Sleep Disturbances During the Menopausal Transition

Abstract

Sleep plays a central role in women's health, and sleep disturbances can significantly affect quality of life, worsen the prognosis of medical comorbidities, and increase risk for mood and anxiety disorders. Fragmented sleep is twice as prevalent in women as in men, regardless of age.1 Moreover, epidemiologic surveys have suggested that prevalence of perceived sleep disturbances rises from 12% to 40% during the age interval coinciding with the menopausal transition.2 In this overview of common causes of sleep disturbance, we discuss several etiologic factors and therapeutic interventions for disrupted sleep in women as they cope with the menopausal transition. Causative and Correlative Factors The etiology of sleep disturbances during the menopausal transition is complex; therefore, organizing the potential causative factors into clinically useful categories may be helpful. Hormonal Flux Decreases in estradiol and increases in follicle-stimulating hormone, progesterone, and testosterone across the menopausal transition have been correlated with sleep difficulties during this midlife stage.3 Hot Flashes Several epidemiologic studies have shown associations between hot flashes and perceived sleep disturbances such as frequent awakenings and lack of restorative sleep,3 and polysomnography studies have confirmed that hot flashes result in an increase in objectively measured awakenings and time spent awake after sleep onset.4 Medical Factors Medical conditions: Several clinical conditions (some more widespread during midlife) adversely affect sleep; these …