency of their use is determined by the doctor.

During pregnancy, bowel problems often occur, which interferes with normal digestion and metabolism. If a corrective diet does not help, you can use mild laxatives, such as Guttalax

. This drug is not contraindicated during pregnancy and does not affect the fetus.

Constipation that often occurs during pregnancy can provoke the development of hemorrhoids - varicose veins of the anus and rectum in the form of painful nodes and lumps that begin to bleed during bowel movements. Can be used after 12 weeks of pregnancy rectal suppositories and Gepatrombin

, suppositories with novocaine. While taking these medications, the hemorrhoids will become smaller and the pain will go away. In addition, hepatrombin will also have a preventive effect: its use sharply reduces the risk of relapse of the disease.

If you have a cold, you can use remedies that boost your immunity.

.
These include, for example, a drug containing interferon, which helps fight bacterial and viral infections, Viferon
. It should be noted that a dosage of 150 thousand ME is suitable for pregnant women.

For prevention, especially during epidemics, you can use a product such as Oxolinic ointment

.
It is placed in a small amount into the nose, lubricating its mucous membrane. The action of oxolinic ointment is based on the fact that it prevents the introduction of the virus. It is recommended to use oxolinic ointment before planning to visit crowded places, as well as in the autumn-winter period. You can use Vitaon
.

In the first half of pregnancy, given the peculiarities of changes in the excitability of the nervous system, for example, increased tearfulness, irritability, and in the second half of pregnancy, given frequent insomnia, you may need a sedative

.
In this capacity, we can recommend Valerian
and
Motherwort
(they can be used in the form of tablets, extracts, decoctions of dry herbs). You can use the drug Novopassit, which is based on herbs and does not contain alcohol.

In the second half of pregnancy, heartburn often appears, because... The increasing size of the uterus “props up” the diaphragm and stomach, as a result of which the outflow of bile is disrupted: it is thrown into the stomach and esophagus. This problem can be eliminated by taking Rennie or Almagel

.

The question often arises: can a pregnant woman take medications for headaches? It should be remembered: enduring a headache is much more harmful than taking painkillers (of course, if the headache is not regular, but occasional). If you are experiencing frequent, painful headaches, they may indicate the development of some disease, and you should consult your doctor.

If a similar reason is excluded, you can take a painkiller

.
The most studied effects on a pregnant woman and fetus are paracetamol and drugs based on it (for example, Panadol
). In small doses or for a short period of treatment, it does not have a negative effect on the fetus.

During pregnancy, due to changes in immune status, there is a high probability of experiencing certain allergic reactions, even if you have never encountered this disease before. In this case, such well-known drugs as Suprastin, Claritin

.

In conclusion, let us remind you: you can use any medications only after consulting a doctor and with extreme caution - up to 12 weeks of pregnancy.