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Lankila H, Kuutti MA, Kekäläinen T, Hietavala EM, Laakkonen EK. Associations of menopausal status and eating behaviour with subjective measures of sleep. J Sleep Res 2024:e14155. [PMID: 38327126 DOI: 10.1111/jsr.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/08/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Abstract
Eating and sleeping behaviour are known to interact with each other, yet research is limited in the context of menopausal women. The aim of this study was to examine whether menopausal status is associated with perceived problems in sleeping. Furthermore, we studied different aspects of eating behaviour as potential risk factors for poor sleep in menopausal women. The present study is exploratory in nature, thus the results should be interpreted as hypothesis-generating. We analysed the sleeping and eating behaviour of 1098 women aged 47-55 years and represented different menopausal statuses with regression analyses. Over 20% of them reported fairly poor or poor perceived sleep quality. A higher number of postmenopausal women reported experiencing at least fairly poor sleep quality compared with the other menopausal groups. However, in regression models controlled for several confounding factors menopausal status was not associated with measures of sleep. Women who reported more snacking-type eating behaviour were more likely to report shorter sleep duration, and more daytime tiredness. Externally cued eating was associated with shorter sleep duration and emotional eating was associated with experiencing daytime tiredness. However, after adjusting for multiple testing, it appears that eating behaviour is associated only with daytime tiredness. Menopausal women with sleeping problems may benefit from nutritional interventions targeting eating behaviour.
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Affiliation(s)
- Hannamari Lankila
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Mari A Kuutti
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Tiia Kekäläinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Enni-Maria Hietavala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eija K Laakkonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
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Virtanen I, Polo-Kantola P, Turpeinen U, Hämäläinen E, Kalleinen N. Effect of external sleep disturbance on sleep architecture in perimenopausal and postmenopausal women. Climacteric 2023; 26:103-109. [PMID: 36682380 DOI: 10.1080/13697137.2022.2158727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study aimed to use external sleep disturbance as a model to evaluate sleep architecture in climacteric women before and after menopausal hormone therapy (MHT). METHODS Seventeen perimenopausal and 18 postmenopausal women underwent a polysomnography protocol: an adaptation night, a reference night and a sleep disturbance night with one hand loosely tied to the bed for blood sampling. The sleep architecture of the reference and disturbance nights were compared. The 24-h urinary free cortisol concentration (UFC) was measured. The procedure was repeated after 6 months on MHT or placebo. RESULTS Fifteen perimenopausal and 17 postmenopausal women completed the study. The perimenopausal and postmenopausal groups were combined. During external sleep disturbance, sleep was shorter and more fragmented; with less stage 2, slow-wave and rapid eye movement (REM) sleep and more wake time and awakenings, both at baseline and after the treatment period. Compared to the placebo group, sleep disturbance was minor for women on MHT: sleep was not shortened and the amount of slow-wave sleep did not decrease. Increased 24-h UFC was observed only during MHT. CONCLUSIONS Sleep in climacteric women is easily disturbed, leading to shorter and more fragmented sleep with less deep sleep and REM sleep. Six months of MHT attenuates the observed sleep disturbance.
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Affiliation(s)
- I Virtanen
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland
| | - P Polo-Kantola
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - U Turpeinen
- HUSLAB Laboratory Services, Helsinki University Central Hospital, Helsinki, Finland
| | - E Hämäläinen
- Department of Clinical Chemistry, Helsinki University, Helsinki and University of Eastern Finland, Kuopio, Finland
| | - N Kalleinen
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
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Toffol E, Kalleinen N, Himanen SL, Partonen T, Haukka J, Polo-Kantola P. Nighttime melatonin secretion and sleep architecture: different associations in perimenopausal and postmenopausal women. Sleep Med 2021; 81:52-61. [PMID: 33639482 DOI: 10.1016/j.sleep.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sleep quality typically decreases after menopause, but the underlying mechanisms are poorly understood. Concentrations of melatonin are lower and its secretion profiles different before and after menopause. However, whether and how melatonin and sleep architecture are associated in women of different reproductive states have not been examined to date. METHODS Overnight serum melatonin samples were taken from 17 perimenopausal and 18 postmenopausal healthy women. Sleep quality was measured with all-night polysomnography recordings. RESULTS Melatonin concentrations tended to be the lowest during NREM sleep, and were associated with higher odds of transitions from wake to NREM sleep. The curves of predicted overnight melatonin values from linear mixed models varied according to sleep phases (NREM, REM, Wake) in perimenopausal, but not in postmenopausal women. In perimenopause higher melatonin area under curve (AUC) correlated with higher slow-wave activity (p = 0.043), and higher minimum concentrations with shorter slow-wave sleep (SWS) latency (p = 0.029). In postmenopause higher mean and maximum melatonin concentrations and AUC correlated with lower SWS percentage (p = 0.044, p = 0.029, p = 0.032), and higher mean (p = 0.032), maximum (p = 0.032) and minimum (p = 0.037) concentrations with more awakenings from REM sleep. In the age- and BMI- adjusted regression models, the association between higher maximum (p = 0.046) melatonin concentration and lower SWS percentage remained. CONCLUSIONS The relationship between melatonin and sleep architecture differed in perimenopausal and postmenopausal women. After menopause, high melatonin concentrations were associated with worse sleep. Whether these different patterns are related to aging of the reproductive system, and to decrease in menopausal sleep quality, remains to be elucidated.
