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Objective and Subjective Sleep Quality in Premenopausal, Perimenopausal, and Postmenopausal Women in the Wisconsin Sleep Cohort Study
Abstract
STUDY OBJECTIVE: Assess objectively measured sleep quality in premenopausal, perimenopausal, and postmenopausal women. DESIGN: Observational epidemiology study. SETTING: Community-based. PARTICIPANTS: Probability sample of 589 premenopausal, perimenopausal, and postmenopausal women recruited from state employee records. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Menopausal status was determined by menstrual history, surgical history, and use of hormone replacement therapy. Sleep quality was objectively measured by full in-laboratory polysomnography and by self-reported sleep problems. Linear and logistic regression were used to estimate associations adjusted for potential confounding factors. OBJECTIVE: Sleep quality was not worse in perimenopausal or postmenopausal women, compared with premenopausal women. To the contrary, postmenopausal woman had more deep sleep (16% vs 13% stages 3/4, P < 0.001) and significantly longer total sleep time (388 minutes vs 374 minutes, P = 0.05). Menopausal status was moderately related to self-reported dissatisfaction with sleep but was not consistently associated with symptoms of insomnia or sleepiness. CONCLUSIONS: Menopause is not associated with diminished sleep quality measured by polysomnography. Although perimenopausal and postmenopausal women, relative to premenopausal women, were less satisfied with their sleep, menopause was not a strong predictor of specific sleep-disorder symptoms. Symptoms and signs of sleep abnormalities in midlife women should not be attributed primarily to menopause before ruling out underlying sleep disorders.
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“The Wisconsin Sleep Cohort study found that peri-menopausal women and postmenopausal women were twice as likely to be dissatisfied with their sleep as pre-menopausal women [96].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [96]
In the citing paper
“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 [96]
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ResultBIXLER, E. O., PAPALIAGA, M. N., VGONTZAS, A. N., LIN, H., PEJOVIC, S., KARATARAKI, M., VELA‐BUENO, A., & CHROUSOS, G. P. (2009) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2008.00713.x · Cited by 195
“…findings are consistent with the complaint of poor sleep in some postmenopausal women (Kravitz et al., 2003; Kuh et al.,1997; Matthews et al., 1990; Young et al., 2003), as well as the symptomatic relief reported by those on HT (Hays et al., 2003; Scharf et al., 1997; Schiff et al., 1979; Thomson…”
BackgroundResultInfluentialOkun, M. L., Kravitz, H. M., Sowers, M. F., Moul, D. E., Buysse, D. J., & Hall, M. H. (2009) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27391 · Cited by 183
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Menopause Related Sleep Disorders
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“Further studies with a large sample of women also observed that menopause increased the likelihood of sleep-disordered breathing (Young et al., 2003) and that HT reduced sleepdisordered breathing (Shahar et al., 2003).”
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Efficacy of yoga for vasomotor symptoms
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Onset of the Menopause Transition
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Objective hot flashes are negatively related to verbal memory performance in midlife women
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“Neither hot flashes nor menopausal stage was associated with differences in objective sleep parameters in a large polysomnography study.(39) A recent study revealed that hot flashYinduced sleep disturbance occurs in the first half of the evening and that rapid eye movement sleep during the second half of the evening s…”
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
Modeling women's health during the menopausal transition
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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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Sex differences in age-related changes in the sleep-wake cycle
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Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors
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“For example, research suggests that prevalence of sleep apnea, which may promote insomnia, is higher among postmenopausal women [36, 37].”
BackgroundHall, M. H., Okun, M. L., Sowers, M., Matthews, K. A., Kravitz, H. M., Hardin, K., Buysse, D. J., Bromberger, J. T., Owens, J. F., Karpov, I., et al. (2012) · SLEEP · doi:10.5665/sleep.1874 · Cited by 123
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“risk, also has been related to increased incidence of insomnia and other sleep disorders; however, discrepant results exist in the literature [39,40].”
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Berger, A. M., Kuhn, B. R., Farr, L., Essen, S. G. V., Chamberlain, J., Lynch, J. C., & Agrawal, S. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2008.20.8306 · Cited by 118
Sleep regulation and sex hormones exposure in men and women across adulthood
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“For example, Young et al. (2003) did not find HT use to be hormones exposure in men and women across adulthood.”
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“Also, peri- and post-menopausal women report less satisfaction with their sleep, yet have better PSG sleep quality indices than premenopausal women (Young et al., 2003).”
