*4.3.3 Treatment*

In pregnancy, a correct treatment for RLS can be iron supplementation when needed. Other pharmacological agents, such as clonazepam, clonidine, and opioids may be needed in severe conditions, despite there is a high risk of neonatal withdrawal with these drugs [9, 18]. Non-pharmacological treatments that can be used in pregnant women with RLS are physical exercise and behavioural strategies, such as reduced caffeine intake [76].

#### **4.4 Narcolepsy**

#### *4.4.1 Definition epidemiology, pathogenesis*

Narcolepsy is a sleep disorder characterised by excessive sleepiness, associated with cataplexy, sleep paralysis, and hypnagogic hallucinations [79]. The prevalence


*Sleep Disorders in Pregnancy DOI: http://dx.doi.org/10.5772/intechopen.100300*

> *Summary of major sleep disorders during pregnancy.*

**Table 2.**

of narcolepsy in the general population is 14/1,000 inhabitants and in pregnant women a similar prevalence can be described. Under a pathogenetic point of view, narcolepsy is the result of an alteration of the nuclei of the reticular system (SRA) that promote wakefulness [7, 80].

Narcolepsy in pregnancy causes adverse effects such as excessive maternal weight gain and gestational diabetes, whilst cataplexy contributes to a higher risk of emergency caesarean section [9].

#### *4.4.2 Treatment*

Narcolepsy is less common in pregnancy than other sleep disorders, but is more difficult to manage during pregnancy and in the perinatal period, also due to possible adverse effects of the drugs that may be used. In fact, amphetamines can cause low birth weight and increased risk of miscarriage is reported in women using sodium oxybate [7, 9, 81]. Data on the safety of selective serotonin reuptake inhibitors are conflicting, since there are not significant association with birth defects with use of fluoxetine, but it may contribute to transient neonatal complications during the third-trimester and to risk of social-behavioural abnormalities in childhood [82]. Subsequently, non-pharmacological treatment options are recommended, such as avoiding drugs can cause daytime sleepiness, intermittent napping and practising good sleep hygiene [9] (See **Table 2**).

#### **5. Conclusions**

According to Immanuel Kant, 'Heaven has given man three things to compensate for the difficulties of life: hope, sleep and a smile'. Indeed, hope and a smile can also be a consequence of satisfactory sleep, especially during pregnancy, but physical changes and conflicting emotions during this period can at the same time alter sleep patterns. Paying attention to sleep disorders during pregnancy could prevent the development of serious health consequences both for the health of mother and child. Identifying sleep disorders also encourages their adequate and early treatment, thus preventing the development of general symptoms such as asthenia, irritability, and emotional lability, or more serious psychiatric disorders, such as depression, mania and psychosis. At the same time, a multidisciplinary approach to sleep disorders in pregnancy is required. Indeed, the cooperation of psychiatrists, neurologists, gynaecologists, and psychologists may allow a improved sleep quality and increase overall well-being of women, children, and their family.

*Sleep Disorders in Pregnancy DOI: http://dx.doi.org/10.5772/intechopen.100300*
