So Glad You Asked with Dr. Ruta Nonacs
RESOURCE HUB – SLEEP CHALLENGES
We hope you enjoyed the first episode of our podcast, as well as the bonus episode with the wonderful Dr. Jade Wu, on sleep challenges during pregnancy and the postpartum period. If you haven’t listened yet, you can find the podcast on Spotify, Apple, or wherever you get your podcasts.
But there’s more…
To supplement the information provided on the podcast, we have created a comprehensive, evidence-based online set of resources for you to explore. The resource hub provides up-to-date, clinically relevant information and resources for both patients and healthcare providers.
Learn More: Sleep Challenges During Pregnancy and the Postpartum Period
A curated collection of articles, videos, and other resources to help you better understand what you’re experiencing — and what can help
Typical Sleep Changes During Pregnancy In this video, Dr. Jade Wu outlines the common sleep changes experienced during pregnancy, including increased daytime sleepiness, nighttime awakenings, and decreased deep sleep, largely due to hormonal and physical changes.
Sleep Efficiency and Deep Sleep During Postpartum In this video, Dr. Jade Wu Postpartum sleep is characterized by reduced sleep efficiency and deep sleep, often due to nighttime awakenings and childcare responsibilities, which can impact maternal health and well-being.
Addressing Sleep Challenges During the Perinatal Period:Â In this resource from Postpartum Support International, sleep coach Talia Shapero, discusses the common sleep challenges faced during pregnancy and postpartum, emphasizing the importance of addressing these issues to prevent adverse outcomes like postpartum depression.
Postpartum Insomnia: This resource from Healthline discusses the causes and treatment of postpartum insomnia, a common sleep disorder affecting new mothers, which can disrupt daily life and increase the risk of mental health issues like depression.
Is ‘Momsomnia’ Keeping You Up at Night? This article highlights the sleep challenges faced by mothers and offering strategies to manage these issues for better rest and overall well-being.
Maternal Sleep Toolkit: This is a printable all-inclusive resource from UNC for patients and providers discussing most common types of sleep problems, specific interventions, and when and where to get specialized medical care for sleep problems. If you have time to check out only one resource, this is the one that covers the broadest range of topics.
Tips for Better Pregnancy Sleep: This printable handout is a practical list of tips from UCSF to help patients improve sleep during pregnancy.
Can’t Sleep? 8 Techniques You Can Do: From the Sleep Foundation
How New Moms Can Get More Sleep
How To Treat Pregnancy & Postpartum Insomnia
Creating a Sleep Hygiene Routine in Postpartum: Essential Tips for New Moms: This guide provides new mothers with practical tips on establishing a sleep hygiene routine during the postpartum period, including optimizing the sleep environment and managing lifestyle factors to improve sleep quality.
Patient Resources from the American Academy of Sleep Medicine (AASM)
For treating insomnia (whether during pregnancy, postpartum, or at other times), cognitive-behavioral therapy for insomnia (or CBT-I) has been the most studied sleep intervention, and many studies supporting its effectiveness. In those with insomnia, this would be an excellent first choice of treatment.
CBT-I helps to restructure the thoughts, feelings, and behaviors that contribute to insomnia and provides an array of techniques that can be used to combat insomnia.
Cognitive Behavioral Therapy for Insomnia (CBT-I): An Overview
To find treaters with expertise in this modality, you can review the provider directories listed below. While there are many specialists who treat sleep disorders, CBT-I is provided by behavioral sleep medicine specialists (typically psychologists and psychiatrists). Your primary care provider can refer you to a sleep specialist. In addition, many academic medical centers have programs offering treatment for sleep disorders.
- Sleep Specialists: When to See One and What to Expect
- Sleep Clinics and Centers
- The Society of Behavioral Sleep Medicine provides a state-by-state list of their members with expertise in the behavioral treatment of sleep disorders.
- International Directory of CBT-I Providers
There are many apps and online resources offering interventions for those with insomnia. Many of these interventions have not been tested in clinical trials; however, there is evidence to support the use of the following digital interventions. While none of interventions listed below specifically target pregnant or postpartum individuals, they do offer users the basic techniques used in CBT-i.
- CBT-i Coach is a FREE mobile app developed by the Veterans Administration, that offers CBT-i techniques and guides users through the process of learning about sleep and developing positive sleep routines.
- SHUTi (now Somryst): Sleep Healthy Using the Internet (SHUTi) is an interactive, Internet-based CBT-I intervention designed to improve the sleep of adults with insomnia. While SHUTi itself is currently not commercially available under that name, its technology and principles have been licensed and integrated into other platforms. The most notable successor is Somryst, which is an FDA-authorized digital therapeutic based on the SHUTi model.
- Sleepio offers a 6-week self-directed program to improve poor sleep. In the UK, Sleepio can be prescribed by healthcare providers within the NHS, making it accessible to patients through the healthcare system. In the US, Sleepio itself is not typically covered by insurance; a prescription version of the intervention, SleepioRx, has received FDA clearance, which may lead to future reimbursement by Medicare and other payers.
