Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women

Abstract

Study objectives: Examine age-adjusted odds and racial/ethnic differences in self-reported difficulties falling and staying asleep and early morning awakening in midlife women to determine whether difficulty sleeping increased with progression through the menopausal transition.

Design: Longitudinal analysis.

Setting: Community-based.

Participants: 3,045 Caucasian, African American, Chinese, Japanese, and Hispanic women, aged 42-52 years and pre- or early peri-menopausal at baseline, participating in the Study of Women's Health Across the Nation (SWAN).

Interventions: None.

Measurements and results: Self-reported number of nights of difficulty falling asleep, staying asleep, and early morning awakening during the previous 2 weeks were obtained at baseline and 7 annual assessments. Random effects logistic regression was used to model associations between each of the 3 sleep measures and the menopausal transition, defined by bleeding patterns, vasomotor symptoms (VMS), and estradiol (E2) and follicle stimulating hormone (FSH) serum levels. Adjusted odds ratios (ORs) for difficulty falling asleep and staying asleep increased through the menopausal transition, but decreased for early morning awakening from late perimenopause to postmenopause. Naturally and surgically postmenopausal women using hormones, compared with those who were not, generally had lower ORs for disturbed sleep. More frequent VMS were associated with higher ORs of each sleep difficulty. Decreasing E2 levels were associated with higher ORs of trouble falling and staying asleep, and increasing FSH levels were associated with higher ORs of trouble staying asleep. Racial/ethnic differences were found for staying asleep and early morning awakening.

Conclusions: Progression through the menopausal transition as indicated by 3 menopausal characteristics--symptoms, bleeding-defined stages, and endogenous hormone levels--is associated with self-reported sleep disturbances.

Figure 1

Prevalence (percentage) of women reporting sleep difficulty ≥3 times per week in the past 2 weeks across menopausal transition status (N = 3045). Percentages reporting each sleep difficulty (Y-axis) are plotted as “trouble falling asleep” (left figure), “wake up several times” (center figure), and “wake up early” (right figure). Note: Percentages were computed as average rates across menopausal status. Women could contribute to more than one menopausal transition state, and within each menopausal transition state a woman could contribute more than one observation. For women with more than one observation within a specific menopausal transition state, the within-woman average sleep score was computed before dichotomizing. Also, “surgery” (i.e., surgically menopausal status) could follow any menopausal status. HT users were excluded from this figure.