Optimizing sleep across the menopausal transition

Abstract

Women frequently experience sleep disturbances, particularly night-time awakenings, as they transition menopause and enter postmenopause. Sleep is essential for optimal functioning and health. Persistent and distressing sleep disturbances across menopause can negatively impact daytime functioning and productivity, and increase risk for mental and physical health conditions. While multiple factors can disturb sleep, two unique factors in the context of menopause are vasomotor symptoms and the changing reproductive hormone environment. Vasomotor symptoms are associated with sleep disturbances and contribute significantly to awakenings and amount of time spent awake during the night. Even after accounting for vasomotor and depressive symptoms, lower estradiol and higher follicle stimulating hormone levels, indicative of menopause, are associated with sleep disturbance, particularly awakenings, suggesting that the hormone environment may directly affect sleep. Management strategies for clinically significant menopausal sleep disturbances include cognitive behavioral therapy for insomnia, which is effective and durable in treating menopausal insomnia. Hormone therapy alleviates sleep disturbances, particularly in the presence of disruptive vasomotor symptoms. Sleep disturbances have a significant impact on women’s functioning and health, and there is a need for further research of the underlying mechanisms to advance effective preventative and treatment strategies that ensure optimal health and well-being of midlife women.

摘要

女性在绝经过渡期和进入绝经后, 经常遇到睡眠障碍, 特别是夜间醒来。睡眠对身体的最佳状态和健康至关重要。在整个绝经阶段, 持续和令人痛苦的睡眠障碍会对白天的工作和生活产生负面影响, 并增加精神和身体健康状况障碍的风险。虽然多种因素会干扰睡眠, 但绝经期血管舒缩性症状和内分泌激素改变是导致睡眠障碍的两个独特因素。血管舒缩性症状与睡眠障碍相关, 并在很大程度上促成了夜间觉醒和清醒。除了血管舒缩性症状, 较低的雌激素和较高的卵泡刺激素水平（表明绝经）也与睡眠障碍有关, 尤其是夜间觉醒, 表明内分泌激素水平可能直接影响睡眠。临床上对于出现显著的绝经睡眠障碍的管理策略包括认知行为疗法治疗失眠, 这对治疗绝经期失眠是有效并且持久的。激素治疗可以缓解睡眠障碍, 尤其是在有严重血管舒缩性症状的情况下。睡眠障碍对女性的生活和健康有很严重的影响, 需要进一步研究其机制, 以推进有效的预防和治疗策略。以确保中年女性获得最佳健康和福祉。

Keywords:

• Menopause
• climacteric
• subjective sleep quality
• sleep architecture
• polysomnography
• vasomotor symptoms
• hot flashes
• depressive symptoms

Potential conflict of interest

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Baker holds stocks and consults for Lisa Health. She also is a consultant for Bayer Consumer Care. Dr Baker has received research funding from Noctrix Health, Inc. and Verily Life Sciences LLC.

Additional information

Funding

This work is supported by National Institutes of Health [Grant RF1AG061355].