Skip to main content
SpringerLink
Log in

Insomnia and Menopause

  • Chapter
  • First Online:
Clinical Handbook of Insomnia

Part of the book series: Current Clinical Neurology ((CCNEU))

  • 2592 Accesses

Abstract

Global life expectancy has increased substantially over the last century. For women, this means that they now live nearly one-third of their lives in the climacteric period with the undesirable effects of hypoestrogenism. The consequences of this decrease in estrogen may occur in the short or long term. Among the early manifestations, the most important are vasomotor symptoms, insomnia, increased irritability, anxiety, depression, and loss of memory. Hormonal changes can be responsible for insomnia in the menopause transition and postmenopause, but it can also be caused by biopsychological changes that often happen in women’s lives. Many women retire during this time, and may pass through social and health changes. Women can develop “empty nest syndrome,” when their children leave home. These changes can lead to depression, a factor which is closely linked to insomnia. In addition, other consequences of hypoestrogenism, such as genital atrophy, nocturia, body pain, and other changes, can lead to sleep fragmentation. The aim of this chapter is not only to review the current literature on the subject but also to describe the pathophysiology of insomnia in postmenopause and the care that can be given by a multidisciplinary team. We highlight the importance of evaluating the patient as a whole, in an individualized and personalized manner. In our view, looking at both the body and the mind, from a hormonal to a biopsychosocial context, is the best approach to effective treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. World Health Organization. Research on the menopause in the 1990s. Geneva: World Health Organization; 1994.

    Google Scholar 

  2. International Menopause Society. Menopause terminology. http://www.imsociety.org/menopause_terminology.php

  3. Soules MR, Sherman S, Parrott E, Rebar R, Santoro N, Utian W, et al. Executive summary: stages of reproductive aging workshop (STRAW). Climacteric. 2001;4(4):267–72.

    Article  CAS  PubMed  Google Scholar 

  4. Girão MJBC, Lima GR, Baracat EC. Ginecologia—Série Ginecologia UNIFESP. Brazil: Manole; 2009. 980 p.

    Google Scholar 

  5. American Psychiatric Association. Diagnostic and statistic manual of mental disorders. 5th ed. Arlington County, VA: American Psychiatric Publishing; 2013.

    Google Scholar 

  6. Castro LS, Poyares D, Leger D, Bittencourt L, Tufik S. Objective prevalence of insomnia in the São Paulo, Brazil epidemiologic sleep study. Ann Neurol. 2013;74(4):537–46.

    Article  PubMed  Google Scholar 

  7. Bittencourt LR, Santos-Silva R, Taddei JA, Andersen ML, de Mello MT, Tufik S. Sleep complaints in the adult Brazilian population: a national survey based on screening questions. J Clin Sleep Med. 2009;5(5):459–63.

    PubMed  PubMed Central  Google Scholar 

  8. Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995;18(6):425–32.

    CAS  PubMed  Google Scholar 

  9. Hachul H, Frange C, Bezerra AG, Hirotsu C, Pires GN, Andersen ML, et al. The effect of menopause on objective sleep parameters: data from an epidemiologic study in São Paulo, Brazil. Maturitas. 2015;80(2):170–8.

    Article  PubMed  Google Scholar 

  10. Vigeta SM, Hachul H, Tufik S, de Oliveira EM. Sleep in postmenopausal women. Qual Health Res. 2012;22(4):466–75.

    Article  PubMed  Google Scholar 

  11. von Mühlen DG, Kritz-Silverstein D, Barrett-Connor E. A community-based study of menopause symptoms and estrogen replacement in older women. Maturitas. 1995;22(2):71–8.

    Article  Google Scholar 

  12. Campos HH, Bittencourt LRA, Haidar MA, Tufik S, Baracat EC. Sleep disturbance prevalence in postmenopausal women. Rev Bras Ginecol Obstet. 2005;27(12):6.

    Google Scholar 

  13. Young T, Rabago D, Zgierska A, Austin D, Laurel F. Objective and subjective sleep quality in premenopausal, perimenopausal, and postmenopausal women in the Wisconsin Sleep Cohort Study. Sleep. 2003;26(6):667–72.

    PubMed  Google Scholar 

  14. Okun ML, Kravitz HM, Sowers MF, Moul DE, Buysse DJ, Hall M. Psychometric evaluation of the Insomnia Symptom Questionnaire: a self-report measure to identify chronic insomnia. J Clin Sleep Med. 2009;5(1):41–51.

    PubMed  PubMed Central  Google Scholar 

  15. Hachul H, Bittencourt LR, Soares JM, Tufik S, Baracat EC. Sleep in post-menopausal women: differences between early and late post-menopause. Eur J Obstet Gynecol Reprod Biol. 2009;145(1):81–4.

