Sleep patterns and stability in perimenopausal women
Abstract
Women between the ages of 40 and 59 years were classified as pre-, peri-, and postmenopausal, with and without hot flash symptoms, for comparison of somnographic sleep variables. Few differences in sleep variables were noted between the groups. However, peri- and postmenopausal women experiencing hot flashes (symptomatic) tended to have lower sleep efficiencies than those not experiencing hot flashes. As well, rapid-eye-movement (REM) latency was longer (p less than 0.05) in the symptomatic women (means = 94.2 min) than in the nonsymptomatic women (means = 71.4 min). Although an age difference existed between the menopausal status groups, it was less than a decade and a main group effect for sleep efficiency and REM latency was seen while controlling for age and/or depression.
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Self-reported nocturnal flashes correlate with subjective poor sleep quality, but the association is less clear when objective sleep measures are used.
“Although self-reported nocturnal flashes correlate with subjective poor sleep quality, such association is less clear when objective sleep measures are used [96,105,106].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [105]
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“Again, objective PSG studies do not reflect this worsening of sleep quality and in fact have shown either no difference (Shaver et al., 1988) or, if anything, better sleep after menopause (Sharkey et al., 2003; Young et al., 2003).”
BackgroundSleep problems during the menopausal transition: prevalence, impact, and management challenges
Baker, F. C., de Zambotti, M., Colrain, I. M., & Bei, B. (2018) · Nature and Science of Sleep · doi:10.2147/nss.s125807 · Cited by 305 · see citing works
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Joffe, H., Massler, A., & Sharkey, K. (2010) · Seminars in Reproductive Medicine · doi:10.1055/s-0030-1262900 · Cited by 195 · see citing works
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Eichling, P. S., & Sahni, J. (2005) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26347 · Cited by 180 · see citing works
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BackgroundSymptom experiences of midlife women: observations from the Seattle midlife women's health study
Mitchell, E. S., & Woods, N. F. (1996) · Maturitas · doi:10.1016/0378-5122(96)01047-x · Cited by 153 · see citing works
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Sleep Quality, Estradiol Levels, and Behavioral Factors in Late Reproductive Age Women
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Kravitz, H. M., Ganz, P. A., Bromberger, J. T., Powell, L. H., Sutton‐Tyrrell, K., & Meyer, P. (2003) · Menopause The Journal of The North American Menopause Society · doi:10.1097/00042192-200301000-00005 · Cited by 143 · see citing works
“Vasomotor symptoms may be related to hormonal factors as well as to disturbances in thermoregulation.(6,7,15,16,52) During the perimenopausal years, sleep difficulties increase and tend to be attributed to hot DIFFICULTY SLEEPING AND MENOPAUSAL TRANSITION”
BackgroundPredictors of Sleep Quality in Women in the Menopausal Transition
Pien, G. W., Sammel, M. D., Freeman, E. W., Lin, H., & DeBlasis, T. L. (2008) · SLEEP · doi:10.5665/sleep/31.7.991 · Cited by 135 · see citing works
Sowers, M. F., Zheng, H. T., Kravitz, H. M., Matthews, K. A., Bromberger, J. T., Gold, E. B., Owens, J., Consens, F. B., & Hall, M. H. (2008) · SLEEP · doi:10.5665/sleep/31.10.1339 · Cited by 137 · see citing works
Magnitude of the impact of hot flashes on sleep in perimenopausal women
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“Studies that have investigated the association between subjective hot flashes and objective measures of sleep have, however, produced variable results, with some showing that hot flashes are associated with a poorer sleep (6, 15, 16), and others showing no relationship between hot flashes and objective measures of sle…”
ResultRelationship of Day-to-day Reproductive Hormone Levels to Sleep in Midlife Women
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Self-citationDORSEY, C., LEE, K., & SCHARF, M. (2004) · Clinical Therapeutics · doi:10.1016/j.clinthera.2004.10.003 · Cited by 113 · see citing works
