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Sleep disturbance in menopause

Freedman, Robert R. PhD1; Roehrs, Timothy A. PhD2

doi: 10.1097/gme.0b013e3180321a22

Objective: To determine the sources of sleep complaints in peri- and postmenopausal women reporting disturbed sleep.

Design: A total of 102 women, ages 44 to 56 years, who reported disturbed sleep were recruited through newspaper advertisements. They were assessed with the Pittsburgh Sleep Quality Index and the Hamilton Anxiety and Depression Rating Scales. Complete polysomnography was performed in a controlled laboratory setting. Results were analyzed by multiple regression.

Results: Fifty-three percent of the women had apnea, restless legs, or both. The best predictors of objective sleep quality (laboratory sleep efficiency) were apneas, periodic limb movements, and arousals (R2 = 0.44, P < 0.0001). The best predictors of subjective sleep quality (Pittsburgh Sleep Quality Index global score) were the Hamilton anxiety score and the number of hot flashes in the first half of the night (R2 = 0.19, P < 0.001).

Conclusions: Primary sleep disorders (apnea and restless legs syndrome) are common in this population. Amelioration of hot flashes may reduce some complaints of poor sleep but will not necessarily alleviate underlying primary sleep disorders. Because these can result in significant morbidity and mortality, they require careful attention in peri- and postmenopausal women.

In postmenopausal women complaining of poor sleep, objective sleep disturbance is associated with apneas and periodic limb movements, whereas subjective sleep distrubance is associated with anxiety and hot flashes in the first half of the night.

From the 1Departments of Psychiatry and Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; and 2Henry Ford Hospital Sleep Disorders Center, Department of Psychiatry, Wayne State University School of Medicine, Detroit, MI.

Received November 9, 2006; revised and accepted December 19, 2006.

Funding/support: Supported by grant R01-MH63089 (R.R.F.) from the National Institutes of Health.

Financial disclosure: None reported.

Address correspondence to: Robert R. Freedman, PhD, C. S. Mott Center, 275 East Hancock, Detroit, MI 48201. E-mail:

©2007The North American Menopause Society