    Article  PubMed  Google Scholar 

  16. Calleja-Agius J, Brincat MP. The urogenital system and the menopause. Climacteric. 2015;18 Suppl 1:18–22.

    Article  PubMed  Google Scholar 

  17. Furtado D, Hachul H, Andersen ML, Castro RA, Girão MB, Tufik S. Nocturia × disturbed sleep: a review. Int Urogynecol J. 2012;23(3):255–67.

    Article  PubMed  Google Scholar 

  18. World Health Organization. Life expectancy—data by WHO region. http://apps.who.int/gho/data/view.main.690?lang=en

  19. Ensrud KE, Stone KL, Blackwell TL, Sawaya GF, Tagliaferri M, Diem SJ, et al. Frequency and severity of hot flashes and sleep disturbance in postmenopausal women with hot flashes. Menopause. 2009;16(2):286–92.

    Article  PubMed  Google Scholar 

  20. Da Fonseca AM, Bagnoli VR, Souza MA, Azevedo RS, Couto EB, Soares JM, et al. Impact of age and body mass on the intensity of menopausal symptoms in 5968 Brazilian women. Gynecol Endocrinol. 2013;29(2):116–8.

    Article  PubMed  Google Scholar 

  21. Cray L, Woods NF, Mitchell ES. Symptom clusters during the late menopausal transition stage: observations from the Seattle Midlife Women’s Health Study. Menopause. 2010;17(5):972–7.

    Article  PubMed  Google Scholar 

  22. Brown JP, Gallicchio L, Flaws JA, Tracy JK. Relations among menopausal symptoms, sleep disturbance and depressive symptoms in midlife. Maturitas. 2009;62(2):184–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sandilyan MB, Dening T. Mental health around and after the menopause. Menopause Int. 2011;17(4):142–7.

    PubMed  Google Scholar 

  24. Wesstrom J, Nilsson S, Sundstrom-Poromaa I, Ulfberg J. Restless legs syndrome among women: prevalence, co-morbidity and possible relationship to menopause. Climacteric. 2008;11(5):422–8.

    Article  CAS  PubMed  Google Scholar 

  25. Guilleminault C, Palombini L, Poyares D, Chowdhuri S. Chronic insomnia, postmenopausal women, and sleep disordered breathing: part 1. Frequency of sleep disordered breathing in a cohort. J Psychosom Res. 2002;53(1):611–5.

    Article  PubMed  Google Scholar 

  26. Guilleminault C, Palombini L, Poyares D, Chowdhuri S. Chronic insomnia, premenopausal women and sleep disordered breathing: part 2. Comparison of nondrug treatment trials in normal breathing and UARS post menopausal women complaining of chronic insomnia. J Psychosom Res. 2002;53(1):617–23.

    Article  PubMed  Google Scholar 

  27. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3 Pt 1):608–13.

    Article  CAS  PubMed  Google Scholar 

  28. Andersen ML, Bittencourt LR, Antunes IB, Tufik S. Effects of progesterone on sleep: a possible pharmacological treatment for sleep-breathing disorders? Curr Med Chem. 2006;13(29):3575–82.

    Article  CAS  PubMed  Google Scholar 

  29. Hachul de Campos H, Brandão LC, D’Almeida V, Grego BH, Bittencourt LR, Tufik S, et al. Sleep disturbances, oxidative stress and cardiovascular risk parameters in postmenopausal women complaining of insomnia. Climacteric. 2006;9(4):312–9.

    Article  CAS  PubMed  Google Scholar 

  30. Parish JM. Sleep-related problems in common medical conditions. Chest. 2009;135(2):563–72.

    Article  PubMed  Google Scholar 

  31. Martínez-Jauand M, Sitges C, Femenia J, Cifre I, González S, Chialvo D, et al. Age-of-onset of menopause is associated with enhanced painful and non-painful sensitivity in fibromyalgia. Clin Rheumatol. 2013;32(7):975–81.

    Article  PubMed  Google Scholar 

  32. Lizcano F, Guzmán G. Estrogen deficiency and the origin of obesity during menopause. Biomed Res Int. 2014;2014:757461.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Zargarian N, Lindquist R, Gross CR, Treat-Jacobson D. Outcome measures of behavioral weight loss programs in perimenopause. South Med J. 2014;107(8):486–96.

    Article  PubMed  Google Scholar 

  34. Terauchi M, Hiramitsu S, Akiyoshi M, Owa Y, Kato K, Obayashi S, et al. Associations between anxiety, depression and insomnia in peri- and post-menopausal women. Maturitas. 2012;72(1):61–5.

    Article  PubMed  Google Scholar 

  35. Stuenkel CA. Menopausal hormone therapy: current considerations. Endocrinol Metab Clin North Am. 2015;44(3):565–85.

    Article  PubMed  Google Scholar 

  36. Attarian H, Hachul H, Guttuso T, Phillips B. Treatment of chronic insomnia disorder in menopause: evaluation of literature. Menopause. 2015;22(6):674–84.

