Severe Hot Flashes Are Associated With Chronic Insomnia

Stanford Sleep Epidemiology Research Center, Stanford University School of Medicine, 3430 W. Bayshore Road, Palo Alto, CA 94303, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 07/2006; 166(12):1262-8. DOI: 10.1001/archinte.166.12.1262
Source: PubMed


Because hot flashes can occur during the night, their presence has been frequently associated with insomnia in women with symptoms of menopause. However, many factors other than hot flashes or menopause can be responsible for insomnia, and several factors associated with insomnia in the general population are also commonly observed in perimenopausal and postmenopausal women who have hot flashes.
A random sample of 3243 subjects (aged > or =18 years) representative of the California population was interviewed by telephone. Included were 982 women aged 35 to 65 years. Women were divided into 3 groups according to menopausal status: premenopause (57.2%), perimenopause (22.3%), and postmenopause (20.5%). Hot flashes were counted if they were present for at least 3 days per week during the last month and were classified as mild, moderate, or severe according to their effect on daily functioning. Chronic insomnia was defined as global sleep dissatisfaction, difficulty initiating sleep, difficulty maintaining sleep, or nonrestorative sleep, for at least 6 months. Diagnoses of insomnia were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, classification.
Prevalence of hot flashes was 12.5% in premenopause, 79.0% in perimenopause, and 39.3% in postmenopause. Prevalence of chronic insomnia was reported as 36.5% in premenopause, 56.6% in perimenopause, and 50.7% in postmenopause (P<.001). Prevalence of symptoms of chronic insomnia increased with the severity of hot flashes, reaching more than 80% in perimenopausal women and postmenopausal women who had severe hot flashes. In multivariate analyses, severe hot flashes were significantly associated with symptoms and a diagnosis of chronic insomnia. Poor health, chronic pain, and sleep apnea were other significant factors associated with chronic insomnia.
Severe hot flashes are strongly associated with chronic insomnia in midlife women. The presence of hot flashes should be systematically investigated in women with insomnia. Treating hot flashes could improve sleep quality and minimize the deleterious consequences of chronic insomnia.

