title: Insomnia during pregnancy: Diagnosis and Rational Interventions.
abstract: Sleep disturbances are common in pregnancy. Insomnia is a frequent sleep disturbance experienced by pregnant women which can be primary or due to co-morbid conditions. The differential diagnosis of insomnia in pregnancy includes anxiety disorders, mood disorders, breathing related sleep disorders and restless legs syndrome. Early interventions to treat the sleep disturbance are recommended to avoid adverse pregnancy outcomes. Management strategies include improving sleep hygiene, behavioral therapies, and pharmacotherapy. The risks of pharmacotherapy must be weighed against their benefits due to the possible risk of teratogenicity associated with some medications.
  
  
  METHODS
  We searched PubMed and Google Scholar employing a combination of key words: pregnancy, sleep disturbances, Obstructive Sleep Apnea, Sleep disorders and insomnia. We included original studies, review articles, meta-analysis and systematic reviews in our search prioritizing articles from the last 10-15 years. Articles older than 15 years were only included if their findings had not been superseded by more recent data. Further selection of articles was done from bibliographies and references of selected articles.
  
  
  CONCLUSIONS
  Sleep disturbances in pregnancy are common and cause considerable morbidity. Management includes a combination of non-pharmacological and pharmacological treatments carefully weighing the risks and benefits of each for the expectant mother and fetus.
authors.affiliation: Ali M. Hashmi, MBBS, MD. Diplomate American Board of Psychiatry and Neurology, Associate Professor of Psychiatry, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Hashmi
authors.affiliation: Shashi K. Bhatia, MD; FACPSYCH; FAACAP Diplomate, American Board of Psychiatry and Neurology in General and Child and Adolescent Psychiatry, Professor and Division Director, Department of Child and Adolescent Psychiatry, Professor, Department of Pediatrics, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors.forename: Shashi K
authors.initials: SK
authors.lastname: Bhatia
authors.affiliation: Subhash K. Bhatia, MD; FACPSYCH, MAMS. Diplomate, American Board Psychiatry and Neurology in General Psychiatry and in the Subspecialties of Addiction, Forensic and Geriatric Psychiatry, Distinguished Professor and Senior Associate Chair for Academic Affairs and Faculty Development, Creighton University Department of Psychiatry Adjunct Professor, University of Nebraska College of Medicine, Omaha, NE 68105, USA.
authors.forename: Subhash K
authors.initials: SK
authors.lastname: Bhatia
authors.affiliation: Imran S. Khawaja MD, FAASM. Medical Director, Center for Sleep Medicine, VA Medical Center, Dallas, Texas, Associate Professor of Psychiatry and Neurology, UT Southwestern School of Medicine, USA.
authors.forename: Imran S
authors.initials: IS
authors.lastname: Khawaja
keywords: Insomnia; Obstructive Sleep apnea; Pregnancy