Pregnancy and safe baby care

Yes. Your sleep disorder could lower your milk supply. Your sleep disorder could also raise your risk of plugged milk ducts, which can lead to breast infections. If you take hypersomnia medicines, you will need to consider the risks and benefits of continuing them.

What can I do to raise my milk supply?

If you need to raise your milk supply, you can:

• Record how often you nurse or pump, with a goal of 8 to 12 or more times every 24 hours
• Be certain that your baby is actively nursing by watching their jaw movements
• Fully empty your breasts of milk by pumping all milk that remains after nursing
• Continue pumping for 5 to 10 minutes past the end of milk flow.

Your body may make less milk if your sleep schedule does not allow you to nurse or pump this often. The more you nurse or pump, the more milk you will make. Any parent who is unable to nurse their baby or pump at least 8 times in 24 hours is more likely to have a low milk supply.

What can I do to lower my risk of plugged milk ducts and breast infections?

Sleep flat on your back whenever possible, and make sure your bra fits your largest breast size well. Rolled towels can help you sleep on your back. Sleeping in other positions, where you may lay on your breasts, or wearing a bra that is too tight raises your risk of plugged milk ducts. This can lead to breast infections.

If you have a high milk supply, completely empty your breasts every time you nurse or pump. Record how often you nurse or pump, with a goal of 8 to 10 times every 24 hours. Nursing or pumping more often is likely to further raise your milk supply. You will have a higher risk of plugged milk ducts if you have a high milk supply and your sleep needs don’t allow you to remove your milk often enough. This can lead to breast infections.

Can I take my hypersomnia medicines while nursing?

Many medicines pass through to human milk, whether you’re nursing or pumping. For all medicines, weigh the possible risks for the baby against the known benefits of human milk for the baby and the benefits of the medicine for your health.

If you’re nursing or pumping, ask your doctors about the medicines you take, and if they can get into your milk supply. Make your own informed decision after talking with your doctors.

Researchers have done some studies on the effects of hypersomnia medicines on nursing, although some of the medicines have only been studied in very small numbers of nursing parents. While these studies do not completely rule out risks to your baby, doctors believe these medicines are most likely safe for nursing:

• Amphetamines (such as Adderall)
• Antidepressants (such as Prozac)
• Clomipramine (such as Anafranil)
• Methylphenidates (such as Ritalin)
• Modafinil and armodafinil (such as Provigil and Nuvigil)
• Pitolisant (such as Wakix)
• Solriamfetol (such as Sunosi)

Oxybates (such as Xyrem, Xywav, and Lumryz)

These medicines are eliminated very quickly by your body, so you can safely take them while nursing if, and only if, you take special steps to avoid exposing your baby. Here are the steps:

1. In the evening, nurse or pump just before taking your first oxybate dose (at bedtime).
2. During the night, feed your baby with formula (or milk you pumped when not exposed to oxybates). Throw out any milk you pump. However, this pumping should help improve your overall milk supply.
3. For immediate-release oxybates (such as Xyrem and Xywav), wait at least 5 hours after your final oxybate dose before nursing or saving pumped milk again. Even though the medicine was in your system when your body made the milk, after 5 hours the amount in your milk should be down to a safe level. For example, if you take your first dose at 10 PM and your final dose at 2 AM, don’t nurse or save pumped milk from 10 PM until 7 AM.
4. For extended-release oxybates (such as Lumryz), wait at least 9 hours after your dose before nursing or saving pumped milk again. Even though the medicine was in your system when your body made the milk, after 9 hours the amount in your milk should be down to a safe level. For example, if you take your dose at 10 PM, don’t nurse or save pumped milk from 10 PM until 7 AM.
5. For extended-release oxybates (such as Lumryz), studies haven’t yet shown how long it takes until it’s gone from breast milk. However, wait at least 9 hours after your dose before nursing or saving pumped milk again. After 9 hours the amount in your milk will likely be down to a safe level, even though the medicine was in your system when your body made the milk. For example, if you take your dose at 10 PM, don’t nurse or save pumped milk from 10 PM until 7 AM.

For more details on nursing while taking these medicines, visit our web page for doctors.

Where can I get support for nursing or pumping?

