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WESTCHESTER, Ill. – Two studies in the July 1 issue of the journal Sleep analyze menopausal sleep problems, finding that complaints may differ according to the stage of menopausal transition and the ethnicity of the woman, and identifying risk factors that may predict sleep problems at any stage of menopause.
A multi-ethnic study of more than 3,000 women shows that the odds of having trouble falling asleep and staying asleep increase through the menopausal transition. In contrast, the odds of having early-morning awakenings decrease from late perimenopause to postmenopause.
“The implications of the findings from this study are that sleep problems, especially problems staying asleep, are relatively common in women as they progress through the menopausal transition,” said principal investigator Dr. Howard M. Kravitz, associate professor of psychiatry and preventive medicine at Rush University Medical Center in Chicago, Ill.
The study also found ethnic differences in the self-reported sleep problems. Caucasian women had higher rates of difficulty staying asleep, while Hispanics had lower rates of both difficulty staying asleep and early-morning awakenings. No ethnic differences were observed for trouble falling asleep.
Women who reported more frequent vasomotor symptoms (a variable that combined hot flashes, night sweats and cold sweats as a single factor) had a higher odds ratio for each of the three types of sleep difficulty. Two hormonal changes during the menopausal transition were associated with sleep problems: decreasing levels of estradiol and increasing levels of follicle stimulating hormone. Findings were inconclusive regarding the potential benefits of hormonal therapy.
The study involved Caucasian, African American, Chinese, Japanese and Hispanic women in the multi-site Study of Women’s Health Across the Nation. Data were collected from 3,045 women during annual visits across seven years, including the drawing of fasting blood specimens to measure hormone levels. Participants were between the ages of 42 and 52 years at the beginning of the study.
“Women should feel comfortable discussing their sleep problems with their health-care providers to sort out the many potential contributing factors because undiagnosed and untreated sleep disturbances can contribute to decreased well-being and functioning in family, social and occupational roles,” said Kravitz.
The factors contributing to the sleep disturbances in the menopausal transition were further examined by another study involving a smaller and younger sample of more than 422 women who were between the ages of 35 and 47 years at the beginning of the study.
Risk factors for poor sleep quality were hot flashes, depressive symptoms and lower levels of the hormone inhibin B, which declines quickly in the early menopausal transition. Sleep quality was not predicted, however, by menopausal status.
“We found that it wasn’t the stage of menopause that mattered, but whether women had other menopausal symptoms that predicted whether they had problems with their sleep,” said lead author Dr. Grace W. Pien, assistant professor of medicine in the Sleep Medicine Division of the Department of Medicine at the University of Pennsylvania School of Medicine in Philadelphia.
The study involved an equal representation of Caucasian and African-American women who were enrolled in the Penn Ovarian Aging Study. Data were collected across eight years, first at nine-month intervals and then annually. Nonfasting blood samples were drawn to measure hormone levels.
Race did not contribute significantly to self-reported sleep quality. Results suggest that hot flashes may be even more detrimental to sleep quality in the later menopausal stages, while depressive symptoms may be less prominent in the late transition and postmenopause.
Pien added that more research is needed to determine the best way for physicians to treat menopause-related sleep complaints.
“A question that I think is raised by our findings is whether clinicians who see women with sleep complaints during menopause should focus on treating the sleep symptoms, or whether treatment of their hot flashes or other symptoms may be another effective way of approaching sleep problems in menopausal women,” she said.
Sleep is the official journal of the Associated Professional Sleep Societies, LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.
The following resources for women are available online from the American Academy of Sleep Medicine:
“Sleep Disturbance During the Menopausal Transition in a Multi-Ethnic Community Sample of Women” and “Predictors of Sleep Quality in Women in the Menopausal Transition” are in the July 1 issue of Sleep, volume 31, number 7. For a copy of either study, or to arrange an interview with an AASM spokesperson, please contact Kathleen McCann, AASM director of communications, at (708) 492-0930, ext. 9316, or firstname.lastname@example.org.