Factors relating to insomnia during the menopausal transition as evaluated by the Insomnia Severity Index
Introduction
The menopause is associated with different physiological, behavioral and socio-demographical changes. Progressive decline in estrogen levels are frequently related to vasomotor symptoms, urogenital discomfort, muscle-skeletal limitations, mood alterations and sleep disorders [1], [2], [3], [4]. Menopausal women have more sleep disturbances when compared to premenopausal ones [5], [6], frequently displaying less than six hours of sleep and reporting more fatigue or difficulty in initiating and maintaining sleep [7]. Under this scenario, there is an increase for short-term (fatigue-related accidents) and long-term problems (hypertension, diabetes and cardiovascular disease) [8]. Despite the aforementioned, caution has been recommended not to impute the menopause a causative role for sleeping disorders [9]. In fact, many psychological menopausal symptoms are similar to those related with insomnia (i.e. fatigue, irritability and sleep disruptions) [10]. It has been proposed that menopausal mood changes are due to sleep disruptions caused by hot flushes [11].
Research related to sleep has used different approaches: population based sampling, assessment of sleep disorders in morbid conditions and the use of sophisticated sleep laboratory techniques. Many questionnaires and tools have been designed to assess sleep duration and disorders [12]. However, while some tools lack insomnia severity assessment, others do not meet DSM-IV diagnostic criteria [13]. In this sense, the Insomnia Severity Index (ISI) is a simple, easy to use instrument designed to assess insomnia intensity and concomitantly fulfill DSM-IV sleep disorder criteria [14]. The objective of the present study was to assess insomnia prevalence, severity and related factors in mid-aged women.
Section snippets
Participants
A cross sectional study was performed during December 2010 at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, an associated teaching facility of the Medical Faculty of the Universidad Católica de Santiago de Guayaquil, Ecuador. Research aimed at assessing insomnia severity and related factors. Hence, healthy women aged 40–59 years visiting inpatients at the different wards of the Hospital (daily visiting hours: noon to 2 pm) were requested to complete the ISI [14] and a
Results
During the study period a total of 355 women were invited to participate. Refusal rate was 4.2% (15/355) which left 340 complete surveys for analysis. Characteristics of surveyed women and their partners are shown in Table 1 (binomial data only). Median [interquartile range = IQR] age, educational level and parity was 48.0 [9] years, 8 [6] years and 3 [2], respectively. A 63.5% had less than 12 years of schooling, 34.1% accessed a free healthcare system and 52.9% were postmenopausal. At the moment
Discussion
Sleep aids the human body to physically recuperate and allow the brain to reorganize and store more efficiently daily gathered information, and hence consolidate memory knowledge and emotions [8]. Sleep disruptions and daytime sleepiness negatively impact quality of life, and seem to increase co-morbid conditions and mortality risk [2], [8], [21]. Although many population-based surveys report that sleep disorders increase with age [22] others have not confirmed this association [23]. In any
Contributors
Masumi Arakene, María F. Rosero, Cindy Castillo, Ricardo Peñafiel declare to have participated in the manuscript entitled “Factors relating to insomnia during the menopausal transition as evaluated by the Insomnia Severity Index” contributing in study design, literature review, data collection and providing intellectual input to final manuscript.
Peter Chedraui, declares to have participated in the manuscript entitled “Factors relating to insomnia during the menopausal transition as evaluated by
Competing interests
The authors declare no conflict of interest.
Funding
This study was partially supported by the B/024535/09 AECID (Agencia Española de Cooperación Internacional para el Desarrollo).
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2017, MaturitasCitation Excerpt :These symptoms are more frequent during the peri- and postmenopause as compared to the premenopause, even after controlling for confounding factors. In addition, women with severe hot flashes are more likely to report depressive symptoms, anxiety, and/or sleep disturbances [5,7–10]. Women experiencing depressive symptoms have worse quality of life, lower work productivity and higher healthcare related costs [11].