Many parents are very motivated to give their baby human milk through nursing or pumping, and are happy to provide whatever milk they can produce. For more support, talk with a lactation consultant, a support organization, or your pediatrician, especially if:

• You have any pain with nursing or pumping
• You have low milk production
• You are unable to nurse or pump 8 to 10 times a day
• You have any other problems with nursing or pumping

Resources for nursing and pumping:

• Womenshealth.gov — “Finding breastfeeding support and information”
• Cleveland Clinic — “Benefits of Breastfeeding”
• Cleveland Clinic — “How to Establish a Good Milk Supply”
• La Leche League — “Birth Control” effects on milk supply
• Breastfeeding.support — “Reasons for Low Milk Supply”
• KellyMom – “Parenting and Breastfeeding”

What are my options for feeding my baby if I don’t nurse or pump or if I need to supplement?

• Formula
• Getting donor milk through a milk bank (visit hmbana.org)
• Community milksharing (for safety guidelines, visit eatsonfeets.org or humanmilk4humanbabies.net) 

Most parents with a new baby are exhausted due to lack of sleep. A parent who has a hypersomnia is usually even more exhausted. In a study of 249 mothers with narcolepsy, 60% (6 out of 10) reported that their symptoms negatively affected care of their baby. These symptoms included:

• Excessive daytime sleepiness in about 50% (5 out of 10)
• Sleep attacks during feeding or nursing in about 33% (1 out of 3) 
• Cataplexy while holding the baby in about 14% (1 out of 7)
• Automatic behavior while nursing or traveling in about 6% (1 out of 16) 

You may need help to prevent accidents, such as falls or drowning while bathing, especially if you have any of these symptoms.

Can I safely sleep with my baby (co-sleep)?

You can safely sleep in the same room with your baby as long as you don’t sleep in the same bed. It’s not a good idea for anyone to sleep in the same bed or on the same surface with an infant (baby 1 year or younger). This could increase the chance of SIDS (sudden infant death syndrome), suffocation, or strangulation. Research has shown a high risk of infants becoming trapped or tangled in upholstered chairs, couches, and on beds with extra pillows and bedding when adults fall asleep, especially if the infant is 6 months or younger.

People with low alertness, difficulty waking up, or using a sedating medicine have a risk of infant sleep-related death during bed-sharing that is more than 10 times higher than the usual risk with bed-sharing. Therefore, you’re likely at very high risk if you:

• Have uncontrolled hypersomnia symptoms, such as very deep sleep with difficulty waking or severe sleep inertia
• Take sedating medicines like oxybates

For more information on safe sleeping for your baby, talk with your pediatrician.

• Talk to your doctor about getting your symptoms as well-controlled as possible.
• Try to get as much sleep as you need, including sleeping when your baby sleeps.
• Plan to have someone else at home to respond to your baby when you’re sleeping, especially if you:
  • Take an oxybate medicine, such as Xyrem.
  • Have very deep sleep or sleep drunkenness.
• Prepare ahead of time to have as much help with your baby as you think you may need, such as help with child care, meal prep, or cleaning.
• Talk to your doctor about the accident prevention guidelines for people with seizures, who have similar risks as people with hypersomnias. (To learn more, visit this WebMD article.) For example:
  • Lower the chance of your baby falling by changing your baby on the floor rather than a changing table.
  • Lower the chance of your baby falling by using a sling or similar baby carrier, as long as you can be alert to your baby’s movements. (Read more at Carrying Matters.)
  • Lower the chance of your baby drowning by sponge bathing instead of tub bathing if you are alone and your symptoms aren’t well-controlled.
• Lower the chance of infant sleep-related death, including SIDS, from you falling asleep while feeding your infant. For example:
  • Sit on the floor (perhaps on a very firm cushion or mattress) or lie on a firm mattress (without any bedding other than a tight-fitting bottom sheet).
  • Avoid couches and armchairs if you might fall asleep because sleeping on couches and armchairs raises the chance for infant death by up to 67 times.
  • Avoid slings or baby carriers if there is any chance you may fall asleep or not be alert to your infant’s movements.
  • Place your infant back on a separate sleep surface as soon as you finish feeding them or as soon as you wake up.
  • Have another awake and alert adult in the room.
  • Have a partner or another helper bottle feed your infant.