Treatment of chronic insomnia disorder in menopause

Attarian, Hrayr; Hachul, Helena; Guttuso, Thomas; Phillips, Barbara

doi:10.1097/gme.0000000000000348

Cited by 68 publications

(52 citation statements)

References 96 publications

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“…A recent review of the treatment of insomnia in women with menopausal symptoms by Attarian et al gave gabapentin a level B rating, owing to its favorable safety profile, especially if vasomotor symptoms play a large role in contributing to the sleep disturbances. 40 They also recommended head-to-head evaluations among promising treatments. This is the first study to demonstrate that acupuncture is as good as, if not better in some respects than, gabapentin for improving sleep parameters in women with breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial

Garland

Xie²,

et al. 2017

Menopause

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Objective Sleep disturbance is a major consequence of hot flashes among breast cancer survivors. This study evaluated the effects of electro-acupuncture vs. gabapentin for sleep disturbances among breast cancer survivors experiencing daily hot flashes. Methods We analyzed data from a randomized controlled trial involving 58 breast cancer survivors experiencing bothersome hot flashes at least two times per day. Participants were randomly assigned to receive eight weeks of electro-acupuncture or daily gabapentin (total dose of 900 mg per day). The primary outcome was change in the total Pittsburgh Sleep Quality Index (PSQI) score between groups at Week 8. Secondary outcomes include specific PSQI domains. Results By the end of treatment at Week 8, the mean reduction in PSQI total score was significantly greater in the electro-acupuncture group as compared to the gabapentin group (−2.6 vs. −0.8, p=0.044). The electro-acupuncture also had improved sleep latency (−0.5 vs. 0.1, p=0.041) and sleep efficiency (−0.6 vs. 0.0, p=0.05) compared to the gabapentin group. By Week 8, the electro-acupuncture group improved sleep duration, sleep disturbance, sleep latency, daytime dysfunction, sleep efficiency, and sleep quality (p<0.05 for all) compared to baseline, whereas the gabapentin group improved in duration and sleep quality only (p<0.05). Conclusions Among women experiencing hot flashes, the effects of electro-acupuncture are comparable to gabapentin for improving sleep quality, specifically in the areas of sleep latency and efficiency. Larger randomized controlled trials with longer follow-ups are needed to confirm this preliminary finding. Clinical Trial Registration NCT01013337

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial

Garland

Xie²,

et al. 2017

Menopause

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“…By improving VMS, menopausal hormone therapy (MHT) improves sleep quality by decreasing the frequency of nighttime wakening, as shown in a study of women with severe hot flushes with objectively measured skin temperature and resistance and waking episodes [6]. A systematic review of MHT for the treatment of chronic insomnia during the menopause was published by Attarian et al in 2015 [7]. They identified and reviewed 23 articles: 14 showed significant and continuous improvement in subjective sleep and VMS with low doses of estrogen, whereas the other 9 found no significant change in sleep parameters.…”

Section: Sleep Disorders Vasomotor Symptoms Menopausal Hormone Thermentioning

confidence: 99%

“…Amongst all the non-pharmacological approaches, cognitive behavioral therapy (CBT) is the first-line treatment for chronic insomnia in adults of any age, as detailed below. Other interventions include highintensity exercise, hypnosis, yoga, and massage therapy [7]. Studies Table 1 Randomized controlled trials from 2000 to 2018 addressing the treatment of postmenopausal sleep disorders.…”

Section: Sleep Disorders Vasomotor Symptoms Menopausal Hormone Thermentioning

confidence: 99%

Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders

et al. 2019

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Insomnia, vasomotor symptoms (VMS) and depression often co-occur after the menopause, with consequent health problems and reductions in quality of life. The aim of this position statement is to provide evidence-based advice on the management of postmenopausal sleep disorders derived from a systematic review of the literature. The latter yielded results on VMS, insomnia, circadian rhythm disorders, obstructive sleep apnea (OSA) and restless leg syndrome (RLS). Overall, the studies show that menopausal hormone therapy (MHT) improves VMS, insomnia, and mood. Several antidepressants can improve insomnia, either on their own or in association with MHT; these include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and mirtazapine. Long-term benefits for postmenopausal insomnia may also be achieved with non-drug strategies such as cognitive behavioral therapy (CBT) and aerobic exercise. Continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) both reduce blood pressure and cortisol levels in postmenopausal women suffering from OSA. However, the data regarding MHT on postmenopausal restless legs syndrome are conflicting.

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“…Endogenous secretion of melatonin decreases with aging across genders [52], and, among women, menopause is associated with a significant reduction of melatonin levels [53,54]. Exogenous melatonin reportedly induces drowsiness and sleep, and may ameliorate sleep disturbances, including the nocturnal awakenings associated with old age [55–58]. …”

Section: Treatment Of Menopausal Insomnia Using Melatoninmentioning

confidence: 99%

Contraceptive Method Mix Utilization and its Associated Factors among Married Women in Gedeo Zone, Southern Nations, Nationality and People Region-Ethiopia: A Community based Cross Sectional Study

Jehan

Masters-Isarilov

Salifu

et al. 2015

Epidemiology (Sunnyvale)

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One of the core symptoms of the menopausal transition is sleep disturbance. Peri-menopausal women often complain of difficulties initiating and/or maintaining sleep with frequent nocturnal and early morning awakenings. Factors that may play a role in this type of insomnia include vasomotor symptoms, changing reproductive hormone levels, circadian rhythm abnormalities, mood disorders, coexistent medical conditions, and lifestyle. Other common sleep problems in this age group, such as obstructive sleep apnea and restless leg syndrome, can also worsen the sleep quality. Exogenous melatonin use reportedly induces drowsiness and sleep and may ameliorate sleep disturbances, including the nocturnal awakenings associated with old age and the menopausal transition. Recently, more potent melatonin analogs (selective melatonin-1 (MT1) and melatonin-2 (MT2) receptor agonists) with prolonged effects and slow-release melatonin preparations have been developed. They were found effective in increasing total sleep time and sleep efficiency as well as in reducing sleep latency in insomnia patients. The purpose of this review is to give an overview on the changes in hormonal status to sleep problems among menopausal and postmenopausal women.

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Treatment of chronic insomnia disorder in menopause

Abstract: Although a variety of interventions are shown to be helpful in improving sleep in menopause, there is a need for well-designed head-to-head trials with uniform outcome measures.

Cited by 68 publications

References 96 publications

Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial

Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial

Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders

Contraceptive Method Mix Utilization and its Associated Factors among Married Women in Gedeo Zone, Southern Nations, Nationality and People Region-Ethiopia: A Community based Cross Sectional Study

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