Structural and functional alterations in postmenopausal women with insomnia: an MRI study of Eight-Section Vajra...

Postmenopausal women exhibit heightened vulnerability to chronic insomnia due to estrogen decline and age-related neural alterations. While non-pharmacological interventions are preferred for long-term management, the neuroplastic mechanisms underlying exercise-based therapies remain poorly characterized.

This study examines the effects of Eight-Section Vajra Exercise (ESVE) on brain structure and function in postmenopausal women with insomnia (PMWI) using multimodal MRI. A 12-week ESVE training program was completed by PMWI patients, followed by clinical assessments (PSQI, ISI, PHQ-9, GAD-7, FSS, MoCA) and neuroimaging (fMRI and structural MRI). Data analysis involved gray matter volume (GMV), ALFF/fALFF, ReHo, degree centrality (DC), and functional connectivity (FC) using advanced MRI processing techniques (CAT12, SPM12, DPABI). Group comparisons and correlations were adjusted for age, education, and intracranial volume.

Among the 24 PMWI patients and 30 healthy controls (HCs), baseline measures showed significantly worse sleep and mood scores in PMWI. Resting-state fMRI revealed reduced ALFF/fALFF in the right precentral gyrus and decreased ReHo in sensorimotor areas. Changes in functional connectivity (FC) were noted, with altered connections between precentral gyrus, temporal and parietal regions. After 12 weeks of ESVE, 78.95% of PMWI patients were medication-free, with post-treatment fMRI showing improved neural activity and connectivity, correlating with clinical improvement. Exercise adherence positively correlated with sleep quality improvement (r = 0.508-0.594, P < 0.05). Responders showed significant improvements in sleep compared to non-responders (P < 0.05).

ESVE alleviates postmenopausal insomnia through PreCG-centered sensorimotor-visual network reorganization, potentially compensating for estrogen-dependent neurocircuitry vulnerabilities. Exercise-induced GMV increases in occipitotemporal regions suggest enhanced sleep-related memory consolidation. Our findings indicate that ESVE is a potential neuromodulatory intervention and identify PreCG-MOG connectivity as a promising biomarker for personalized insomnia management.