Self-citationLevine, D. W., Dailey, M. E., Rockhill, B., Tipping, D., Naughton, M. J., & Shumaker, S. A. (2005) · Psychosomatic Medicine · doi:10.1097/01.psy.0000151743.58067.f0 · Cited by 112 · see citing works
Ford, K., Sowers, M. R., Crutchfield, M., Wilson, A. L., & Jannausch, M. L. (2005) · Menopause The Journal of The North American Menopause Society · doi:10.1097/01.gme.0000163869.89878.d9 · Cited by 110 · see citing works
“Reproductive status Premenopausal 439 (73) 414 (72) 392 (71) 358 (69) 317 (65) 331 (62) 317 (59) 255 (51) OCP use 97 (16) 92 (16) 82 (15) 73 (14) 60 (12) 70 (13) 69 (13) 66 (13) HT use 38 (7) 38 (7) 43 (8) 50 (10) 74 (15) 77 (15) 93 (17) 106 (22) Postmenopausal 26 (4) 30 (5) 32 (6) 36 (7) 39 (8) 54 (10) 58 (11) 70 (14…”
Scharf, M. B., McDannold, M. D., Stover, R., Zaretsky, N., & Berkowitz, D. V. (1997) · Clinical Therapeutics · doi:10.1016/s0149-2918(97)80118-x · Cited by 110 · see citing works
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“However, polysomnographic (PSG) evidence of poorer sleep during this stage is sparse (Shaver et al., 1988; Young et al., 2003; Kalleinen et al., 2008), with a large epidemiological study showing even better PSG sleep in peri- and postmenopausal women, despite less sleep satisfaction, compared with premenopausal women…”
ResultSleep Loss and Fatigue in Healthcare Professionals
Owens, J. A. (2007) · The Journal of Perinatal & Neonatal Nursing · doi:10.1097/01.jpn.0000270624.64584.9d · Cited by 107 · see citing works
Woods, N. F., Smith-DiJulio, K., Percival, D. B., Tao, E. Y., Taylor, H. J., & Mitchell, E. S. (2007) · Journal of Women s Health · doi:10.1089/jwh.2006.0138 · Cited by 106 · see citing works
“55 It is possible that the aging processes, as well as conditions such as sleep-disordered breathing, are associated with increased arousals that cause perceptions of disrupted sleep.”
Assessment and treatment of hot flushes and menopausal mood disturbance
Joffe, H., Soares, C. N., & Cohen, L. S. (2003) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(03)00045-5 · Cited by 105 · see citing works
“However, unlike depression or other insomnia syndromes, sleep disruption associated with hot flushes is not characterized by difficulty falling asleep at the beginning of the night (sleep-onset latency), difficulty falling back asleep after an awakening, or early morning awakening (see references [8,26,57,60,61]).”
BackgroundFrequency and severity of hot flashes and sleep disturbance in postmenopausal women with hot flashes
Ensrud, K. E., Stone, K. L., Blackwell, T. L., Sawaya, G. F., Tagliaferri, M., Diem, S. J., & Grady, D. (2009) · Menopause · doi:10.1097/gme.0b013e31818c0485 · Cited by 104 · see citing works
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“However, some studies using PSG measures did not observe sleep impairments [12,36], while our study showed significant differences on objective but not on subjective sleep measures.”
ResultInsomnia in women: an overlooked epidemic?
Soares, C. N. (2005) · Archives of Women's Mental Health · doi:10.1007/s00737-005-0100-1 · Cited by 89 · see citing works
“Menopausal women with hot flashes report more frequent awakenings, reduced sleep efficiency, and poor sleep quality, compared with those without hot flashes (Shaver et al., 1988; Woodward & Freedman, 1994).”
BackgroundJoffe, H., Soares, C. N., Thurston, R. C., White, D. P., Cohen, L. S., & Hall, J. E. (2009) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3181957377 · Cited by 87 · see citing works
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Self-citationQuality of life and menopausal transition for middle-aged women on Kinmen island
Fuh, J., Wang, S., Lee, S.-J., Lu, S. ‐., & Juang, K. (2003) · Quality of Life Research · doi:10.1023/a:1022074602928 · Cited by 85 · see citing works
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BackgroundSleep and the menopause – do postmenopausal women experience worse sleep than premenopausal women?
Kalleinen, N., Polo‐Kantola, P., Himanen, S., Salo, P., Joutsen, A. S., Urrila, A. S., & Polo, O. J. (2008) · Menopause international · doi:10.1258/mi.2008.008013 · Cited by 82 · see citing works
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“Shaver et al. 3 reported that 63% of perimeno-pausal and 80% of postmenopausal women experienced hot flushes.”
