Improving daytime functioning, work performance, and quality of life in postmenopausal women with insomnia: comparing cognitive behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education
Open accessAbstract
Study objectives Insomnia is a chief complaint among postmenopausal women, and insomnia impairs daytime functioning and reduces quality of life. Recent evidence supports the efficacy of cognitive behavioral therapy for insomnia (CBTI) for menopausal insomnia, but it remains unclear whether treating insomnia improves daytime function in this population. This study evaluated whether CBTI improves daytime fatigue, energy, self-reported sleepiness, work productivity, and quality of life in postmenopausal women with insomnia, and whether sleep restriction therapy (SRT)-a single component of CBTI-is equally efficacious.Methods Single-site, randomized control trial. One hundred fifty postmenopausal women (56.44 ± 5.64 years) with perimenopausal or postmenopausal onset or exacerbation of chronic insomnia were randomized to 3 treatment conditions: sleep hygiene education control (SHE), SRT, and CBTI. Blinded assessments were performed at pretreatment, posttreatment, and 6-month follow-up.Results CBTI and SRT produced moderate-to-large improvements in fatigue, energy, sleepiness, and work function at posttreatment and 6 months later. The CBTI group reported better quality of life as indicated by substantial improvements in emotional wellbeing and resiliency to physical and emotional problems, whereas the SRT and SHE groups only showed improvements in resiliency to physical problems. Pain complaints decreased as sleep improved but were not associated with specific treatment conditions. Similarly, insomnia remitters reported fewer daytime and nighttime hot flashes, although reductions were not associated with any specific treatment.Conclusions CBTI and SRT are efficacious options for postmenopausal women with chronic insomnia. Both interventions improve daytime function, quality of life, and work performance, although CBTI produces superior results including the added benefit of improved emotional health.Clinical trial registration Registry: ClinicalTrials.gov; Title: Behavioral Treatment of Menopausal Insomnia; Sleep and Daytime Outcomes; Identifier: NCT01933295; URL: https://clinicaltrials.gov/ct2/show/record/NCT01933295.
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Three studies (Ayers et al., 2012; Kalmbach et al., 2019; Mann et al., 2012) found evidence for the effectiveness of CBT on SF-36 outcomes.
“Three studies (Ayers et al., 2012; Kalmbach et al., 2019; Mann et al., 2012) found evidence for the effectiveness of CBT on the outcomes of the 36 Item Short Form Health Survey (SF-36, Ware & Sherbourne, 1992).”
From The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis (2024) · cites this paper as Kalmbach et al., 2019
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- Authors
- Kalmbach, D. A., Cheng, P., Arnedt, J. T., Cuamatzi-Castelan, A., Atkinson, R. L., Fellman-Couture, C., Roehrs, T., & Drake, C. L.
- Affiliations
- Henry Ford Health (US)
- University of Michigan (US)
- Corresponding author
- Drake, Christopher L.
- ORCID
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2019-07-15
- Volume
- 15
- Issue
- 7
- Pages
- 999-1010
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC6622507
- OpenAlex
- W2959723247
- Cited by
- 58
- References
- 51
- Citations by year
- 2026: 11 · 2025: 5 · 2024: 7 · 2023: 10 · 2022: 11 · 2021: 7 · 2020: 7
- FWCI
- 7.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Nursing Research (R01NR013959)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- postmenopausal women, cognitive behavioral therapy for insomnia, sleep restriction therapy, sleep hygiene education, daytime fatigue, labor productivity, quality of life, emotional well-being, hot flashes, pain, insomnia remission
- MeSH terms
- Work Performance, Sleep Hygiene, Behavior Therapy, Female, Humans, Sleep Initiation and Maintenance Disorders, Middle Aged, Patient Education as Topic, Quality of Life, Surveys and Questionnaires, Cognitive Behavioral Therapy, Treatment Outcome, Postmenopause
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