Insomnia and menopause: a narrative review on mechanisms and treatments

Abstract

The menopausal transition is associated with an increased frequency of sleep disturbances. Insomnia represents one of the most reported symptoms by menopausal women. According to its pathogenetic model (3-P Model), different predisposing factors (i.e. a persistent condition of past insomnia and aging per se) increase the risk of insomnia during menopause. Moreover, multiple precipitating and perpetuating factors should favor its occurrence across menopause, including hormonal changes, menopausal transition stage symptoms (i.e. hot flashes, night sweats), mood disorders, poor health and pain, other sleep disorders and circadian modifications. Thus, insomnia management implies a careful evaluation of the psychological and somatic symptoms of the individual menopausal woman by a multidisciplinary team. Therapeutic strategies encompass different drugs but also behavioral interventions. Indeed, cognitive behavioral therapy represents the first-line treatment of insomnia in the general population, regardless of the presence of mood disorders and/or vasomotor symptoms (VMS). Different antidepressants seem to improve sleep disturbances. However, when VMS are present, menopausal hormone therapy should be considered in the treatment of related insomnia taking into account the risk–benefit profile. Finally, given its good tolerability, safety, and efficacy on multiple sleep and daytime parameters, prolonged-released melatonin should represent a first-line drug in women aged ≥ 55 years.

摘要

绝经过渡与睡眠障碍的频率增加有关。失眠是绝经女性最常见的症状之一。根据其致病模型（3-P模型）, 各种诱因（如：既往失眠持续和衰老）会增加更年期失眠的风险。此外, 多种突发和持久因素会促使更年期发生失眠, 包括激素变化, 绝经过渡期症状（如潮热, 盗汗）, 情绪障碍, 健康状况低下和疼痛, 其他睡眠障碍和昼夜节律改变。因此, 失眠的治疗意味着多学科团队对绝经妇女的心理和躯体症状进行仔细的评估。治疗策略包括各种药物, 也包括行为干预。的确, 无论是否存在情绪障碍和/或血管舒缩症状（VMS）, 认知行为疗法是一般人群失眠的一线治疗。各种抗抑郁药似乎可以改善睡眠障碍。但是, 当存在VMS时, 考虑到相关风险-获益, 应考虑应用绝经激素治疗相关失眠。最后, 由于缓释褪黑素良好的耐受性、安全性和对多种睡眠觉醒参数的疗效, 缓释褪黑素应成为55岁以上女性的一线药物。

Keywords:

• Insomnia
• sleep disorders
• melatonin
• hormone replacement therapy
• cognitive behavioral treatment
• circadian system

Potential conflict of interest

The authors declare no conflict of interest concerning the manuscript contents. Dr Nobili reports personal fees from EISAI, others from FIDIA Pharma, outside the submitted work.

Source of funding

Nil.