Peri- and post-menopausal women frequently complain of insomnia or poor sleep quality. Sleep disturbance is often attributed to nocturnal hot flashes; however, a study from researchers at Wayne State University School of Medicine suggests that a sizeable proportion of menopausal women may have a primary sleep disorder.  Clinically we see that sleep disruption, especially when prolonged, can lead to a constellation of other symptoms including irritability, anxiety, depression, and poor cognitive performance.  A recent study suggests that certain interventions which improve sleep may also lead to improvements in mood.

In this study researchers recruited 117 postmenopausal women (56.34 ± 5.41 years) with peri- or postmenopausal onset of insomnia.  These women were randomized to one of the following three treatment conditions: sleep hygiene education (SHE), sleep reduction therapy (SRT), and cognitive behavioral therapy for insomnia (CBTI). Blinded assessments were performed at baseline, immediately after treatment, and at a follow-up visit at six months.

Women receiving CBTI or SRT reported a reduction in depressive symptoms.  In contract, sleep hygiene did not have any effect on the level of depressive symptoms.  However, only 4.3% of the women reported depressive symptoms so this effect was seen in a small proportion of the women.  Unfortunately this study excluded women diagnosed with major depression, so we cannot say for sure that CBTI or sleep restriction would be effective in with depressive symptoms and insomnia.

In our clinic, we see a large number of women with depression emerging or worsening during the menopausal transition.  The majority, if not all, of these women report insomnia and poor sleep quality in addition to their mood symptoms. Often treatment will include both an antidepressant and a medication for sleep (such as a benzodiazepine or gabapentin).  This and other studies suggest that behavioral interventions, such as CBTI or sleep restriction, may provide benefit in this population of women.

Ruta Nonacs, MD PhD

 

Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia(CBTI), sleep restriction therapy, and sleep hygiene education.

Kalmbach DA, Cheng P, Arnedt JT, Anderson JR, Roth T, Fellman-Couture C, Williams RA, Drake CL.  Sleep Med. 2019 Mar;55:124-134.