Management of sleep disorders in the menopausal transition

Abstract

The menopausal transition is associated with increasing sleep disorders including sleep apnoea and restless leg syndrome. Insomnia is the most common and is recognised as a core symptom of the menopause. Guidelines to support decision making for women with sleep problems during the menopausal transition are lacking. Sleep problems are associated with negative impacts on healthcare utilisation, quality of life and work productivity. Sleep deprivation is a risk factor for cardiovascular disease, diabetes, obesity and neurobehavioral dysfunction. Declining oestrogen is implicated as a cause of menopausal sleep disruption. Vasomotor symptoms (VMS) and menopausal mood disturbance are also factors in the complex aetiology. VMS commonly precipitate insomnia and, due to their prolonged duration, they often perpetuate the condition. Insomnia in the general population is most effectively treated with cognitive behavioural therapy (CBT) (also effective in the menopausal transition.) The associations of menopausal sleep disturbance with VMS and depression mean that other treatment options must be considered. Existing guidelines outline effectiveness of hormone replacement therapy (HRT), CBT and antidepressants. HRT may indirectly help with sleep disturbance by treating VMS and also via beneficial effect on mood symptoms. The evidence base underpinning menopausal insomnia often references risks associated with HRT that are not in line with current international menopause guidelines. This may influence clinicians managing sleep disorders, leading to hesitation in offering HRT, despite evidence of effectiveness. Viewing sleep symptoms on an axis of menopausal symptoms – towards vasomotor symptoms or towards mood symptoms may help tailor treatment options towards the symptom profile.

Primary and Secondary Prevention in Delusional Disorder

“…This period, and the postmenopausal stage that follows, are associated with a significant increase in sleep disturbances such as sleep apnea, insomnia and restless leg syndrome, all of which impact the quality of life, health, and social and personal functioning. 63 During perimenopause, insomnia is the most frequently experienced and treatable sleep disorder. 64 Effective treatment of pre-existing sleep problems can prevent the onset of psychotic thinking and can reduce symptom severity if diagnosed after the onset of psychosis 65 although this has not yet been specifically studied in DD.…”

“…Insomnia Insomnia can worsen DD symptoms. 62, 63 Rx of insomnia to improve outcome. 62 Sleep apnea (OSA) OSA can increase symptom severity esp.…”

Regulatory role of cytokines on etiology of depression in animal models: their biological mechanisms and clinical implication with physical exercise

“…Also, psychoneurological symptoms are shown in almost all women in the perimenopausal period. Ovarian hormones regulate cognitive and mood function ( Azizi-Malekabadi et al, 2015 ; Lozza-Fiacco et al, 2022 ; Schaedel et al, 2021 ; Shors and Leuner, 2003 ). 17β-estradiol (E 2 ) replacement exhibits anti-inflammatory properties in the CNS ( Brown et al, 2010 ).…”

“…17β-estradiol (E 2 ) replacement exhibits anti-inflammatory properties in the CNS ( Brown et al, 2010 ). Some studies reported that mood disorders are related to change of neuroimmune systems ( Lozza-Fiacco et al, 2022 ; Schaedel et al, 2021 ). Also, psychological stress is related with proinflammatory cytokines in the brain such as IL-6, IL-1β, and TNF-α ( Buchanan et al, 2008 ).…”

Hormone Targets for the Treatment of Sleep Disorders in Postmenopausal Women with Schizophrenia: A Narrative Review

“…The menopausal transition and the postmenopausal period are associated with a significant increase in sleep disorders, such as sleep apnea, insomnia, and restless leg syndrome [ 24 ]. Insomnia is the sleep disorder most commonly found in women, and it has been associated with negative impacts on healthcare, quality of life, and functionality [ 25 ].…”