Joffe, H., Crawford, S. L., Economou, N. I., Kim, S., Regan, S., Hall, J. E., & White, D. P. (2013) · SLEEP · doi:10.5665/sleep.3244 · Cited by 80 · see citing works
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Moe, K. E. (2004) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2004.07.005 · Cited by 78 · see citing works
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Shaver, J., & Zenk, S. N. (2000) · Journal of Womens Health & Gender-Based Medicine · doi:10.1089/152460900318605 · Cited by 63 · see citing works
“17 Among the menopausal groups, there were no clear differences in PSG sleep quality, including PSG sleep fragmentation, arousal, or efficiency.”
Self-citationSleep, rhythms and women's mood. Part II. Menopause
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Evaluation of the Association of Menopausal Status with Delta and Beta EEG Activity during Sleep
Campbell, I. G., Bromberger, J. T., Buysse, D. J., Hall, M. H., Hardin, K. A., Kravitz, H. M., Matthews, K. A., Rasor, M. O., Utts, J. M., & Gold, E. B. (2011) · SLEEP · doi:10.5665/sleep.1398 · Cited by 72 · see citing works
Herzog-Krzywoszańska, R., & Krzywoszański, Ł. (2019) · Frontiers in Neuroscience · doi:10.3389/fnins.2019.00963 · Cited by 66 · see citing works
Sleep in women across the life cycle from adulthood through menopause
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“On polysomnography, some investigators found an association of hot flashes with nocturnal awakenings [97] and decreased sleep efficiency [98] [99], whereas others found no correlation between the presence of hot flashes and polysomnographic measures of poor sleep [100].”
BackgroundAdverse effects of induced hot flashes on objectively recorded and subjectively reported sleep
Joffe, H., White, D. P., Crawford, S. L., McCurnin, K. E., Economou, N. I., Connors, S., & Hall, J. E. (2013) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e31828292d1 · Cited by 63 · see citing works
“The baseline level of sleep efficiency that we recorded and the magnitude of sleep efficiency reduction after the development of hot flashes are similar to those seen in other studies.(11,13,14) Although a 3% median reduction in sleep efficiency among those developing hot flashes is modest, it is notable that pharmaco…”
ResultHachul, H., Frange, C., Bezerra, A. G., Hirotsu, C., Pires, G. N., Andersen, M. L., Bittencourt, L., & Tufik, S. B. (2014) · Maturitas · doi:10.1016/j.maturitas.2014.11.002 · Cited by 61 · see citing works
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Gervais, N. J., Mong, J. A., & Agnès Lacreuse, A. (2017) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2017.08.002 · Cited by 57 · see citing works
“Similarly, other studies either report better sleep patterns in postmenopausal women (e.g. Sharkey et al., 2003), or no disruptions in PSG recordings in peri- and postmenopausal women (Shaver et al., 1988).”
ResultSex differences in sleep health
Meers, J. M., Stout-Aguilar, J., & Nowakowski, S. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815373-4.00003-4 · Cited by 57 · see citing works
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Lindberg, E., Bonsignore, M. R., & Polo‐Kantola, P. (2019) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2019.101225 · Cited by 56 · see citing works
Menopausal symptoms among Thai women in Bangkok
Sukwatana, P., Meekhangvan, J., Tamrongterakul, T., et al. (1991) · Maturitas · doi:10.1016/0378-5122(91)90196-w · Cited by 54 · see citing works
Shaver, J. L. F. (2002) · Nursing Clinics of North America · doi:10.1016/s0029-6465(02)00033-6 · Cited by 54 · see citing works
“Epidemiological studies of symptoms during menopausal transition indicated that 23% to 51% of women between the ages of 40 and 54 (ie, around the time of menopause) reported sleep problems [13–16].”
BackgroundSelf-citationSleep and the reproductive cycle: A review
Mauri, M. (1990) · Health Care For Women International · doi:10.1080/07399339009515911 · Cited by 53 · see citing works
Yurcheshen, M. E., Guttuso, T. J., McDermott, M., Holloway, R. G., & Perlis, M. L. (2009) · Journal of Women s Health · doi:10.1089/jwh.2008.1257 · Cited by 52 · see citing works
“Subjective complaints of insomnia are common in this population, though consensus has not been reached on alterations in polysomnographic characteristics.(4,5,6,23) The study on which this secondary analysis was based demonstrated a significant improvement in daily hot flashes with the use of gabapentin.”
