The National Institute for Health and Clinical Excellence (NICE) guideline on antenatal and postnatal mental health (2018) recommends that pharmacological treatment should be considered when women do not respond to nonpharmacologic therapy and may present severe forms of insomnia symptoms, when there are no alternatives and the benefit outweighs the risk. It is suggested to follow a shared decision-making approach. Among sleep-promoting GABAergic compounds, lorazepam is the drug with more studies while sleep-promoting melatonergic compounds are not sufficiently studied during pregnancy and the postpartum period. Among antagonists of the arousal-promoting system, some data are currently related to the antihistaminergic action of trazodone and diphenhydramine, while no available data are present for new compounds currently available for insomnia treatment such as dual orexin receptor antagonists (DORA). Accordingly, pharmacological insomnia treatment during pregnancy and the postpartum period is still a challenge.