BackgroundGreendale, G. A., Derby, C. A., & Maki, P. M. (2011) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2011.05.007 · Cited by 122
Effects of menopause on sleep quality and sleep disorders: Canadian Longitudinal Study on Aging
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Temporal Relationships between Physical Activity and Sleep in Older Women
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Symptoms reported by women in midlife
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“A previous study measuring sleep quality by polysomnography did not find sleep quality to be worse in perimenopausal or postmenopausal women, although menopause status was related to self-reported dissatisfaction with sleep.(15) This implies that although we found the risk for difficulty sleeping to increase with the…”
MethodInsomnia in women approaching menopause: Beyond perception
Baker, F. C., Willoughby, A. R., Sassoon, S. A., Colrain, I. M., & de Zambotti, M. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.06.005 · Cited by 117
“…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 (Young et al., 2003).”
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“57,58 In turn, sleep disturbances in this population may exacerbate vasomotor symptoms, cognitive symptoms, and depressed mood.”
Frequency 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
“38 Married or living as married 140 (65) 35 (69) 36 (63) 36 (67) 33 (60) Divorced or separated 32 (15) 10 (20) 5 (9) 10 (19) 7 (13) Single 32 (15) 5 (10) 11 (19) 6 (11) 10 (18) In a significant relationship 11 (5) 4 (7) 2 (4) 5 (9) Widowed 2 (1) 1 (2) 1 (2) Education, n (%) 0.”
Prairie, B. A., Wisniewski, S. R., Luther, J. F., Hess, R., Thurston, R. C., Wisner, K. L., & Bromberger, J. T. (2015) · Journal of Women s Health · doi:10.1089/jwh.2014.4798 · Cited by 105
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“The process of menopause can be separated into three general phases: premenopause, in which menstruation has occurred within the past 3 months; perimenopause, in which menstruation was absent (amenorrhea) for at least 3 months but there has been less than a year of irregular menstrual cycles; postmenopause, in which a…”
BackgroundInfluentialPrevalence of insomnia and its relationship to menopausal status in middle‐aged Korean women
Shin, C., Lee, S., Lee, T., Shin, K., Yi, H., Kimm, K., & Cho, N.-H. (2005) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2005.01391.x · Cited by 98
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Freeman, E. W., Sammel, M. D., Gross, S. A., & Pien, G. W. (2014) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000000392 · Cited by 103
Lee, J., Han, Y., Cho, H. H., & Kim, J.-H. (2019) · Journal of Menopausal Medicine · doi:10.6118/jmm.19192 · Cited by 97
Sleep disturbance associated with the menopause
Maki, P. M., Panay, N., & Simon, J. A. (2024) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002386 · Cited by 116
Xu, M., Bélanger, L., Ivers, H., Guay, B., Zhang, J., & Morin, C. M. (2010) · Sleep Medicine · doi:10.1016/j.sleep.2010.09.003 · Cited by 95
“examined the sleep of 589 premenopausal, perimenopausal, and postmenopausal women and reported that menopause was not associated with decreased sleep quality [12].”
BackgroundResultSLEEP AND METABOLIC CONTROL: WAKING TO A PROBLEM?
Trenell, M. I., Marshall, N. S., & Rogers, N. L. (2006) · Clinical and Experimental Pharmacology and Physiology · doi:10.1111/j.1440-1681.2007.04541.x · Cited by 94
Does the reproductive cycle influence sleep patterns in women with sleep complaints?
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Guidozzi, F. (2012) · Climacteric · doi:10.3109/13697137.2012.753873 · Cited by 92
Ensrud, K. E., Joffe, H., Guthrie, K. A., Larson, J. C., Reed, S. D., Newton, K. M., Sternfeld, B., LaCroix, A. Z., Landis, C. A., Woods, N. F., et al. (2012) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3182476099 · Cited by 89
“These findings are consistent with those reported in a similar randomized trial study population(5) and are in agreement with population-based studies in women not selected based on hot flashes, which have reported a strong association between the presence of hot flashes or greater hot flash frequency and self-reporte…”
Subjective Sleep Quality Deteriorates Before Development of Painful Temporomandibular Disorder
Sanders, A. E., Akinkugbe, A. A., Bair, E., Fillingim, R. B., Greenspan, J. D., Ohrbach, R. K., Dubner, R. A., Maixner, W. D., & Slade, G. D. (2016) · Journal of Pain · doi:10.1016/j.jpain.2016.02.004 · Cited by 100
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“(Lee & Gay, 2004) Insomnia and other sleep disturbances are also quite common among women transitioning from the premenopausal to perimenopausal stage (Joffe et al., 2003), although such decrease in sleep quality is not always captured by objective measures (Young et al., 2003).”