    Article  PubMed  Google Scholar 

  37. Marjoribanks J, Farquhar C, Roberts H, Lethaby A. Trial does not change the conclusions of Cochrane review of long term hormone therapy for perimenopausal and postmenopausal women. BMJ. 2012;345:e8141. author reply e64.

    Article  PubMed  Google Scholar 

  38. Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012;2(1):e000850.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Kao CH, Sun LM, Liang JA, Chang SN, Sung FC, Muo CH. Relationship of zolpidem and cancer risk: a Taiwanese population-based cohort study. Mayo Clin Proc. 2012;87(5):430–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Farkas RH, Unger EF, Temple R. Zolpidem and driving impairment—identifying persons at risk. N Engl J Med. 2013;369(8):689–91.

    Article  CAS  PubMed  Google Scholar 

  41. Joffe H, Petrillo L, Viguera A, Koukopoulos A, Silver-Heilman K, Farrell A, et al. Eszopiclone improves insomnia and depressive and anxious symptoms in perimenopausal and postmenopausal women with hot flashes: a randomized, double-blinded, placebo-controlled crossover trial. Am J Obstet Gynecol. 2010;202(2):171.e1–11.

    Article  Google Scholar 

  42. Greenblatt DJ, Harmatz JS, Roth T, Singh NN, Moline ML, Harris SC, et al. Comparison of pharmacokinetic profiles of zolpidem buffered sublingual tablet and zolpidem oral immediate-release tablet: results from a single-center, single-dose, randomized, open-label crossover study in healthy adults. Clin Ther. 2013;35(5):604–11.

    Article  CAS  PubMed  Google Scholar 

  43. Dobkin RD, Menza M, Bienfait KL, Allen LA, Marin H, Gara MA. Ramelteon for the treatment of insomnia in menopausal women. Menopause Int. 2009;15(1):13–8.

    PubMed  PubMed Central  Google Scholar 

  44. Ensrud KE, Joffe H, Guthrie KA, Larson JC, Reed SD, Newton KM, et al. Effect of escitalopram on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flashes: a randomized controlled trial. Menopause. 2012;19(8):848–55.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Soares CN, Arsenio H, Joffe H, Bankier B, Cassano P, Petrillo LF, et al. Escitalopram versus ethinyl estradiol and norethindrone acetate for symptomatic peri- and postmenopausal women: impact on depression, vasomotor symptoms, sleep, and quality of life. Menopause. 2006;13(5):780–6.

    Article  PubMed  Google Scholar 

  46. Defronzo Dobkin R, Menza M, Allen LA, Marin H, Bienfait KL, Tiu J, et al. Escitalopram reduces hot flashes in nondepressed menopausal women: a pilot study. Ann Clin Psychiatry. 2009;21(2):70–6.

    PubMed  Google Scholar 

  47. Suvanto-Luukkonen E, Koivunen R, Sundström H, Bloigu R, Karjalainen E, Häivä-Mällinen L, et al. Citalopram and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized, 9-month, placebo-controlled, double-blind study. Menopause. 2005;12(1):18–26.

    Article  PubMed  Google Scholar 

  48. Frey BN, Haber E, Mendes GC, Steiner M, Soares CN. Effects of quetiapine extended release on sleep and quality of life in midlife women with major depressive disorder. Arch Womens Ment Health. 2013;16(1):83–5.

    Article  PubMed  Google Scholar 

  49. Dolev Z. Case series of perimenopausal women with insomnia treated with mirtazapine followed by prolonged-release melatonin add-on and monotherapy. Arch Womens Ment Health. 2011;14(3):269–73.

    Article  PubMed  Google Scholar 

  50. Yurcheshen ME, Guttuso T, McDermott M, Holloway RG, Perlis M. Effects of gabapentin on sleep in menopausal women with hot flashes as measured by a Pittsburgh Sleep Quality Index factor scoring model. J Womens Health (Larchmt). 2009;18(9):1355–60.

    Article  Google Scholar 

  51. Guttuso T. Nighttime awakenings responding to gabapentin therapy in late premenopausal women: a case series. J Clin Sleep Med. 2012;8(2):187–9.

    PubMed  PubMed Central  Google Scholar 

  52. Mucci M, Carraro C, Mancino P, Monti M, Papadia LS, Volpini G, et al. Soy isoflavones, lactobacilli, Magnolia bark extract, vitamin D3 and calcium. Controlled clinical study in menopause. Minerva Ginecol. 2006;58(4):323–34.

    CAS  PubMed  Google Scholar 

  53. Hachul H, Brandão LC, D’Almeida V, Bittencourt LR, Baracat EC, Tufik S. Isoflavones decrease insomnia in postmenopause. Menopause. 2011;18(2):178–84.