Jade Wu, PhD, DBSM, is a Board-certified behavioral sleep medicine psychologist who specializes in the treatment of sleep problems during pregnancy and the postpartum. On her website, you will find a collection of useful resources for patients and providers.
Her book, Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications (St. Martin’s Press), is a practical and compassionate guide to having a better relationship with sleep and overcoming insomnia. Dr. Wu also offers a 4-week Quiet Mind For Better Sleep workbook (free to newsletter subscribers).
Setting Yourself Up For Successful Sleep – Jade Wu, PhD
Rethinking Sleep Health with Dr. Jade Wu
Solving All Of Your Sleep Problems with Insomnia Expert Dr. Jade Wu
The Most Important Thing Most Americans Misunderstand About Insomnia
Sometimes, medications are necessary for managing severe or prolonged sleep disturbances during pregnancy. Non-pharmacological interventions, such as cognitive-behavioral therapy (CBT), may not be effective for everyone, and in these cases, short-term use of a sleep aid can provide relief. When considering medications, it’s crucial to evaluate not only their efficacy and potential side effects but also their safety profile for pregnancy and breastfeeding.
Over-the-counter (OTC) medications like doxylamine (in Diclegis and some UniSom formulations) and diphenhydramine, another sedating antihistamine, are commonly used for promoting sleep. While melatonin is often used to treat insomnia, data on its reproductive safety is limited, making it a medication that we would not typically recommend for the treatment of insomnia during pregnancy.
Prescription sleep medications include zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata). These Z-drugs are sometimes used during pregnancy as needed. Several large studies do not suggest any increase in the risk of malformations in children exposed during pregnancy to this class of medication, although there we have the most data to support the use of zolpidem.
When sleep problems are linked to depression or anxiety, treating the underlying condition is essential. Serotonergic SSRIs and SNRIs are commonly used to treat depression and anxiety, but they may take several weeks to become effective. In this setting, sedating medications like benzodiazepines might be considered for short-term treatment of insomnia.
There is data to support the use of commonly prescribed benzodiazepines, including lorazepam (Ativan) and clonazepam (Klonopin), during pregnancy, and they have not been associated with an increase in the overall risk of malformations.  One of the main advantages of the benzodiazepines is their rapid onset of action; however, with this class of medication, there is the potential for abuse, as well as dependence, tolerance, and withdrawal symptoms in those taking benzodiazepines on a daily basis for longer period of time.
Sedating antidepressants, such as tricyclic antidepressants (TCAs), trazodone, and mirtazapine (Remeron), can help with insomnia. However, they may cause additional side effects like daytime drowsiness (trazodone) and weight gain (mirtazapine).
More information on medications and pregnancy can be found HERE on our website.
More information on medications and breastfeeding can be found on the Drugs and Lactation Database (LactMed®).
Where to Turn for Support and Professional Care
Helping you to connect with trusted and reliable resources, so you don’t have to navigate alone
- Call 911 if you are in an immediate crisis, e.g., in imminent danger of harm to self, others, or have overdosed.
- 988Â is the Suicide and Crisis Lifeline.Â
- The National Maternal Mental Health Hotline 1-833-TLC-MAMA (1-833-852-6262): For non-crisis specialized perinatal mental health support and resources. The National Maternal Mental Health Hotline is available 24/7, in English and Spanish, and 60 other languages by request.
- The Postpartum Support International Helpline 800-944-4773Â is a warmline that connects callers with support volunteers and PSI resources
This is a good place to start when you are looking for help because you already have a relationship with that provider and your OB is likely to be connected to providers and other resources in your community. The obstetric service may have mental health professionals who provide services in their office. The hospital may also offer support groups for expecting and new moms. Some OBs are also comfortable prescribing medications for perinatal mood and anxiety disorders.
Psychotherapy can be provided by licensed mental health professionals, including psychologists, licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), and psychiatrists who specialize in therapy. It is important to look for professionals with experience in perinatal mental health to ensure specialized care. In some cases, OBs may also prescribe medications for perinatal mood and anxiety disorders. Some of these providers may have a Perinatal Mental Health Certificate (PMH-C); however, there are many excellent providers who have experience in the treatment of perinatal mental health issues who do not have this certification.
- Postpartum Support International maintains an online directory of qualified perinatal mental health professionals in the US, Canada, and Australia.
- Psychology Today also maintains a list of mental health providers available for in-person or telehealth visits.
Psychiatrists, nurse practitioners, and physician assistants have the authority to prescribe medication; their prescribing rights vary by state. Some of these providers may have a Perinatal Mental Health Certificate (PMH-C); however, there are many excellent providers who have experience in the treatment of perinatal mental health issues who do not have this certification
- Postpartum Support International maintains an online directory of qualified perinatal mental health professionals in the US, Canada, and Australia.
- Psychology Today also maintains a list of mental health providers available for in-person or telehealth visits.
