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Sleep in midlife women: effects of menopause, vasomotor symptoms, and depressive symptoms

Lampio, Laura MD1; Polo-Kantola, Päivi MD, PhD1,2; Polo, Olli MD, PhD1,3; Kauko, Tommi MSc4; Aittokallio, Jenni MD, PhD5; Saaresranta, Tarja MD, PhD1,6

doi: 10.1097/GME.0000000000000239
Original Articles

Objective This study aims to evaluate subjective sleep quality in premenopausal and postmenopausal women and to study its association with night sweats, hot flashes, and depressive symptoms.

Methods A total of 158 healthy women were recruited; 107 were premenopausal (44-48 y) and 51 were postmenopausal (53-58 y). Sleep quality was evaluated with the Basic Nordic Sleep Questionnaire, night sweats and hot flashes were evaluated with a specific symptom questionnaire, and depressive symptoms were evaluated with the Beck Depression Inventory.

Results Postmenopausal women had poorer general sleep quality (P < 0.001), slept more restlessly (P = 0.020), and had more nocturnal awakenings (P = 0.015). However, the frequency of difficulty falling asleep, snoring, witnessed apnea, or use of sleep medication was similar between the groups. Furthermore, sleep latency, morning tiredness, or daytime tiredness did not differ between the groups. Postmenopausal women did not report more unintentional falling asleep at work or during leisure time; however, when not active, they dozed off more easily than premenopausal women (P < 0.001). Postmenopausal women had more night sweats (P < 0.001), hot flashes (P < 0.001), and depressive symptoms (P < 0.001). Even a low frequency of night sweats disturbed sleep in postmenopausal women, whereas only frequent night sweats were disturbing in premenopausal women. Depressive symptoms disturbed sleep regardless of menopause status.

Conclusions Maintenance insomnia, most evidently because of night sweats and hot flashes, seems to be the major type of insomnia in postmenopausal women and has to be considered when choosing insomnia treatment for this group. Initiation of sleep and daytime vitality are not, in general, affected by menopause.

From the 1Sleep Research Unit, Department of Physiology, University of Turku, Turku, Finland; 2Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland; 3Department of Pulmonary Diseases, Tampere University Hospital, Tampere, Finland; 4Department of Biostatistics, University of Turku, Turku, Finland; 5Department of Anesthesiology and Intensive Care, Turku University Hospital, Turku, Finland; and 6Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital and University of Turku, Turku, Finland.

Received November 26, 2013; revised and accepted February 20, 2014.

Funding/support: This study was supported by the Finnish Anti-Tuberculosis Association, Finnish Menopause Society, Finnish Sleep Research Society, Turku University Hospital (government EVO grant), and Väinö and Laina Kivi Foundation.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Laura Lampio, MD, Sleep Research Unit, University of Turku, Lemminkäisenkatu 14-18 A, Turku FIN-20520, Finland. E-mail:

© 2014 by The North American Menopause Society.