Elsevier

Maturitas

Volume 30, Issue 1, 20 September 1998, Pages 41-50
Maturitas

Sleep disturbance in healthy middle-aged women

https://doi.org/10.1016/S0378-5122(98)00039-5Get rights and content

Abstract

Objectives: The objectives of the study were to (a) describe the sleep patterns of a sample of healthy middle-aged women, (b) to characterize the psychological, behavioral and biological profiles of middle-aged women who report sleep disturbance, and (c) to determine the influence of change in menopausal status on the quality and quantity of self-reported sleep. Methods: A total of 521 women of varying menopausal status were evaluated in a clinic setting. Measurements included blood pressure, height, weight, waist/hip ratio, and self-reported sleep disturbances, demographic and family characteristics, psychosocial questionnaires, physical activity and nutritional intake. The women who were premenopausal at this initial visit were later evaluated, in an identical protocol, when they became postmenopausal. Results: A total of 42% of the women reported some type of sleep disturbance. Trouble sleeping was associated with higher levels of anxiety, depression, stress, tension and public self-consciousness. Women with trouble falling asleep had higher systolic and diastolic blood pressures and greater waist/hip ratios. Women who woke earlier than desired had higher systolic and diastolic blood pressures. Sleep disturbance was independent of menopausal status in cross-sectional analyses. In longitudinal analyses, the transition from pre- to postmenopausal status was associated with a significant increase in sleep disturbance in women who chose to not take hormone replacement therapy. Conclusions: There is a high level of sleep disturbance in middle-aged women. Sleep disturbance is associated with worse mood, higher blood pressure and higher waist/hip ratios. Transition into postmenopausal status is associated with deleterious changes in sleep patterns among women who do not take hormone replacement therapy.

Introduction

Complaints of sleep disturbance by adults include trouble falling asleep and waking during the night or earlier than desired in the morning. Sleep appears to be important for longevity as well as good health. In a large prospective study, sleeping less than 4 h was found to predict an increased risk of all cause mortality for both men and women [1]. The same study found that sleeping longer each night, 10 h or more, also was associated with increased risk of death [1]. Cardiovascular diseases such as hypertension, stroke and congestive heart failure are associated with insomnia [2]and persons reporting symptoms of psychological distress, such as depression and/or anxiety, often have disturbed sleep [3]. The Framingham Study identified several psychosocial predictors of myocardial infarction and coronary death; interestingly, among the predictors was difficulty falling asleep [4]. Other factors associated with sleep disturbances are obesity, older age, and increased consumption of alcohol.

Sleep disturbances are twice as common among women compared to men [5], with gender differences presenting in early childhood [6]. Variation in sleep quality occurs during the menstrual cycle in premenopausal women [7]as well as during pregnancy [8]. The number of women complaining of sleep disturbances increases in their forties and plateaus by the end of the fifth decade [1]. Anxiety and depression are associated with sleep disturbance and both of these disorders are more prevalent in women. It is a commonly held belief that anxiety and depression are associated with changes in hormone levels, accounting perhaps for the increase in sleep disturbance symptoms reported by some women in the premenstrual phase of the menstrual cycle [9]and during the postpartum period [10]. Taken together, these findings suggest that the changes in hormone levels that occur during the menopausal transition may contribute significantly to the risk for insomnia.

As part of a longitudinal study on the menopause in healthy middle-aged women, we measured dimensions of sleep. The purposes of this investigation were to (a) describe sleep patterns in a sample of healthy middle-aged women, (b) characterize the psychological, behavioral and biological profiles of middle-aged women who report sleep disturbance, and (c) determine the influence of change in menopausal status on the quality and quantity of self-reported sleep.

Section snippets

Study population

Beginning in 1983, a sample of 541 premenopausal women between 42 and 50 years of age were recruited by the Graduate School of Public Health at the University of Pittsburgh to participate in a study of the natural history of the menopause. In order to be eligible for the study, women had to be premenopausal, free of chronic disease, and normotensive (blood pressure less than 140 mmHg systolic and 100 mmHg diastolic).

All women were examined at study entry, and the women available for follow up 3

Data reduction and statistical analyses

In cross sectional analyses of the sleep disturbance inventory administered at the 3-year examination, the relationship between menopausal status (pre-, peri-, postmenopause not on HRT, postmenopause on HRT) and sleep disturbance (yes/no) was determined by 4×2 chi-square analyses. Since preliminary analyses did not show a relationship between educational attainment or smoking (P's>0.94), further analyses were not controlled for these factors. The relationships of menopausal status and sleep

Sleep patterns of healthy women at midlife

A total of 64% of the women felt that they needed about the same amount of sleep currently as they used to need, although 23% felt that they could use more. Napping was reported by 37% of the sample and 54% of those who reported napping did so with some consistency (two to five times/week or more). The overall sleep patterns of the sample are shown in Table 2. The women are approximately evenly divided on whether or not they felt they had experienced trouble sleeping in the past 6 months. Among

Discussion

This study found that 42% of healthy middle-aged women had some trouble sleeping. The most frequent problem was awakening during the night, followed by waking earlier than desired. Trouble falling asleep was the least frequent problem.

Unlike studies in older populations where sleep disturbances have been found to be associated with chronic diseases or physical disabilities [21], the women in this study were selected for good health and for the most part remained in good health during this

Acknowledgements

Research reported in this manuscript was supported by NIH grant HL28266. The authors thank Drs Donna Giles, Lewis Kuller, and Anne Newman for their thoughtful review of this article, and Linda Jansen-McWilliams, M.S. for her statistical expertise.

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