Sleep issues are just one of the many things that can make pregnancy a waking nightmare. If you’ve been wondering whether melatonin is a safe solution for pregnancy insomnia, we’ve got expert guidance to help you make a healthy and informed choice.
When people talk about melatonin, they’re often referring to the synthetic supplement—but it’s also a naturally-occurring hormone that supports your circadian rhythm.
“Melatonin is a hormone that is normally secreted by the pineal gland in our bodies, and it’s really important in regulating normal sleep/wake cycles,” explains Dr. Tali Bogler, a family physician and chair of family medicine obstetrics at St. Michael's Hospital in Toronto. Essentially, melatonin can make you drowsy and help you drift off to dreamland successfully. The hormone is produced as a response to darkness, according to the National Centre for Complementary and Integrative Health, and being exposed to natural or artificial light (e.g., the blue light emitted by screens) can block melatonin production.
That depends. While melatonin is an incredibly popular supplement that’s sold over-the-counter as a sleep aid, there is limited evidence to support its effectiveness in treating insomnia. “Melatonin can help people fall asleep, so it helps with jet lag or shift work, but it’s not necessarily for pregnancy insomnia,” Bogler says. While the drowsiness some people experience after taking melatonin supplements can help you nod off, neither natural nor synthetic melatonin helps a person stay asleep. So whether your insomnia is chronic or pregnancy-related (or you’re struggling to regulate your sleep patterns thanks to the addition of a newborn) melatonin supplements are not likely to make a huge impact on your sleep health.
You can, but not without some level of risk. Bogler notes that because melatonin is known as a “natural” sleep aid, it’s become very popular and is often assumed to be safe for long-term use, paediatric use or use in pregnancy. However, there isn’t enough clinical research on humans to firmly support these beliefs.
“We do have studies on animals, but we know animals are different,” says Bogler. “To adequately say this is safe in pregnancy, we need human data.” She cites a clinical study which showed some changes to the sexual maturation and reproductive hormones in rats that received a high melatonin dose, but no further adverse effects. So while there aren’t any known significant risks to humans, we can’t rule them out.
Another concern about melatonin use in pregnancy is the dosage, particularly when the product is bought off the shelf rather than prescribed by a physician. “The amount in these over-the-counter preparations is often way higher than what's produced in the body, and you don’t always know exactly the dose you’re getting,” Bogler says, noting that it’s often “way higher” than what’s natural or necessary. Pregnant or not, that could be an issue.
The bottom line is that while it’s not known to be harmful, there isn’t enough research to conclusively say that melatonin is safe for use during pregnancy. (The “pregnancy gap” in clinical research is an issue pregnant information-seekers are all-too-familiar with.) “In smaller doses—which we typically recommend anyway—it’s probably fine. But we can’t say it with total certainty,” Bogler says.
Knowing this, Bogler isn’t convinced it’s worth it. “If you’re going to use something that has very little effect, why use it at all?”
Bogler doesn’t prescribe a lot of sleep aids for her patients, pregnant or not, because sleep issues are so multifactorial. “Is it stress, body positioning, discomfort, underlying depression or anxiety?” she says, acknowledging that physical changes in pregnancy can make sleep particularly challenging. “It is hard, you can’t deny it, but medication can’t always help those things.”
To support patients with insomnia and other sleep issues, Bogler addresses proper sleep hygiene and makes behavioural recommendations: getting enough exercise during the day and avoiding screen time for at least an hour before bed, for example. Cognitive Behavioural Therapy, or CBT, can be helpful for some individuals with sleep issues. Bogler often recommends pregnant patients use a sleep pillow, sleep upright, or elevate their legs.
“I really try to offer lifestyle approaches for sleep before medications,” Bogler says. That said, it’s beneficial to have your thyroid and iron levels checked to rule out physical issues that could cause cramping or restless legs in the evening.
Like the discussion around melatonin and pregnancy, taking melatonin while breastfeeding is a bit of an unknown due to limited human data. “Low doses of melatonin are probably OK,” Bogler says, again emphasizing the lack of research on humans.
“Studies have shown that melatonin does pass through the breast milk, but it doesn’t have a known adverse effect,” she says. “I would just make sure you’re taking the recommended lower doses.”
The thing to know here is that natural doesn’t necessarily mean safe. Melatonin may not have any major known risks to pregnant or nursing mothers, or to their babies, but that doesn’t mean the same can be said for all supplements. Naturally occurring products are often assumed to be harmless when in fact, some may be dangerous.
“We used to have things like Motherisk where you could call about natural products, but right now in Canada, we don’t have access to that,” Bogler says, suggesting that it’s better to be safe than sorry.
Sleep deprivation and exhaustion can be incredibly difficult, but supplements like melatonin aren’t necessarily the answer. If you find yourself struggling to sleep while pregnant or nursing, ask your doctor for support—they may be able to offer solutions outside the vitamin aisle.