Peri- and post-menopausal women frequently complain of insomnia or poor sleep quality. Sleep disturbance is often attributed to nocturnal hot flashes; however, a recent study from researchers at Wayne State University School of Medicine suggests that about half of these women may have a primary sleep disorder.

In this study, 102 women (ages 44 to 56 years) reporting disrupted sleep were recruited through newspaper advertisements. They were assessed with the Pittsburgh Sleep Quality Index and the Hamilton Anxiety and Depression Rating Scales and completed one night of polysomnography in a controlled laboratory setting.

53% of the women were found to have a primary sleep disorder (sleep apnea, restless legs syndrome, or both). The best predictors of objective sleep quality (laboratory sleep efficiency) were apneas, periodic limb movements, and brief arousals. The best predictors of subjective sleep quality (as measured by the Pittsburgh Sleep Quality Index global score) were the Hamilton anxiety score and the number of hot flashes in the first half of the night.

These findings suggest that while nocturnal hot flushes may be the cause of sleep disruption in many peri- and postmenopausal women, many of these women have an underlying primary sleep disorder, like restless leg syndrome or sleep apnea. Thus interventions that are intended to reduce the frequency and severity of hot flushes may not be fully effective for a significant number of women. The authors recommend that for peri- and postmenopausal women presenting with sleep problems, clinicians must take a comprehensive sleep history to rule out a primary sleep disorder and, if necessary, obtain polysomnography to confirm the diagnosis.

Ruta Nonacs, MD PhD

Freedman RR and Roehrs TA. Sleep disturbance in menopause. Menopause 2007; 14:826-9.