Support may come from many different places, including family, friends, neighbors, other moms, and your community. Support groups, whether in-person or virtual can be immensely helpful in decreasing the isolation many moms feel and can help moms learn about other resources and to connect with their community. There are also specialized groups that support women with specific backgrounds or needs.
- Postpartum Support International offers over 50+ FREE and virtual support groups led by trained peer facilitators. Many of these groups cater to specific populations, for example military moms or individuals with fertility challenges
- Your local hospital may also offer support groups
- Postpartum Support International volunteer coordinators can help you find support resources in your community
- Postpartum Support International also offers a Peer Mentor Program that pairs individuals in need of support with a trained volunteer who has also experienced and has recovered from a perinatal mood or anxiety disorder
Deep Dive: Recent Research and Clinical Insights on Sleep in the Perinatal Period
For you and your providers, evidence-based perspectives and expert opinions to deepen your understanding and inform your care
Sleep disturbance is extremely common during pregnancy, affecting up to 75% of pregnant individuals, and includes insomnia, restless legs syndrome (RLS), poor sleep quality, excessive daytime sleepiness, and sleep-disordered breathing. While much research and guideline development has focused on obstructive sleep apnea (OSA), clinicians must also assess for other sleep problems.
Sleep problems are highly prevalent in the postpartum period, with studies showing that up to 67–68% of women experience poor sleep quality in the first six months after childbirth. Insomnia is particularly common, affecting about 20% of postpartum women, and is the most frequently diagnosed sleep disorder in this period. Regular screening and targeted interventions for sleep problems are recommended to improve maternal well-being and reduce the risk of mood disorders in the postpartum period.
Maternal Sleep Toolkit: This is a printable all-inclusive resource from UNC for patients and providers discussing most common types of sleep problems, specific interventions, and when and where to get specialized medical care for sleep problems. If you have time to check out only one resource, this is the one that covers the broadest range of topics.
Maternal Sleeping Problems Before and After Childbirth – A Systematic Review
Sleep and sleep disorders during pregnancy and postpartum: The Life-ON study
Sleep in the Postpartum: Characteristics of First-Time, Healthy Mothers
Sleep Quality across Pregnancy and Postpartum: Effects of Parity and Race
From Our Website:
Poor Sleep Quality During Pregnancy Increases Risk for Perinatal Depression
Poor Sleep Quality Predicts Severity of Postpartum Depression
Restless Legs Syndrome Increases Risk of Perinatal Depression
Sleep Interventions During Pregnancy Reduce the Risk of Postpartum Depression
Postpartum Depression and Poor Sleep Quality Occur Together
Understanding the Complex Relationship Between Infant Sleep and Maternal Sleep and Mental Health
Medical Articles and Reviews:
Associations between prenatal sleep and psychological health: a systematic review
Sleep Deprivation during Pregnancy and Maternal and Fetal Outcomes: Is There a Relationship?
Sleep During Pregnancy and Offspring Outcomes From Infancy to Childhood: A Systematic Review
The role of sleep protection in preventing and treating postpartum depression
Diagnosis and management of common sleep disorders during the perinatal period.
MATERNAL SLEEP & SLEEP IN INFANTS: This publication from the University of Rochester Medical Center provides basic information for providers on how to improve sleep in mothers and their infants.
2025 Canadian guideline for physical activity, sedentary behaviour and sleep throughout the first year postpartum: This comprehensive guideline, available for free, outlines specific recommendations for physical activity, sedentary behavior, and sleep to support maternal and infant health during the postpartum period.
WHEN COUNTING SHEEP FAILS: ADMINISTERING SINGLE-SESSION COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA IN A GROUP PSYCHOEDUCATIONAL FORMATÂ (Powerpoint presentation)
Novel psychotherapies for insomnia.
Jade Wu, PhD, DBSM, is a Board-certified behavioral sleep medicine psychologist who specializes in the treatment of sleep problems during pregnancy and the postpartum. On her website, you will find a collection of useful resources for patients and providers.
Her book, Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications (St. Martin’s Press), is a practical and compassionate guide to having a better relationship with sleep and overcoming insomnia. Dr. Wu also offers a 4-week Quiet Mind For Better Sleep workbook (free to newsletter subscribers).
Setting Yourself Up For Successful Sleep – Jade Wu, PhD
Rethinking Sleep Health with Dr. Jade Wu
Solving All Of Your Sleep Problems with Insomnia Expert Dr. Jade Wu
The Most Important Thing Most Americans Misunderstand About Insomnia
Essential Reads: Melatonin and Pregnancy
Essential Reads: The Use of Trazodone During Pregnancy
Essential Reads: Mirtazapine (Remeron) and Pregnancy
Essential Reads: The Use of Sedative-Hypnotic Drugs During Pregnancy
Essential Reads: Prenatal Exposure to Benzodiazepines and Neurodevelopmental Outcomes
More information on medications and pregnancy can be found HERE on our website.
More information on medications and breastfeeding can be found on the Drugs and Lactation Database (LactMed®).