Treatment of chronic insomnia disorder in menopause: evaluation of literature : Menopause

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Review Article

Treatment of chronic insomnia disorder in menopause

evaluation of literature

Attarian, Hrayr MD1; Hachul, Helena MD, PhD2; Guttuso, Thomas MD3; Phillips, Barbara MD, MPH4

Author Information
Menopause 22(6):p 674-684, June 2015. | DOI: 10.1097/GME.0000000000000348

Abstract

Objective 

Insomnia both as a symptom and as part of chronic insomnia disorder is quite common in menopause. Comorbid conditions, such as restless legs syndrome and obstructive sleep apnea, occur with high prevalence among perimenopausal women with insomnia. Insomnia in this population group is associated with adverse health outcomes, and there are no clear standards on how to treat it.

Methods 

Based on extensive literature search, 76 articles were identified. Two authors independently graded evidence according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence.

Results 

Evaluation and treatment of other comorbid sleep disorders are recommended, as is cognitive-behavioral therapy for insomnia. Hormone therapy, eszopiclone, escitalopram, gabapentin, isoflavones, valerian, exercise, and hypnosis are suggested. Zolpidem, quiteiapine XL, citalopram, mirtazapine followed by long-acting melatonin, ramelteon, Pycnogenol, Phyto-Female Complex, yoga, and massage may be considered. Kampo formulas are not recommended. Acupuncture may not be suggested, and cognitive-behavioral therapy that is not tailored for insomnia probably should not be considered.

Conclusions 

Although a variety of interventions are shown to be helpful in improving sleep in menopause, there is a need for well-designed head-to-head trials with uniform outcome measures.

© 2015 by The North American Menopause Society.

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