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Affiliation(s)
- Elena Toffol
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Nea Kalleinen
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Sleep Research Center, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Sari-Leena Himanen
- Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Clinical Neurophysiology, Tampere University Hospital, Tampere, Finland
| | - Timo Partonen
- Mental Health Unit, Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Päivi Polo-Kantola
- Sleep Research Center, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland; Department of Obstetrics and Gynecology, Turku University Hospital and Turku University, Turku, Finland
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De Franciscis P, Conte A, Schiattarella A, Riemma G, Cobellis L, Colacurci N. Non-hormonal Treatments For Menopausal Symptoms and Sleep Disturbances: A Comparison Between Purified Pollen Extracts and Soy Isoflavones. Curr Pharm Des 2020; 26:4509-4514. [DOI: 10.2174/1381612826666200721002022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022]
Abstract
Background:
Besides hot-flushes, sleep disturbances increase around menopause, impacting on the
quality of life. When hormone replacement therapy is contraindicated, it is necessary to provide alternative treatments.
Objectives:
This study aimed to observe the effects of an herbal remedy from pollen extracts and soy isoflavones
for menopausal complaints, particularly on sleep disorders.
Methods:
A six-month prospective observational study was performed in women in natural menopause suffering
from menopausal symptoms and sleep disturbances. Three groups were compared: 57 women receiving two tablets/
day containing herbal remedy from pollen extracts (group A), 60 women receiving one tablet/day containing
isoflavones 60 mg (group B), 47 women not receiving any treatment (group C). At 3 (T3) and 6 months (T6), the
daily number of hot-flushes, Kupperman index for menopausal symptoms, the Pittsburgh Sleep Quality Index
(PSQI) test were assessed.
Results:
Both groups A and B showed a significant improvement of hot flushes (p<0.001) and Kuppermann Index
(p<0.001) from T0 to T3 and from T0 to T6. No significant differences between treatment groups were found
at T3, while at T6 group A showed greater decrease of daily hot flashes and better improvement of Kupperman
Index as compared to group B (respectively, -48.8% versus -18.4% and -24.4% versus -15.4%; p<0.001). Improvement
of global sleep quality was more evident in the pollen treated group compared to isoflavones group at
both three (-24.7% versus -9.3%, p<0.001) and six (-52.9% vs -4.0%; p<0.001) months, mainly for the scores
related to subjective sleep quality, sleep latency and habitual sleep efficiency.
Conclusions:
Non-hormonal treatments can effectively be used in symptomatic menopausal women: among these,
after six months of treatment, pollen extracts might achieve a better improvement of hot flushes, sleep disturbances
and menopause-related symptoms than soy isoflavones. Herbal remedy from pollen extracts is mainly
effective when the quality of sleep is the most disturbing complaint.
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Affiliation(s)
- Pasquale De Franciscis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anna Conte
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Schiattarella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luigi Cobellis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Nicola Colacurci
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Abstract
The menopausal transition is associated with an increase in insomnia symptoms, especially difficulty staying asleep, which negatively impacts quality of life. Vasomotor symptoms are a key component of sleep disruption. Findings from polysomnographic studies are less consistent in showing disrupted sleep in menopausal transition independent of aging; further prospective studies are needed. Hormone therapy alleviates subjective sleep disturbances, particularly if vasomotor symptoms are present. However, because of contraindications, other options should be considered. Further work is needed to develop preventive and treatment strategies for alleviating sleep disturbances to ensure better health, quality of life, and productivity in midlife women.
