Sleep Aid Options for Breastfeeding Moms: Safety and Recommendations

During the breastfeeding period, please advise on the use of sleeping medications?

Hello Dr.
Lee! I am a breastfeeding mother, and my child is currently 14 months old.
Recently, my child has been waking up more frequently at night to nurse, which has made it increasingly difficult for me to fall asleep.
I have been experiencing insomnia for over a week now! I sought help from a psychiatrist who informed me that I am breastfeeding.
Two psychiatrists prescribed me 0.5 mg of Zyprexa (Olanzapine) and 1.0 mg of Atarax (Hydroxyzine) to take.
However, after researching online, I found that these medications may affect the infant through breast milk, so I have been hesitant to take them.
I would like to ask the doctor: 1.
If I must take medication, which is better, 1 mg of Atarax or 0.5 mg of Zyprexa? 2.
Are there any other medications that are more suitable for breastfeeding mothers? (Over-the-counter medications are also acceptable.) 3.
If I take these medications, what recommendations do you have to minimize the impact on my infant? Thank you very much for your attention and response, Dr.
Lee!

Fang, 40~49 year old female. Ask Date: 2023/10/30

Dr. Li Guanying reply Psychiatry

Dear Sir/Madam,
From your letter, it is clear that you are experiencing distress.
However, if you are concerned about the use of sleep medications during breastfeeding, it is advisable to have your condition evaluated by a physician.
Regarding the combination of medications, a professional assessment is necessary.
1.
Facing an uncertain future, psychosomatic disorders, such as depression, are common in modern society.
These are chronic conditions that require long-term treatment for recovery.
2.
Psychosomatic disorders are chronic illnesses that have periods of exacerbation, remission, recovery, and relapse.
More than half of the patients may experience a recurrence of symptoms even after they have improved.
Due to individual differences in physiology, it may take time to identify the appropriate medication, so please be patient and cooperate with your physician.
3.
In terms of pharmacological treatment, each primary medication requires 4 to 6 weeks to assess its efficacy.
If you experience any discomfort, please note the duration and frequency of the symptoms.
Some medications can be monitored through blood tests to check their concentration, so discuss this with your physician.
4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, anesthetic-free treatment option that is highly safe and does not require hospitalization.
It can improve anxiety and depressive symptoms, and patients with treatment-resistant depression or poor medication response often show significant improvement after rTMS therapy.
If you have concerns about psychosomatic disorders or prefer not to undergo medication treatment, please discuss this thoroughly with your physician during your follow-up visit.
Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
We recommend that you consider visiting the clinic for a personal evaluation of your symptoms, allowing for a collaborative discussion to determine the best course of action for you.
Wishing you mental and physical well-being.

Reply Date: 2023/10/30

More Info

When it comes to choosing sleep aids for breastfeeding mothers, safety for both the mother and the infant is paramount. As you mentioned, you have been experiencing sleep disturbances due to your child's frequent nighttime awakenings for breastfeeding. This situation is common among breastfeeding mothers, and it can be quite challenging to manage sleep deprivation while ensuring the well-being of your child.

Safety of Sleep Medications
The two medications you mentioned, Zolpidem (known as Stilnox) and Lorazepam (known as Ativan), have different safety profiles when it comes to breastfeeding. Zolpidem is classified as a Category C drug, which means that risk cannot be ruled out, while Lorazepam is also a Category C drug. However, studies suggest that Zolpidem is generally considered to have a lower risk of significant effects on breastfeeding infants compared to Lorazepam. This is primarily because Zolpidem has a shorter half-life and is less likely to accumulate in breast milk.

Recommendations for Sleep Aids
1. Zolpidem vs. Lorazepam: If you must choose between the two, Zolpidem (Stilnox) is often preferred for breastfeeding mothers due to its shorter duration of action and lower potential for sedation in the infant. However, it is crucial to take it right before bedtime to minimize any potential transfer to breast milk.

2. Alternative Medications: If you are hesitant to use either of these medications, there are other options that may be safer. Some healthcare providers may recommend Melatonin, a natural hormone that regulates sleep-wake cycles. Melatonin is generally considered safe for breastfeeding mothers, but you should still consult with your healthcare provider to determine the appropriate dosage.

3. Non-Pharmacological Approaches: Before resorting to medication, consider implementing non-pharmacological strategies to improve your sleep. These may include:
- Sleep Hygiene: Establish a regular sleep schedule, create a calming bedtime routine, and ensure your sleep environment is conducive to rest (dark, cool, and quiet).

- Relaxation Techniques: Practices such as deep breathing, meditation, or gentle yoga can help reduce anxiety and promote relaxation before bedtime.

- Dietary Adjustments: Consuming foods rich in tryptophan (like turkey, bananas, and dairy) may help improve sleep quality. Avoiding caffeine and heavy meals close to bedtime can also be beneficial.

Minimizing Infant Exposure
If you decide to take a sleep aid, here are some tips to minimize any potential impact on your baby:
- Timing: Take the medication right before you plan to sleep, ideally after the last breastfeeding session of the night. This can help reduce the amount of medication that enters your breast milk during the time your baby is awake.

- Monitor Your Baby: Keep an eye on your infant for any unusual behavior or signs of sedation. If you notice anything concerning, consult your pediatrician immediately.

- Consult Your Healthcare Provider: Always discuss any medications you are considering with your healthcare provider, who can help you weigh the risks and benefits based on your specific situation.

Conclusion
In summary, while both Zolpidem and Lorazepam have their risks, Zolpidem may be the safer choice for breastfeeding mothers. However, exploring non-pharmacological methods and consulting with your healthcare provider can lead to a more tailored approach to managing your sleep issues. Remember, your well-being is crucial not only for you but also for your ability to care for your child.

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