Sleep and pregnancy

[sunlioness]

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Does anyone have a favorite sleep med that they like to use in pregnancy? I have a patient who is in her second trimester and complaining of night terrors.

 

[watto]

Night terrors or nightmares? If the former, there are limited interventions. For children with NREM parasomnias, I occasionally suggest instituting brief naps to "burn off" some NREM during the day (works well for somnambulism). For nightmare disorder, I do imagery rehearsal training that can be helpful but isn't indicated for sleep terrors.

 

[sunlioness]

It's probably more nightmares, actually. Thanks.

 

[xlithiumx]

It's probably more nightmares, actually. Thanks.

Well, something specific for nightmares would be prazosin, which is pregnancy category C, like most of the medications we prescribe. Alternatively, most OB/GYNs include various antihistamines on their "generally safe in pregnancy" list. I believe when my wife was pregnant, both diphenhydramine and doxylamine are recommended, and doxylamine is often prescribed for nausea during pregnancy. Both are over the counter and pretty sedating, particularly the doxylamine.

 

[MarcusD]

hydroxyzine...last trimester - Ambien is also considered ok (per midwife) for occasional use

 

[sunlioness]

Thanks, everyone.

 

[nitemagi]

When I was an intern I tried to manage a manic pregnant woman with just antihistamines. Didn't work so well.

I would always start conservative with sleep hygiene, relaxation exercises (PMR).

 

[michaelrack]

have you considered psychodynamic exploration of the content of her nightmares?

 

[notdeadyet]

Well, something specific for nightmares would be prazosin, which is pregnancy category C, like most of the medications we prescribe.

This will depend on the quality of the nightmare. Prazosin typically only has good effect for the nightmares that wake patients from sleep with an increased autonomic response (tachycardia, diaphoresis, SOB, etc.).

 

[xlithiumx]

This will depend on the quality of the nightmare. Prazosin typically only has good effect for the nightmares that wake patients from sleep with an increased autonomic response (tachycardia, diaphoresis, SOB, etc.).

I think that description accounts for most remembered nightmares, i.e. the nightmares that are reported to us.

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[notdeadyet]

I think that description accounts for most remembered nightmares, i.e. the nightmares that are reported to us.

Most likely. But I've seen patients go through intake interviews, get asked if they've had nightmares, checked yes, and then had prazosin referred to them even when the nightmares were disturbing dreams rather than ones that woke them in an autonomically increased state.

 

[PikminOC]

i use trazodone...or remeron if indicated