Insomnia in pregnancy

C/o- 32/f . Suffering from severe insomnia. Having 35 mnth of pregnancy .. Vitals Bp-120/80 p/r 75/mint Spo2 98% Lab Report Hb 9.8 TFT normal Rbs normal

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R/O common causes of insomnia. Which are... 1. GERD : Ask for heart burn 2. Anxiety disorder : Ask for it and any relevant risk factors. 3. Mood disorder 4. Sleep apnoea : Ask for respiratory distress during sleeping. 5. Restless leg syndrome : Ask for muscle cramp and shaking of leg at night. Test for Folic acid and iron deficiency. 6. Other : Snoring by husband, Baby disturbs at night etc. Non pharmacological management (try first) : 1. Avoid sleeping in the daytime specially at later half of the day. 2. Advice intake of much fluid but not after 5 PM. 3. Light exercises for 20-30 minutes before going to bed (only those which don't harm the pregnancy) 4. Use of dim light at bedroom and even in toilet as if it doesn't harm your sleep when you return to bed from there. 5. Avoid spicy foods to get rid of GERD / Acidity. 6. Avoid intake of tea / coffee at night. 7. Take light non fatty diet at night. 8. Keep your bed room tidy and clean for a comfortable sleep. Sleep in left lateral position keeping soft pillow in between the knees and at back to add comfort. Pharmacological treatment : 1. For GERD : Any OTC antacid or PPI of choice. 2. For RLS : Levo carnitine, Foilc acid etc. 3. To induce sleep : -Diphenhyramine is the safest which neither disturb the unborn baby much nor the lactation. -Zolpidm in low dose. It's pregnancy category B in low dose. Also safe in breastfeeding.

Give promethazine 10 mg hs Or zolpidem 5mg hs or SOS At higher dose zolpidem harms in pregnancy

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