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
“Several studies that do address the impact of VMS on sleep have reported that women with VMS have reduced sleep efficiency,(23,24) or more awakenings and time-awake after sleep onset, whereas still others have found that objectively measured sleep did not differ between those with and without VMS.(11,21)”
BackgroundResultChen, P.-H., Kuo, H.-Y., & Chueh, K. (2010) · Journal of Nursing Research · doi:10.1097/jnr.0b013e3181fbe3fd · Cited by 89
Non-Pharmacological Treatment of Insomnia
Siebern, A. T., Suh, S., & Nowakowski, S. (2012) · Neurotherapeutics · doi:10.1007/s13311-012-0142-9 · Cited by 88
Kline, C. E., Sui, X., Hall, M. H., Youngstedt, S. D., Blair, S. N., Earnest, C. P., & Church, T. S. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-001044 · Cited by 87
Sleep in post-menopausal women: Differences between early and late post-menopause
Hachul, H., Bittencourt, L., Soares, J. M., Tufik, S., & Baracat, E. C. (2009) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2009.03.019 · Cited by 87
Kline, C. E., Irish, L. A., Krafty, R. T., Sternfeld, B., Kravitz, H. M., Buysse, D. J., Bromberger, J. T., Dugan, S. A., & Hall, M. H. (2013) · SLEEP · doi:10.5665/sleep.2946 · Cited by 85
Subjective sleep disturbance and its correlates in middle-aged Hong Kong Chinese women
Chung, K., & Tang, M. K. (2005) · Maturitas · doi:10.1016/j.maturitas.2005.07.001 · Cited by 84
“A majority of Western tudies have obtained a similar finding [1–5].”
BackgroundResultInfluentialRole of Ovarian Hormones in the Modulation of Sleep in Females Across the Adult Lifespan
Brown, A., & Gervais, N. J. (2020) · Endocrinology · doi:10.1210/endocr/bqaa128 · Cited by 94
Sleep 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
Thurston, R. C., Blumenthal, J. A., Babyak, M. A., & Sherwood, A. (2006) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm1302_8 · Cited by 82
“It is notable, however, that more recent studies using objective sleep measures, including one that was particularly well designed (Young, Rabago, Zgierska, Austin, & Laurel, 2003), have generally shown null relations between objective sleep and reported sleep hot flashes (Polo-Kantola et al., 1999; Young et al., 2003…”
BackgroundResultDaily vasomotor symptoms, sleep problems, and mood
Burleson, M. H., Todd, M. W., & Trevathan, W. R. (2010) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3181b20b2d · Cited by 79
“Later studies found no relationship between hot flashes and polysomnographic indicators of sleep quality.(22,23,30) Another recent study using sternal skin conductance as a marker of hot flash occurrence found that subjective hot flashes were significantly positively related to sleep characteristics, but objective hot…”
BackgroundJoffe, 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 82
Hot flashes and sleep in women
Moe, K. E. (2004) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2004.07.005 · Cited by 78
Lampio, L., Polo‐Kantola, P., Polo, O. J., Kauko, T., Aittokallio, J., & Saaresranta, T. (2014) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000000239 · Cited by 78
“In another US study (Wisconsin Sleep Cohort Study) with 589 participants, postmenopausal women were more dissatisfied with their sleep quality thanwere premenopausal women.(2) Furthermore, according to a study of 2,400 Korean women, perimenopausal and postmenopausal women experienced difficulty initiating sleep, diffi…”
BackgroundJoffe, H., Crawford, S. L., Freeman, M. P., White, D. P., Bianchi, M. T., Kim, S., Economou, N. I., Camuso, J., Hall, J. E., & Cohen, L. S. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-2348 · Cited by 79
Sleep, rhythms and women's mood. Part II. Menopause
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Sleep During Menopausal Transition: A 6-Year Follow-Up
Lampio, L., Polo‐Kantola, P., Himanen, S., Kurki, S. H., Huupponen, E., Engblom, J., Heinonen, O. J., Polo, O. J., & Saaresranta, T. (2017) · SLEEP · doi:10.1093/sleep/zsx090 · Cited by 80
“X, 2017 Sleep During Menopausal Transition—Lampio et al. after adjusting with age, BMI, and hot flashes and in premenopausal noninsomniacs with higher proportion of WASO and N1 sleep.13 We essentially confirmed the results of Young and coworkers, as well as of Sowers and colleagues, showing the association between men…”
InfluentialStress hormones, sleep deprivation and cognition in older adults
Maggio, M. G., Colizzi, E., Fisichella, A., Valenti, G., Ceresini, G., Dall’Aglio, E., Ruffini, L., Lauretani, F., Parrino, L., & Ceda, G. P. (2013) · Maturitas · doi:10.1016/j.maturitas.2013.06.006 · Cited by 79
“he peri and postmenopausal years [133].”
