iStock_000008661605XSmallInsomnia or difficulty falling asleep can affect pregnant women and is usually seen during the last four weeks of pregnancy. It usually occurs because hormone levels mimic menopause and resolves after the baby is born. In extreme cases, some healthcare practitioners will prescribe sleep aids such as Ambien® or its generic form, Zolpidem on a short term basis.

Recently, I interviewed a third-trimester patient who had transferred from another state.  Towards the end of the interview, she asked me if I would prescribe Zolpidem which she had been taking since fourteen weeks.  I found this highly unusual because pregnant women do not usually experience insomnia that early in their pregnancy. Because I do not prescribe sleeping pills in my practice, I consulted with a high-risk specialist for his expert opinion and received a rude awakening. He informed me that women who take Zolpidem are at high risk for committing suicide and there is probably a mental health issue that needs to be addressed. When I asked the patient whether she was depressed, she admitted that she has been “under stress” during her pregnancy, her husband was previously incarcerated and that she would be amenable to going to a mental health professional for a depression screening and possible medication. I was both relieved and annoyed. Upon investigating the medication further, I discovered that

  1. Zolpidem or Ambien° should never be prescribed without first determining the reason for the sleep disturbance
  2. It is only to be used on a SHORT TERM basis
  3. It is often used as a drug of choice for suicide attempts, can worsen depression
  4. Stopping it abruptly could lead to withdrawal symptoms
  5. It is a Category C med meaning it can be taken during pregnancy but there are risks

Pregnant women should not take sleeping pills on a long-term basis. If insomnia lasts for more than two weeks, insist that further tests be done.