Sleep problems during the menopausal transition: prevalence, impact, and management challenges

Abstract

A substantial number of women experience sleep difficulties in the approach to menopause and beyond, with 26% experiencing severe symptoms that impact daytime functioning, qualifying them for a diagnosis of insomnia. Here, we review both self-report and polysomnographic evidence for sleep difficulties in the context of the menopausal transition, considering severity of sleep complaints and links between hot flashes (HFs) and depression with poor sleep. Longitudinal population-based studies show that sleep difficulties are uniquely linked with menopausal stage and changes in follicle-stimulating hormone and estradiol, over and above the effects of age. A major contributor to sleep complaints in the context of the menopausal transition is HFs, and many, although not all, HFs are linked with polysomnographic-defined awakenings, with HF-associated wake time contributing significantly to overall wakefulness after sleep onset. Some sleep complaints may be comorbid with depressive disorders or attributed to sleep-related breathing or movement disorders, which increase in prevalence especially after menopause, and for some women, menopause, age, and environmental/behavioral factors may interact to disrupt sleep. Considering the unique and multifactorial basis for sleep difficulties in women transitioning menopause, we describe clinical assessment approaches and management options, including combination treatments, ranging from cognitive behavioral therapy for insomnia to hormonal and nonhormonal pharmacological options. Emerging studies suggest that the impact of severe insomnia symptoms could extend beyond immediate health care usage and quality of life issues to long-term mental and physical health, if left untreated in midlife women. Appropriate treatment, therefore, has immediate benefit as well as advantages for maintaining optimal health in the postmenopausal years.

Avocado–Soybean Unsaponifiables: A Panoply of Potentialities to Be Exploited

“…Menopause is described as the end of menstruating and is a normal condition that all women experience when they age [104]. In the initial days/years of menopause, the associated symptoms include hot flashes, vaginal dryness, and rapid bone loss as a result of osteoporosis and sleep disturbances [105]. Hormone replacement therapy (HRT) has been used as the most common therapy to get relief from menopausal dysfunction.…”

“…Soy isoflavones and extracts are the preferred phytoestrogen sources, with estrogen-like properties. Phytoestrogens are the chief constituents of polyphenols, structurally similar to endogenous estrogen, but having weak estrogenic properties as compared to endogenous ones [105].Keeping this in mind, soybean rich in unique dietary phytoestrogens (i.e., isoflavones daidzein, genistin, and glycetin) has gained considerable importance; apart from this, gabapentin, clonidine, selective serotonin reuptake inhibitors (SSRI's), black cohosh, and vitamin E are other alternatives used for conventional HRT [83]. These phytoestrogens are reported to have selective estrogen receptor modulators preferential for estrogen receptor-beta (ER-β) rather than for estrogen receptor-alpha (ER-α).…”

Fibromyalgia, sleep disturbance and menopause: Is there a relationship? A literature review

“…The majority of studies in the literature are observational and do not control for confounding factors, such as presence of comorbidities, use of medication, and presence of previous sleep disturbances. The results are also inconsistent and discordant . Although the literature does not allow conclusions, sleep‐related complaints should be taken into consideration.…”

Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders

“…Management of insomnia during the menopausal transition constitutes a priority for the improvement of well-being because of its impact on daytime functioning, quality of life and health [16][17][18][19]. Treatments for insomnia during the menopause include sleep hygiene, behavioral interventions, and drugs, mainly hypnotics.…”