Evaluation and Management of Sleep Disturbance During the Menopause Transition

Hadine Joffe, M.D., M.Sc.; Anda Massler, M.D., M.Sc.; Katherine M. Sharkey, M.D., Ph.D.

Disclosures

Semin Reprod Med. 2010;28(5):404-421. 

In This Article

Abstract and Introduction

Abstract

Sleep disturbances in midlife women are common and have been associated with the menopause transition itself, symptoms of hot flashes, anxiety and depressive disorders, aging, primary sleep disorders (i.e., obstructive sleep apnea, periodic limb movement disorder), comorbid medical conditions and medications, as well as with psychosocial and behavioral factors. Because there are several common sources of sleep problems in midlife women, the cause of an individual woman's sleep disturbance may be multifactorial. Effective behavioral and pharmacological therapies are available to treat sleep disturbances of different etiologies. This review provides an overview of different types of sleep disturbance occurring in midlife women and presents data supporting the use of hormone therapy, hypnotic agents, and behavioral strategies to treat sleep problems in this population. The review aims to equip clinicians evaluating menopause-age women with the knowledge and evaluation tools to diagnose, engage sleep experts where appropriate, and treat sleep disturbance in this population. Sleep disorders in midlife women should be treated because substantial improvements in quality of life and health outcomes are achievable.

Introduction

Sleep complaints increase dramatically in women during midlife,[1] suggesting a potential association between sleep disturbance and the menopause transition. In the 2005 National Institutes of Health State-of-the-Science Conference panel report on menopause-related symptoms,[2] sleep disturbance was identified as a key symptom of the menopause transition. Nocturnal hot flashes have been hypothesized to be a primary source of menopause-associated sleep disturbance. However, other contributors to sleep disruption must also be considered in midlife women who report sleeping problems. Common etiologies of persistent sleep disturbance in this population include hot flashes, age-related factors, primary sleep disorders, and psychiatric illness.[3] Additional nonpathological causes of sleep disruption may result from psychosocial, behavioral, and stress-related factors.

This review provides an overview of different types of sleep disturbance occurring in midlife women. Sleep-related concerns associated with (1) vasomotor symptoms; (2) depressive and anxiety symptoms; (3) primary sleep disorders, and (4) aging and medical illness are described. Data supporting these common sources of sleep disturbance during the menopause transition, as well as other nonpathological contributors, are reviewed. Throughout the article, differences between perceived and objectively measured sleep are discussed. The review aims to equip clinicians evaluating menopause-age women with the knowledge and evaluation tools to diagnose, engage sleep experts where appropriate, and treat sleep disturbance in midlife women.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....