Elsevier

Sleep Medicine

Volume 45, May 2018, Pages 98-105
Sleep Medicine

Original Article
Factors associated with poor sleep during menopause: results from the Midlife Women's Health Study

https://doi.org/10.1016/j.sleep.2018.01.012Get rights and content

Highlights

  • Poor sleep in one menopause stage does not predict poor sleep later in menopause.

  • Depression and hot flashes are consistent risk factors for poor sleep in menopause.

  • Insomnia, sleep disturbances, and restless sleep commonly co-occur.

Abstract

Background

Poor sleep is one of the most common problems reported during menopause, and is known to vary throughout the menopause transition. The objective of this study was to describe the dynamics of poor sleep among participants of the Midlife Women's Health Study and to identify risk factors associated with poor sleep during the menopausal transition.

Methods

Annual responses to surveys that included questions about the frequency of sleep disturbances and insomnia were analyzed to determine the likelihood of persistent poor sleep throughout the menopausal transition and the correlation of responses to the different sleep-related questions, including frequency of restless sleep during the first year of the study. Responses to questions about a large number of potential risk factors were used to identify risk factors for poor sleep.

Results

Poor sleep in premenopause was not predictive of poor sleep in perimenopause, and poor sleep in perimenopause was not predictive of poor sleep in postmenopause. Frequencies of each of the measures of poor sleep were highly correlated. For all sleep outcomes, high frequency of depression was related to a high frequency of poor sleep. Vasomotor symptoms were also significantly related with a higher frequency of all poor sleep outcomes. A history of smoking was also associated with higher frequencies of insomnia and sleep disturbances.

Conclusions

The risk factors identified for poor sleep, depression and vasomotor symptoms, were consistently associated with poor sleep throughout the menopausal transition. The likelihood of these risk factors changed from premenopause, through perimenopause, and into postmenopause, however, which could explain changes in sleep difficulties across the menopausal transition. Treatment of these risk factors should be considered when addressing sleep difficulties in menopausal women.

Introduction

One of the most common problems reported during menopause is poor sleep, with one-third to half of all women aged 40–64 reporting sleep problems [1]. Sleep problems seem to peak in late perimenopause and continue into postmenopause [2], with the odds of reporting severe sleep difficulty increased 2–3.5 fold during the menopausal transition [3], [4]. While it is possible that these problems are due to aging [5], [6], their clear variation across menopause stages [7] even when controlling for age [8] indicates that menopause itself plays a role in disrupting women's sleep [9], [10]. This may be due to direct physical impacts (changes in the hypothalamic-pituitary-ovarian hormones) or be related to emotional or behavioral responses to menopause (ie, stress or behavior changes) [9] or both [11]. However, other studies have found that the best predictor of poor sleep during menopause is poor sleep prior to menopause [12].

Although many studies have examined the role of different risk factors for poor sleep, reports have shown variable results due to heterogeneity in study design [9] and the fact that sleep is a complex outcome with many different functions (such as sleep efficiency [8], sleep architecture [5], sleep duration [13], night awakenings [14], circadian robustness [15], and polysomnography [15], [16]), each of which can be affected by different risk factors [17]. Adding to the problems in determining the role of risk factors is the fact that many risk factor effects are likely bidirectional [9]; for instance, poor sleep is known to increase depression, anxiety, and stress, which in turn increase rates of poor sleep [2], [8], [9], [17], [18].

Poor sleep includes insomnia, restless sleep, and sleep disturbances; the frequency of each of these outcomes was self-reported during the Midlife Women's Health Study. The objective of this study was to describe the dynamics of poor sleep among participants of the Midlife Women's Health Study and to identify risk factors associated with poor sleep during the menopausal transition.

Section snippets

Data collection

The Midlife Women's Health Study was a cohort study of hot flashes among women 45–54 years of age conducted starting in 2006 among residents of Baltimore and its surrounding counties. All participants gave written informed consent according to procedures approved by the University of Illinois and Johns Hopkins University Institutional Review Boards. The study design for the parent study is described in detail elsewhere [19]. Briefly, women were recruited by mail, and were included if they were

Data collection

A total of 776 women provided data for this analysis. Of these, 191 provided one year of data, 104 provided two years of data, 91 provided three years of data, 231 provided four years of data, and the remaining 159 provided between five and seven years of data, for a total of 2479 observations. During the study, 436 women transitioned from premenopausal to perimenopausal, and 219 women transitioned from perimenopausal to postmenopausal. In total, 51 women did not respond to the question about

Discussion

This study shows that the risk factors for poor sleep are consistent and stable throughout the menopausal transition. However, as the most consistent of these risk factors are often time-varying, the experience of poor sleep does not appear to be consistent as women transition from premenopause, through perimenopause, and into postmenopause. The one exception is women with frequent insomnia (more than five times a week) during perimenopause, who were more likely to experience higher levels of

Funding

This work was supported by the National Institutes of Health (grant number R01 ES 026956, 2017) and the Carle Illinois Collaborative Research Seed Program (2017).

Acknowledgements

We acknowledge Lisa Gallicchio, Susan Miller, Judith Keifer, Teresa Greene and Howard Zacur for their help with recruitment on this study.

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