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    • "Together with hot flashes/night sweats, feeling tired and weight gain, sleep problems are the most common symptoms women discuss with their healthcare providers (Williams et al., 2007). In 26% of perimenopausal women (a prevalence that is higher than in premenopausal or postmenopausal women), sleep disturbances cause significant distress and impact women's daytime functioning qualifying them for a diagnosis of insomnia disorder (Ohayon, 2006). "
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    ABSTRACT: The menopausal transition is marked by increased prevalence in disturbed sleep and insomnia, present in 40-60% of women, but evidence for a physiological basis for their sleep complaints is lacking. We aimed to quantify sleep disturbance and the underlying contribution of objective hot flashes in 72 women (age range: 43-57 years) who had (38 women), compared to those who had not (34 women), developed clinical insomnia in association with the menopausal transition. Sleep quality was assessed with two weeks of sleep diaries and one laboratory polysomnographic (PSG) recording. In multiple regression models controlling for menopausal transition stage, menstrual cycle phase, depression symptoms, and presence of objective hot flashes, a diagnosis of insomnia predicted PSG-measured total sleep time (p<0.01), sleep efficiency (p=0.01) and wakefulness after sleep onset (WASO) (p=0.01). Women with insomnia had, on average, 43.5min less PSG-measured sleep time (p<0.001). There was little evidence of cortical EEG hyperarousal in insomniacs apart from elevated beta EEG power during REM sleep. Estradiol and follicle stimulating hormone levels were unrelated to beta EEG power but were associated with the frequency of hot flashes. Insomniacs were more likely to have physiological hot flashes, and the presence of hot flashes predicted the number of PSG-awakenings per hour of sleep (p=0.03). From diaries, women with insomnia reported more WASO (p=0.002), more night-to-night variability in WASO (p<0.002) and more hot flashes (p=0.012) compared with controls. Women who develop insomnia in the approach to menopause have a measurable sleep deficit, with almost 50% of the sample having less than 6h of sleep. Compromised sleep that develops in the context of the menopausal transition should be addressed, taking into account unique aspects of menopause like hot flashes, to avoid the known negative health consequences associated with insufficient sleep and insomnia in midlife women.
    Psychoneuroendocrinology 06/2015; 60. DOI:10.1016/j.psyneuen.2015.06.005 · 4.94 Impact Factor
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    • "Gender differences in sleep disturbances have repeatedly demonstrated a greater frequency of sleep complaints in women than in men [1] [2] [3], which has often been attributed to hormonal changes, particularly during the midlife years [4] [5] [6] [7]. Increasing age has also been associated with increased frequency of sleep disturbance; however, this relationship is considerably modified when screening for comorbidity [2] [8] and depends on the specific definition provided for the assessment of sleep disturbance [1] [9]. "
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    ABSTRACT: Objectives/Background: We assessed prevalence and correlates of insomnia; associations between changes in insomnia with incidence of physical, emotional, and mixed impairments (PI, EI, and MI, respectively); and age as a moderator in these relationships. Participants/Methods: TheWomen’s Health Initiative (WHI) clinical trial (CT) and observational study (OS) cohorts with 1- and 3-year follow-ups, respectively, were studied. Participants included 39,864 CT and 53,668 OS postmenopausal women free of PI or EI at baseline. Insomnia Rating Scale (IRS), with a cutoff score of ≥9 indicated insomnia. Normal–Normal, Abnormal–Abnormal, Normal–Abnormal, and Abnormal– Normal categories indicated change in insomnia over time. PI, EI, and MI were constructed using Short Form-36 (SF-36) Physical and Emotional subscales (cutoff ≤60) and the modified Center for Epidemiological Studies Depression scale (cutoff ≤0.06). Results: Among 93,532 women, 24.5% had insomnia at baseline. The highest odds ratios (ORs) for impairments were found in the Normal–Abnormal and Abnormal–Abnormal categories. In the CT cohort, Normal–Abnormal category, ORs were 1.86 (95% CI = 1.57–2.20) for PI, 4.11 (95% CI = 3.59–4.72) for EI, and 6.37 (95% CI = 4.65–8.74) for MI. Respective ORs for the OS cohort were 1.70 (95% CI = 1.51–1.89), 3.80 (95% CI = 3.39–4.25), and 4.41 (95% CI = 3.56–5.46). Interactions between changes in insomnia and age showed distinct albeit nonsignificant patterns. Conclusions: The results suggest that exposure to insomnia increases vulnerability to impairment. Future studies are needed to understand the directionality of these relationships.
    Sleep Medicine 01/2015; DOI:10.1016/j.sleep.2014.11.008 · 3.15 Impact Factor
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    • "Therefore, it is important to identify risk factors for chronic sleep disturbance separately, as chronic problems with sleep may indicate increased risk of mental health problems, above and beyond the risk of mental health problems associated with intermittent sleep disturbance. Furthermore, chronic insomnia may have different causes to intermittent insomnia , including chronic pain [37] and hormonal changes [38]. It is common for sleep disturbance to occur intermittently, precipitated by specific stressors and then remitting once these stressors either dissipate naturally or are adapted to [39]. "
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    ABSTRACT: Objective To determine the role of health status and social support in the relationship between job-stress and sleep disturbance, both for intermittent and chronic sleep disturbance. Methods 1,946 mid-life adults completed three questionnaires spanning an 8-year time frame. Sleep disturbance was assessed at each time point, and participants were classified as experiencing intermittent, chronic or no sleep disturbance across this 8-year period. Independent variables included a range of job stress measures, social support, physical and mental health, and demographic characteristics. Results After controlling for physical and mental health, perceived lack of job marketability increased risk for intermittent sleep disturbance (OR = 1.33, p = 0.012). No other job stress measures were associated with either intermittent or chronic sleep disturbance after adjusting for years of education, social support and employment status. Poorer mental and physical health status, although significantly increasing odds for intermittent sleep disturbance, represented a significantly greater increase in the odds for chronic sleep disturbance over and above intermittent disturbance (OR = .96, p < 0.001 for both SF-12 mental and physical health). Conclusion This population based cohort study found little evidence that job stress had an independent effect on chronic or intermittent sleep disturbance independent of health, social support and education. Risk profiles for intermittent and chronic sleep disturbance did not differ with regards to job stress, however various demographic and social support factors were distinguishing factors. Health status, both physical and mental, also showed a significantly greater impact on chronic sleep disturbance than intermittent sleep disturbance. Karasek’s model of job strain had little value in predicting sleep disturbance outcomes.
    Sleep Medicine 08/2014; 15(8). DOI:10.1016/j.sleep.2014.04.007 · 3.15 Impact Factor
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