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Affiliation(s)
- Fiona C Baker
- Human Sleep Research Program, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Laura Lampio
- Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Centre, University of Turku, Turku, Finland; Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Tarja Saaresranta
- Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Centre, University of Turku, Turku, Finland; Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Centre, University of Turku, Turku, Finland; Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
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Climacteric-related symptoms in menopause transition and beyond: a prospective 19-year follow-up study on previously hysterectomized women. Menopause 2018; 25:890-896. [DOI: 10.1097/gme.0000000000001091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Frange C, Hachul H, Hirotsu C, Tufik S, Andersen ML. Insomnia with Musculoskeletal Pain in Postmenopause: Associations with Symptoms, Mood, and Quality of Life. J Menopausal Med 2018; 24:17-28. [PMID: 29765923 PMCID: PMC5949304 DOI: 10.6118/jmm.2018.24.1.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/22/2018] [Accepted: 03/08/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives To investigate the relationship between insomnia (INS) combined with chronic musculoskeletal pain (MSP) in postmenopausal women and its characteristics regarding MSP, menopausal and mood symptoms, sleep and quality of life (QOL). Methods A cross-sectional control study in 4 groups of postmenopausal women: control (n = 15), MSP (n = 15), INS (n =15) and INS + MSP (n = 17). Sixty-two participants completed questionnaires and had blood collected, and 43 underwent polysomnography. Results INS was associated with increased anxiety (P = 0.04) and sleep fragmentation (P = 0.02); worse MSP severity (P = 0.00), MSP interference with daily function (P = 0.00), higher pain intensity at midday (P = 0.02) and menopausal symptoms (P = 0.00); and reduced QOL (P = 0.00). MSP was associated with increased anxiety (P = 0.02) and menopausal symptoms (P = 0.00), and reduced QOL (P = 0.05). In the whole sample, depression symptoms were higher but no statistical differences were found between groups (P = 0.47). Worse QOL was associated with both higher depressive symptoms (P = 0.01) and worse pain interference (P = 0.02) Conclusions INS + MSP was related to higher menopausal and anxiety symptoms, more sleep fragmentation and complaints of MSP severity and interference, more pain sites and worse QOL. The presence of INS was associated to more MSP. Sleep management is essential in women who have developed chronic MSP.
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Affiliation(s)
- Cristina Frange
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Helena Hachul
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynecology, Casa de Saúde Santa Marcelina, São Paulo, Brazil
| | - Camila Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Levy Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
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Gervais NJ, Mong JA, Lacreuse A. Ovarian hormones, sleep and cognition across the adult female lifespan: An integrated perspective. Front Neuroendocrinol 2017; 47:134-153. [PMID: 28803147 PMCID: PMC7597864 DOI: 10.1016/j.yfrne.2017.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 12/22/2022]
Abstract
Loss of ovarian function in women is associated with sleep disturbances and cognitive decline, which suggest a key role for estrogens and/or progestins in modulating these symptoms. The effects of ovarian hormones on sleep and cognitive processes have been studied in separate research fields that seldom intersect. However, sleep has a considerable impact on cognitive function. Given the tight connections between sleep and cognition, ovarian hormones may influence selective aspects of cognition indirectly, via the modulation of sleep. In support of this hypothesis, a growing body of evidence indicates that the development of sleep disorders following menopause contributes to accelerated cognitive decline and dementia in older women. This paper draws from both the animal and human literature to present an integrated view of the effects of ovarian hormones on sleep and cognition across the adult female lifespan.
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Affiliation(s)
- Nicole J Gervais
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, 135 Hicks Way, Amherst, MA 01003, United States.
| | - Jessica A Mong
- Department of Pharmacology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, United States
| | - Agnès Lacreuse
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, 135 Hicks Way, Amherst, MA 01003, United States
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Gender differences in actual and preferred nocturnal sleep duration among Finnish employed population. Maturitas 2016; 94:77-83. [DOI: 10.1016/j.maturitas.2016.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/16/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022]
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Monterrosa-Castro Á, Portela-Buelvas K, Salguedo-Madrid M, Mo-Carrascal J, Duran-Méndez Leidy C. Instruments to study sleep disorders in climacteric women. ACTA ACUST UNITED AC 2016; 9:169-178. [PMID: 28123656 PMCID: PMC5241627 DOI: 10.1016/j.slsci.2016.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/27/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023]
Abstract
To identify the scales to assess sleep disorders applied to women with climacteric stage. Bibliographical research without intervention, the available information in scientific databases. Performed in PubMed, ScienceDirect, Scopus, Ebscohos OvidSP and Health Library. The words used in this article: insomnia, adjustment sleep disorder, questionnaires, studies and menopause. Publications of all types were included. Seven scales were identified: Insomnia Severity Index, Athens Insomnia Scale, Pittsburgh Quality of sleep Index, Epworth Sleepiness Scale, Jenkins Sleep Scale, Basic Nordic Sleep Questionnaire and The St Mary's Hospital Sleep Questionnaire. There are validated scales in multiple languages and considered appropriate for studying sleep disorders.