Joffe, H., Partridge, A. H., Giobbie‐Hurder, A., Li, X., Habin, K. R., Goss, P. E., Winer, E. P., & Garber, J. E. (2010) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3181dbee1b · Cited by 52 · see citing works
“It is unknown whether SSRI/SNRI use in women would improve or paradoxically worsen hot flashYassociated sleep disturbance as it can in depressed individuals given that there are different underlying sleep patterns caused by hot flashes and depression.(1,2,46)”
BackgroundEffects of Menopausal Status on Sleep in Midlife Women
Sharkey, K. M., Bearpark, H., Acebo, C., Millman, R. P., Cavallo, A., & Carskadon, M. A. (2003) · Behavioral Sleep Medicine · doi:10.1207/s15402010bsm0102_1 · Cited by 52 · see citing works
“Consistent with previous reports (Shaver et al., 1988, Clark et al., 1995), our data failed to support the hypothesis that menopause per se has a significant impact on laboratory-monitored sleep in women without sleep complaints.”
BackgroundResultEFFECTS OF LIGHT THERAPY ON SLEEP, MOOD, AND TEMPERATURE IN WOMEN WITH NONSEASONAL MAJOR DEPRESSION
McEnany, G. W., & Lee, K. A. (2005) · Issues in Mental Health Nursing · doi:10.1080/01612840591008410 · Cited by 48 · see citing works
“Core temperature mesor (24-hour adjusted mean) increases at ovulation (Lee, 1988), and temperature instability is common during perimenopause (Hollander et al., 2001; Shaver et al., 1988).”
BackgroundSelf-citationSavard, M., Savard, J., Caplette‐Gingras, A., Ivers, H., & Bastien, C. (2013) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3182885e31 · Cited by 45 · see citing works
“6) [30-67] Body mass index, mean (SD) [range], kg/m(2) 25.”
BackgroundInsomnia and sleep apnea in midlife women: prevalence and consequences to health and functioning
Hall, M. H., Kline, C. E., & Nowakowski, S. (2015) · F1000Prime Reports · doi:10.12703/p7-63 · Cited by 50 · see citing works
“When hot flashes occur during the night, they frequently but not invariably awaken women from sleep [18,19].”
BackgroundStress, support, psychological states and sleep
Paulsen, V. M., & Shaver, J. L. F. (1991) · Social Science & Medicine · doi:10.1016/0277-9536(91)90038-e · Cited by 42 · see citing works
Self-citationSecondary insomnia in the primary care setting: review of diagnosis, treatment, and management
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Variations in sleep hygiene practices of women with and without insomnia
Cheek, R. E., Shaver, J. L. F., & Lentz, M. J. (2004) · Research in Nursing & Health · doi:10.1002/nur.20025 · Cited by 43 · see citing works
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Sleep disturbance in mid‐life women
Clark, A. J., Flowers, J., Boots, L. R., & Shettar, S. M. (1995) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.1995.22030562.x · Cited by 38 · see citing works
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Vitex agnus-castus (Chaste-Tree/Berry) in the Treatment of Menopause-Related Complaints
van Die, M. D., Burger, H., Teede, H. J., & Bone, K. M. (2009) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2008.0447 · Cited by 39 · see citing works
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EVALUATION AND TREATMENT OF CHANGES IN MOOD, SLEEP, AND SEXUAL FUNCTIONING ASSOCIATED WITH MENOPAUSE
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- Authors
- Shaver, J., Giblin, E., Lentz, M., & Lee, K.
- Affiliations
- University of Washington (US)
- University of California, San Francisco (US)
- Corresponding author
- Shaver, Joan
- Venue
- SLEEP
- Publisher
- Oxford University Press (OUP)
- Published
- 1988-09
- Volume
- 11
- Issue
- 6
- Pages
- 556-561
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W89794934
- Cited by
- 186
- References
- 0
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 7 · 2018: 3 · 2017: 4 · 2016: 5 · 2015: 6 · 2014: 8 · 2013: 8 · 2012: 6
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- sleep patterns, sleep stability, perimenopause, menopause, hot flashes, sleep efficiency, REM latency, middle-aged women, age differences in sleep
- MeSH terms
- Adult, Arousal, Climacteric, Female, Follicle Stimulating Hormone, Humans, Menopause, Middle Aged, Reaction Time, Sleep Stages, Sleep, REM
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