Original ArticleFactors associated with poor sleep during menopause: results from the Midlife Women's Health Study
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.
References (34)
Sleep disturbances at the menopause
Maturitas
(2015)- et al.
The effect of menopause on objective sleep parameters: data from an epidemiologic study in São Paulo, Brazil
Maturitas
(2015) - et al.
Sleep disturbance and correlates in menopausal women in Shanghai
J Psychosom Res
(2014) - et al.
Acute stress alters autonomic modulation during sleep in women approaching menopause
Psychoneuroendocrinology
(2016) - et al.
Endogenous hormones, participant characteristics, and symptoms among midlife women
Maturitas
(2008) - et al.
Body mass, estrogen levels, and hot flashes in midlife women
Am J Obstet Gynecol
(2005) - et al.
Does quitting smoking decrease the risk of midlife hot flashes? A longitudinal analysis
Maturitas
(2015) - et al.
Sex differences in anxiety and depression clinical perspectives
Front Neuroendocrinol
(2014) - et al.
The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research
Psychiatry Res
(1989) Menopause and sleep
Menopause
(2014)
Self-reported sleep difficulty during the menopausal transition: results from a prospective cohort study
Menopause
Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women
Sleep
Sleep during menopausal transition: a 6-year follow-up
Sleep
Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition
Menopause
Relationship of sleep alterations with perimenopausal and postmenopausal symptoms
Menopause
Sleep and menopause: a narrative review
Menopause
Examining the relationship between subjective sleep disturbance and menopause
Menopause
Cited by (44)
Factors associated with poor sleep quality in midlife Singaporean women: The Integrated Women's Health program (IWHP)
2023, Sleep Medicine: XCitation Excerpt :Anxiety and depression have also been linked to poor sleep quality [7,8,11–13,15–17]. Self-reported depression was associated with poor sleep outcomes (insomnia, sleep disturbances, restless sleep) among participants from the Seattle Midlife Women’s Health Study [11]. Most sleep studies among midlife women to date have been conducted in Caucasian populations [7,8,10–13,17], while studies in Asian women have been small and non-representative [14,15], not specific to midlife [4,18], or were conducted in ethnically homogeneous Asian populations [16,19].
Environmental exposure to per- and polyfluoroalkyl substances and sleep disturbance in pregnant women: A prospective cohort study
2022, Science of the Total Environment