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Affiliation(s)
- Álvaro Monterrosa-Castro
- Physician, Gynecology and Obstetrics, Facultad de Medicina, Grupo de Investigación Salud de la Mujer, Facultad de Medicina, Universidad de Cartagena, Colombia
| | - Katherin Portela-Buelvas
- Physician, Grupo de Investigación Salud de la Mujer, Facultad de Medicina, Universidad de Cartagena, Colombia
| | - Marlon Salguedo-Madrid
- Student, Facultad de Medicina, Grupo de Investigación Salud de la Mujer, Facultad de Medicina. Universidad de Cartagena, Colombia
| | - Joulen Mo-Carrascal
- Student, Facultad de Medicina, Grupo de Investigación Salud de la Mujer, Facultad de Medicina. Universidad de Cartagena, Colombia
| | - Carolina Duran-Méndez Leidy
- Student, Facultad de Medicina, Grupo de Investigación Salud de la Mujer, Facultad de Medicina. Universidad de Cartagena, Colombia
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Predictors of sleep disturbance in menopausal transition. Maturitas 2016; 94:137-142. [PMID: 27823734 DOI: 10.1016/j.maturitas.2016.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/13/2016] [Accepted: 10/04/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This follow-up study aimed to evaluate risk factors for menopausal sleep disturbances already identifiable before menopause. METHODS At baseline, all 81 women were premenopausal. At year-five follow-up, 27 of the women were premenopausal, 40 postmenopausal, and 14 postmenopausal and using hormone therapy. We used the Basic Nordic Sleep Questionnaire to study sleep; additional questionnaires evaluated risk factors for sleep impairment. RESULTS Sleep quality differed only marginally between the groups. The following baseline variables were associated with impaired sleep quality at follow-up: depressive symptoms increased the risk of nocturnal awakenings (OR 1.16 (95%CI 1.02-1.32), p=0.025), morning tiredness (OR 1.22 (95%CI 1.06-1.40), p=0.007), daytime tiredness (OR 1.24 (95%CI 1.06-1.44), p=0.007) and propensity to fall asleep during work or leisure time (OR 1.18 (95%CI 1.01-1.37), p=0.036). Personal crises increased the risk of longer sleep latency (OR 5.46 (95%CI 1.13-26.32), p=0.035) and of propensity to fall asleep when not active (OR 5.41 (95%CI 1.42-20.83), p=0.014). Use of medications affecting the CNS increased the risk of worse general sleep quality (OR 11.44 (95% CI 1.07-121.79), p=0.044). Perceived impaired general health (OR 2.87 (95%CI 1.04-7.94), p=0.043) and frequent night sweats (OR 10.50 (95%CI 2.25-49.01), p=0.003) increased the risk of difficulty falling asleep. CONCLUSIONS Various premenopausal health-related factors seem to predict poor sleep in menopausal transition. Menopause itself appears to have only minor effects. Thus, it is essential to identify high-risk women to allow timely interventions that may prevent the development of sleep disturbances at menopause.
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Zaslavsky O, LaCroix AZ, Hale L, Tindle H, Shochat T. Longitudinal changes in insomnia status and incidence of physical, emotional, or mixed impairment in postmenopausal women participating in the Women's Health Initiative (WHI) study. Sleep Med 2015; 16:364-71. [DOI: 10.1016/j.sleep.2014.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 12/12/2022]
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Dørheim SK, Bjorvatn B, Eberhard-Gran M. Can insomnia in pregnancy predict postpartum depression? A longitudinal, population-based study. PLoS One 2014; 9:e94674. [PMID: 24732691 PMCID: PMC3986207 DOI: 10.1371/journal.pone.0094674] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/18/2014] [Indexed: 11/20/2022] Open
Abstract
Background Insomnia and depression are strongly interrelated. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression. Methods A longitudinal, population-based study was conducted among perinatal women giving birth at Akershus University Hospital, Norway. Women received questionnaires in weeks 17 and 32 of pregnancy and eight weeks postpartum. This paper presents data from 2,088 of 4,662 women with complete data for insomnia and depression in week 32 of pregnancy and eight weeks postpartum. Sleep times, wake-up times and average sleep durations were self-reported. The Bergen Insomnia Scale (BIS) was used to measure insomnia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms. Results After delivery, sleep duration was reduced by 49 minutes (to 6.5 hours), and mean sleep efficiency was reduced from 84% to 75%. However, self-reported insomnia scores (BIS) improved from 17.2 to 15.4, and the reported prevalence of insomnia decreased from 61.6% to 53.8%. High EPDS scores and anxiety in pregnancy, fear of delivery, previous depression, primiparity, and higher educational level were risk factors for both postpartum insomnia and depression. Insomnia did not predict postpartum depression in women with no prior history of depression, whereas women who recovered from depression had residual insomnia. Limitations Depression and insomnia were not verified by clinical interviews. Women with depressive symptoms were less likely to remain in the study. Conclusions Although women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased. Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression.
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Affiliation(s)
- Signe K. Dørheim
- MoodNet Research Group, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- * E-mail:
| | - Bjørn Bjorvatn
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Malin Eberhard-Gran
- Health Services Research Center, Akershus University Hospital, Lørenskog, Norway
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway
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