Management of Hypersomnia in Pregnancy

Abstract

Pregnant women commonly experience sleep problems. Hypersomnia is one of these problems. The approach to hypersomnia in pregnancy is similar to the non-pregnant population. Thorough history taking regarding sleep, medical and psychiatric conditions; social and family history; medications; and physical examination are key to help identify possible causes of hypersomnia. Standard sleep testing, when indicated, may be required. There is limited literature regarding the treatment of hypersomnia in pregnancy. Over all, patients with narcolepsy have similar pregnancy outcomes compared to pregnant women without narcolepsy. However, there is higher incidence of impaired glucose metabolism and anemia during pregnancy in patients with narcolepsy type I. Treatment of hypersomnia in pregnancy can be challenging and limited due to concern of possible teratogenicity of the commonly used medications. If possible, medications should be stopped, at least for the first trimester, and as long as possible during pregnancy. This should also be extended while breast-feeding. If medications are needed, using the lowest effective doses and medications with the least chance of complications are recommended. Non-pharmacologic options such as protected night sleep and scheduled naps may also be considered. Caffeine may also be of benefit. Short-term disability may also be considered for women who are employed. Multidisciplinary care among sleep specialists, primary care physicians, and obstetricians is important in this patient population.