Primary Menopausal Insomnia: Definition,Review, and Practical Approach |
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| Institution: | 1. Campus Atlacomulco, Autonomous University of the State of Mexico, Atlacomulco, Mexico;2. Psychology Department, Iberoamerican University, Mexico City, Mexico;3. Laboratory of Animal Behavior, Faculty of Sciences, Autonomous University of the State of Mexico, Atlacomulco, Mexico;4. Department of Biology, Faculty of Sciences, Autonomous University of Madrid, Madrid, Spain;1. Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy;2. Vascular Surgery Unit, University of Bari, Bari, Italy;1. Cardiovascular Engineering Inc, Norwood, MA;2. Icelandic Heart Association, Kopavogur, Iceland;3. Tufts Medical Center, Boston, MA;4. University of Iceland, Reykjavik, Iceland;5. National Institute on Aging, National Institutes of Health, Bethesda, MD;1. Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;2. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania;4. NYU Langone Medical Center, New York, New York;5. Lankenau Hospital, Wynnewood, Pennsylvania;7. School of Arts & Sciences, University of Pennsylvania, Philadelphia, Pennsylvania;11. Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut;12. Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut;8. School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania;9. Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;71. Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania;2. School of Computing Science and Engineering, Vellore Institute of Technology, Vellore, India;1. Institute of Zoology, University of Veterinary Medicine Hannover, Hannover, Germany;2. Centre National de la Recherche Scientifique (CNRS), Université Paris-Sud, Université Paris-Saclay, Neurodegenerative Diseases Laboratory, Fontenay-aux-Roses, France;3. Commissariat à l’Energie Atomique et aux Energies Alternatives (CEA), Direction de la Recherche Fondamentale (DRF), Institut François Jacob, MIRCen, Fontenay-aux-Roses, France;4. Laboratoire de Psychopathologie et de Neuropsychologie, Université Paris 8, St Denis, France;5. MMDN, University of Montpellier, EPHE, INSERM, U1198, PSL University, Montpellier, France;6. ZTL-Imaging, Institute of Laboratory Animal Science, Hannover Medical School, Hannover, Germany;7. Small Animal Clinic, University of Veterinary Medicine Hannover, Hannover, Germany |
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| Abstract: | ObjectiveTo present a case of primary menopausal insomnia with hot flashes to introduce recent changes in technology and nomenclature of sleep medicine and to review presentation, diagnosis, and therapies for menopausal insomnia.MethodsClinical findings and results of sleep evaluation in the menopausal study patient are presented with details about polysomnography performed before and after therapy with pregabalin.ResultsA 56.5-year-old female athlete with severe hot flashes and insomnia of 12 years duration was treated with pregabalin, which ameliorated the hot flashes and sweats and improved sleep quality and architecture. Menopause is associated with hormonal and metabolic changes that disrupt sleep. Disruption of sleep can in turn lead to morbidity and metabolic sequelae. Hormonal treatment, although effective, carries risks unacceptable to many patients and physicians. To date, nonhormonal therapies of symptomatic menopause have not been objectively studied for effects on sleep efficiency and architecture. Primary menopausal insomnia is insomnia associated with menopause and not attributable to secondary causes. Polysomnographically, it seems characterized by a high percentage of slow-wave (N3) sleep, decreased rapid eye movement sleep, cyclic alternating pattern, and arousals.ConclusionsPrimary menopausal insomnia is probably mediated through a mechanism separate from hot flashes, and one can occur without the other. Thermal dysregulation and sleep abnormalities of menopause are probably related to more general changes mediated through loss of estrogenic effects on neuronal modulation of energy metabolism, and more clinical direction is expected as this research field develops. Identification of sleep disorders in menopausal women is important, and polysomnographic evaluation is underused in both clinical and research evaluations of metabolic disturbances. (Endocr Pract. 2011; 17:122-131) |
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