Sleep disturbances frequently occur during pregnancy, and existing sleep disorders may either exacerbate or emerge throughout gestation. While nonpharmacologic approaches are generally considered the safest, they often prove ineffective, leaving patients to contend with sleep disturbances and the adverse effects associated with inadequate sleep during pregnancy. As with any medical condition encountered during pregnancy, effective management necessitates a comprehensive understanding of pregnancy physiology, awareness of how specific conditions affect pregnancy and fetal or neonatal outcomes, and the ability to assess the risks associated with untreated or inadequately treated conditions in comparison to the risks posed by certain medications. This chapter will discuss sleep disorders during pregnancy, outline general prescribing principles for pregnancy and lactation, and discuss the safety of various therapeutic options available during this period.