Comparison of subjective and objective sleep quality in menopausal and non-menopausal women with insomnia

Insomnia affects midlife women as they approach and experience menopause at a rate higher than most other stages of life. Insomnia is considered one of the climacteric symptoms of menopause, which can be controlled with hormone replacement therapy (HRT). This study examined the relationship between menopause and sleep in women with insomnia and compared the sleep quality of menopausal women with and without HRT.

A total of 74 women (age range=40-59 years old) with insomnia who were either pre or peri/post menopause were evaluated at Laval University's Sleep Disorders Center as part of ongoing clinical trials of insomnia therapies. All participants completed daily sleep diaries for a 2-week period and a series of psychological and insomnia questionnaires, followed by three consecutive nights of polysomnographic evaluation (PSG). A detailed medical history interview was taken by the study physician.

PSG measures showed that menopausal women had significantly longer total wake time (TWT, 84.2 vs. 63.2 min, Cohen's d=0.504) and lower sleep efficiency (SE, 81.8% vs. 86.0%, d=0.487) than the non-menopausal women. Women using HRT did not show significantly better sleep compared to those who did not use HRT. No significant difference was observed between menopausal groups on subjectively assessed sleep parameters.

Menopause may contribute to specific aspects of sleep disturbances in midlife women with insomnia. Use of HRT for menopausal symptoms does not seem to attenuate such disturbances, although further investigation using hormonal level dosing and a larger sample size is warranted.