    PubMed  Google Scholar 

  54. Holzl J, Godau P. Receptor bindings studies with Valeriana officinalis on the benzodiazepine receptor. Planta Med. 1989;55(6):642.

    Google Scholar 

  55. Bent S, Padula A, Moore D, Patterson M, Mehling W. Valerian for sleep: a systematic review and meta-analysis. Am J Med. 2006;119(12):1005–12.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Sarris J, Byrne GJ. A systematic review of insomnia and complementary medicine. Sleep Med Rev. 2011;15(2):99–106.

    Article  PubMed  Google Scholar 

  57. Taavoni S, Ekbatani N, Kashaniyan M, Haghani H. Effect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trial. Menopause. 2011;18(9):951–5.

    Article  PubMed  Google Scholar 

  58. Kohama T, Negami M. Effect of low-dose French maritime pine bark extract on climacteric syndrome in 170 perimenopausal women: a randomized, double-blind, placebo-controlled trial. J Reprod Med. 2013;58(1–2):39–46.

    PubMed  Google Scholar 

  59. Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol. 2007;23(2):117–22.

    Article  PubMed  Google Scholar 

  60. Green SM, Haber E, McCabe RE, Soares CN. Cognitive-behavioral group treatment for menopausal symptoms: a pilot study. Arch Womens Ment Health. 2013;16(4):325–32.

    Article  PubMed  Google Scholar 

  61. Alder J, Eymann Besken K, Armbruster U, Decio R, Gairing A, Kang A, et al. Cognitive-behavioural group intervention for climacteric syndrome. Psychother Psychosom. 2006;75(5):298–303.

    Article  PubMed  Google Scholar 

  62. Hunter MS, Liao KL. Determinants of treatment choice for menopausal hot flushes: hormonal versus psychological versus no treatment. J Psychosom Obstet Gynaecol. 1995;16(2):101–8.

    Article  CAS  PubMed  Google Scholar 

  63. Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep. 2006;29(11):1415–9.

    PubMed  Google Scholar 

  64. Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry. 2002;159(1):5–11.

    Article  PubMed  Google Scholar 

  65. Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009;301(19):2005–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Becker PM. Hypnosis in the management of sleep disorders. Sleep Med Clin. 2015;10(1):85–92.

    Article  PubMed  Google Scholar 

  67. Elkins GR, Fisher WI, Johnson AK, Carpenter JS, Keith TZ. Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial. Menopause. 2013;20(3):291–8.

    PubMed  Google Scholar 

  68. Afonso RF, Hachul H, Kozasa EH, Oliveira DS, Goto V, Rodrigues D, et al. Yoga decreases insomnia in postmenopausal women: a randomized clinical trial. Menopause. 2012;19(2):186–93.

    Article  PubMed  Google Scholar 

  69. Weinrich SP, Haddock S, Robinson K. Therapeutic massage in older persons: research issues. Br J Nurs. 1999;8(3):159–64.

    Article  CAS  PubMed  Google Scholar 

  70. Oliveira D, Hachul H, Tufik S, Bittencourt L. Effect of massage in postmenopausal women with insomnia: a pilot study. Clinics (Sao Paulo). 2011;66(2):343–6.

    Article  Google Scholar 

  71. Oliveira DS, Hachul H, Goto V, Tufik S, Bittencourt LR. Effect of therapeutic massage on insomnia and climacteric symptoms in postmenopausal women. Climacteric. 2012;15(1):21–9.

    Article  CAS  PubMed  Google Scholar 

  72. Bezerra AG, Pires GN, Andersen ML, Tufik S, Hachul H. Acupuncture to treat sleep disorders in postmenopausal women: a systematic review. Evid Based Complement Alternat Med. 2015;2015:563236.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The valuable assistance of Gabriel Pires and Lais Berro is appreciated.

Author information

Authors and Affiliations

  1. Departments of Gynecology and Psychobiology, Head of the Women’s Sleep Division, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, SP, 04021-002, Brazil

    Helena Hachul M.D., Ph.D.

  2. Department of Psychobiology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, SP, 04021-002, Brazil

    Andréia Gomes Bezerra M.Sc. & Monica Levy Andersen Ph.D.

Authors
  1. Helena Hachul M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andréia Gomes Bezerra M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monica Levy Andersen Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helena Hachul M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Sleep Disorders Center, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Hrayr P. Attarian

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Hachul, H., Bezerra, A.G., Andersen, M.L. (2017). Insomnia and Menopause. In: Attarian, H. (eds) Clinical Handbook of Insomnia. Current Clinical Neurology. Springer, Cham. https://doi.org/10.1007/978-3-319-41400-3_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-41400-3_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-41398-3

  • Online ISBN: 978-3-319-41400-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation