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Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition *

Kravitz, Howard M. DO, MPH1,2; Ganz, Patricia A. MD3; Bromberger, Joyce PhD4,5; Powell, Lynda H. PhD2; Sutton-Tyrrell, Kim PhD4; Meyer, Peter M. PhD2


Objective To compare age-adjusted and ethnic differences in prevalences of sleep difficulty at various stages of the menopausal transition and to determine the relative contribution of other factors, including vasomotor symptoms, sociodemographics, and psychological and physical health factors, to self-reported sleep difficulty in middle-aged women.

Design A community-based survey of women's health and menopausal symptoms was conducted between November 1995 and October 1997 at each of the seven US sites participating in the Study of Women's Health Across the Nation. A multiethnic sample of 12,603 Caucasian, African American, Chinese, Japanese, and Hispanic women aged 40 to 55 years was categorized into six groups: premenopausal, early perimenopausal, late perimenopausal, naturally postmenopausal, surgically postmenopausal, and postmenopausal receiving hormone replacement therapy. The women were asked whether they had experienced difficulty sleeping in the past 2 weeks.

Results Difficulty sleeping was reported by 38%. Age-adjusted rates were highest in the late perimenopausal (45.4%) and surgically postmenopausal (47.6%) groups. Among ethnic groups, rates ranged from 28% in Japanese women to 40% in Caucasian women. In the multivariate analysis, menopausal status was significantly associated with difficulty sleeping. Ethnicity, vasomotor and psychological symptoms, self-perceived health and health behaviors, arthritis, and education also were significantly associated with difficulty sleeping.

Conclusions These results suggest that stage of the menopausal transition, independent of other potential explanatory factors, is associated with self-reported sleep difficulty. Older age per se was not significantly associated with difficulty sleeping.

From the 1Departments of Psychiatry and 2Preventive Medicine, Rush Medical College, Chicago, IL; 3Schools of Medicine and Public Health, University of California, Los Angeles, CA; and the 4Graduate School of Public Health and 5Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.

Received December 26, 2001; revised and accepted July 10, 2002.

The Study of Women's Health Across the Nation (SWAN) was funded by grants from the National Institute on Aging and the National Institute of Nursing Research of the National Institutes of Health to the following participating centers: University of Michigan, Ann Arbor, MI (U01 NR04061; U01 AG12495); Massachusetts General Hospital, Boston, MA (U01 AG12531); Rush University, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL (U01 AG12505); University of California, Davis, CA (U01 AG12554); University of California, Los Angeles, CA (U01 A12539); University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ (U01 AG12535); University of Pittsburgh, Pittsburgh, PA (U01 AG12546); New England Research Institutes, Watertown, MA (U01 AG12553).

Address correspondence to Howard M. Kravitz, DO, MPH, Rush Institute for Mental Well-Being, 1725 West Harrison Street, Suite 955, Chicago, IL 60612, USA. E-mail:

*This paper was presented in part at the 12th Annual Meeting of the Associated Professional Sleep Societies, New Orleans, LA, June 23, 1998, and published in abstract form as Kravitz HM, Ganz PA, Sherman S, Sutton-Tyrrell K, Bromberger JT, Powell LH. Sleep difficulty during the menopausal transition [Abstract 589.H]. Sleep 1998; 21(Suppl):299.

©2003The North American Menopause Society