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The relationship of self-reported sleep disturbance, mood, and menopause in a community study
Cheng, M., Hsu, C., Wang, S., et al. (2008) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e318160dafa · Cited by 72
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
Arakane, M., Castillo, C., Basurto, M. R., Peñafiel, R., Pérez-López, F. R., & Chedraui, P. A. (2011) · Maturitas · doi:10.1016/j.maturitas.2011.02.015 · Cited by 80
Sleep Characteristics and Carotid Atherosclerosis Among Midlife Women
Thurston, R. C., Chang, Y., von Känel, R., Barinas‐Mitchell, E., Jennings, J. R., Hall, M. H., Santoro, N. F., Buysse, D. J., & Matthews, K. A. (2017) · SLEEP · doi:10.1093/sleep/zsw052 · Cited by 72
Kravitz, H. M., Janssen, İ., Bromberger, J. T., Matthews, K. A., Hall, M. H., Ruppert, K. M., & Joffe, H. (2017) · Current Sleep Medicine Reports · doi:10.1007/s40675-017-0084-1 · Cited by 80
Isoflavones decrease insomnia in postmenopause
Hachul, H., Brandão, L. C., D’Almeida, V., Bittencourt, L., Baracat, E. C., & Tufik, S. (2010) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3181ecf9b9 · Cited by 71
“However, some studies have reported no difference in sleep parameters between premenopause and postmenopause.(7)”
BackgroundEshete, A. (2015) · Epidemiology Open Access · doi:10.4172/2167-0277.1000212 · Cited by 71
“Post menopausal women have been found to report subjective poor quality sleep even when the polysomnography examination shows higher amounts of deep sleep and longer sleep times as compared to premanopausal women [18].”
BackgroundInsomnia in Japanese peri- and postmenopausal women
Terauchi, M., Obayashi, S., Akiyoshi, M., Kato, K., Matsushima, E., & Kubota, T. (2009) · Climacteric · doi:10.3109/13697130903353478 · Cited by 71
Kravitz, H. M., Avery, E., Sowers, M. R., Bromberger, J. T., Owens, J. F., Matthews, K. A., Hall, M. H., Zheng, H. T., Gold, E. B., & Buysse, D. J. (2011) · SLEEP · doi:10.5665/sleep.1244 · Cited by 71
Sleep in women across the life cycle from adulthood through menopause
Moline, M. L., Broch, L., & Zak, R. (2004) · Medical Clinics of North America · doi:10.1016/j.mcna.2004.01.009 · Cited by 66
Sleep quality and the menstrual cycle
Romans, S. E., Kreindler, D., Einstein, G., Laredo, S., Petrovic, M. J., & Stanley, J. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2014.12.001 · Cited by 63
“The discrepancy between subjective and objective sleep information has long been reported and reasons for it considered [8–11].”
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
Yetton, B. D., McDevitt, E. A., Cellini, N., Shelton, C. R., & Mednick, S. C. (2018) · PLoS ONE · doi:10.1371/journal.pone.0194604 · Cited by 66
Madsen, M. T., Hansen, M. V., Andersen, L. T., Hageman, I., Rasmussen, L. S., Bokmand, S., Rosenberg, J., & Gögenür, I. (2016) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.5490 · Cited by 62
“38 Sleep efficiency ranged from 91% to 97% and was never under 85%, which is an established value for pathological sleep.”
Hachul, 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
Hormone therapy and sleep quality in women around menopause
Sarti, C. D., Chiàntera, A., Graziottin, A., Ognisanti, F., Sidoli, C., Mincigrucci, M., & Parazzini, F. (2005) · Menopause The Journal of The North American Menopause Society · doi:10.1097/01.gme.0000172270.70690.5e · Cited by 61
Metadata
- Authors
- Young, T., Rabago, D., Zgierska, A., Austin, D., & Finn, L.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- Young, Terry
- Venue
- SLEEP
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-09-01
- Volume
- 26
- Issue
- 6
- Pages
- 667-672
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W172588831
- Cited by
- 371
- References
- 0
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 7 · 2023: 18 · 2022: 8 · 2021: 16 · 2020: 11 · 2019: 14 · 2018: 12 · 2017: 15 · 2016: 19 · 2015: 18 · 2014: 22 · 2013: 24 · 2012: 15
- FWCI
- 21.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (AG1412)
- National Heart, Lung, and Blood Institute (R01HL062252, HL62252)
- National Center for Research Resources (RR03186)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- sleep quality, menopause, perimenopause, postmenopausal women, premenopausal women, slow-wave sleep, total sleep time, sleep dissatisfaction, insomnia, daytime sleepiness, sleep disorders, Wisconsin Sleep Cohort Study
- MeSH terms
- Adult, Climacteric, Female, Humans, Sleep Initiation and Maintenance Disorders, Middle Aged, Population Surveillance, Probability, Sleep Apnea Syndromes, Sleep Stages, Vasomotor System, Cohort Studies, Body Mass Index, Polysomnography, Premenopause, Postmenopause
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