Sleep disorders in menopause: results from an Italian Multicentric Study

Monica Fabbrini, Irene Aricò, Francesco Tramonti, Rosaria Condurso, Luca Carnicelli, Anna De Rosa, Caterina Di Perri, Maria Rosaria Bonsignore, Anna Zito, Giovanna Russo, Maria Giovanna Pagliarulo, Biancamaria Guarnieri, Gianluigi Cerroni, Gianfranco Mennuni, Giacomo Della Marca, Enrica Bonanni, Rosalia Silvestri


Menopause in the female life cycle is a special period due to important hormonal, physical and psychological changes. Sleep disruption represents a common complaint for midlife and menopausal women, related to primary sleep disorders, including insomnia, sleep disordered breathing, and restless legs syndrome (RLS), mood and anxiety disorder, other medical illness, hormonal-related vasomotor symptoms, and aging per se. Aims of our study were to evaluate the prevalence of sleep disorders in a sample of pre and post menopausal women, and to investigate the relationship between them and other medical disorders, and life habits. Among workers in the six participant centers, we enrolled 334 women, aged between 40 and 60 years, that completed a questionnaire included screening on menarche, menstrual cycle, fertility, parity, menopause, life habits, personal medical and sleep history and related treatment, and self-administered scales for sleep quality (PSQI), excessive daytime sleepiness [Epworth Sleepiness Scale (ESS)], mood disorder [Beck Depression Inventory (BDI)], Berlin Questionnaire for sleep disordered breathing (SDB), IRLS diagnostic interview and Rating Scale. Menopausal and perimenopausal women showed an increased prevalence of poor sleep, high risk of SDB, and mood disorder; menopausal women also reported increased RLS severity. Mood disorder had a significant impact on night sleep measures and excessive daytime sleepiness, as well as on RLS severity, and had a greater prevalence in hypertensive women. Sleep disturbances are frequent in menopausal status. Their aetiology is unclear, but probably multifactorial, and many factors contribute to the sleep disruption. Our data suggest the importance of correctly investigate and address sleep problems associated with menopause, through sleep history, and a sleep study could be obtained if clinically warranted. Pharmacological and behavioural treatment strategies should then be aimed to improve sleep and life quality in perimenopausal and menopausal women.


sleep; menopause

Full Text:



AASM. The international classification of sleep disorders 3rd ed. 2014, Darien IL: American Academy of Sleep Medicine.

Anttalainen U., Saaresranta T., Kalleinen N., Aittokallio J., Vahlberg T., Polo O. Gender differences in age and BMI distributions in partial upper airway obstruction during sleep. Respir Physiol Neurobiol, 159: 219-226, 2007.

Beck A.T., Steer R.A., Carbin M.G. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev, 8: 77–100, 1988.

Berger K., Luedemann J., Trenkwalder C., John U., Kessler C. Sex and the risk of restless legs syndrome in the general population. Arch Intern Med, 164: 196-202, 2004.

Brandes J.L. The influence of estrogen on migraine: a systematic review. JAMA, 295: 1824-1830, 2006.

Bruyneel M. Sleep disturbances in menopausal women: Aetiology and practical aspects. Maturitas, 81: 406-409, 2015.

Burleson M.H., Todd M., Trevathan W.R. et al. Daily vasomotor symptoms, sleep problems, and mood: using daily data to evaluate the domino hypothesis in middle-aged women. Menopause, 17: 87-95, 2010.

Buysse D.J., Reynolds III C.F., Monk T.H., Berman S.B., Kupfer D.J. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res, 28: 193-221, 1989.

Calhoun D.A., Harding S.M. Sleep and hypertension. Chest, 138: 434–443, 2010.

Cohen L.S., Soares C.N., Vitonis A.F., Otto M.W., Harlow B.L. Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Arch Gen Psychiatry, 63: 385–390, 2006.

Culpepper L. Secondary insomnia in the primary care setting: review of diagnosis, treatment, and management. Curr Med Res Opin, 22: 1257-68, 2006.

Ferini-Strambi L., Walters A.S., Sica D. The relationship among restless legs syndrome (Willis-Ekbom Disease), hypertension, cardiovascular disease, and cerebrovascular disease. J Neurol, 261: 1051-1068, 2014.

Freedman R.R., Roehrs T.A. Sleep disturbance in menopause. Menopause, 14: 826-829, 2007.

Ghorayeb I., Bioulac B., Scribans C., Tison F. Perceived severity of restless legs syndrome across the female life cycle. Sleep Med, 9: 799-802, 2008.

Guidozzi F. Sleep and sleep disorders in menopausal women. Climacteric, 16: 214-219, 2013.

Hachul H., Frange C., Bezerra A.G. et al. The effect of menopause on objective sleep parameters: data from an epidemiologic study in São Paulo, Brazil. Maturitas, 80: 170-178, 2015.

Joffe H., Massler A., Sharkey K.M.. Evaluation and Management of Sleep Disturbance During the Menopause Transition. Semin Reprod Med, 28: 404–421, . 2010.

Johns M.W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 14: 540-545, 1991.

Kalleinen N., Polo-Kantola P., Himanen S.L., Alhola P., Joutsen A., Urrila A.S., Polo O. Sleep and the menopause - do postmenopausal women experience worse sleep than premenopausal women? Menopause Int., 14: 97-104, 2008.

Kravitz H.M., Ganz P.A., Bromberger J., Powell L.H., Sutton-Tyrrell K., Meyer P.M. Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause, 10: 19-28, 2003.

Leger D., Guilleminault C., Dreyfus J.P., Delahaye C., Paillard M. Prevalence of insomnia in a survey of 12,778 adults in France. J Sleep Res, 9: 35-42, 2000.

Li R.H., Wing Y.K., Ho S.C., Fong S.Y. Gender differences in insomnia--a study in the Hong Kong Chinese population. J Psychosom Res, 53: 601-609, 2002.

Manconi M., Ulfberg J., Berger K., Ghorayeb I., Wesström J., Fulda S., Allen R.P., Pollmächer T. When gender matters: restless legs syndrome. Report of the "RLS and woman" workshop endorsed by the European RLS Study Group. Sleep Med Rev, 4: 297-307, 2012.

Marin J.M., Carrizo S.J., Vicente E., Agusti A.G. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet, 365: 1046-1053, 2005.

McKinkay S.M., Brambilla D.J., Posner J.G. The normal menopause transition. Maturitas, 61: 1-2, 2008.

Netzer N.C., Stoohs R.A., Netzer C.M., Clark K., Strohl K.P. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med, 131: 485-491, 1999.

Nichols D.A., Allen R.P., Grauke J.H., Brown J.B., Rice M.L., Hyde P.R., Dement W.C., Kushida C.A. Restless legs syndrome symptoms in primary care: a prevalence study. Arch Intern Med, 163: 2323-2329, 2003.

Owens J.F., Matthews K.A. Sleep disturbance in healthy middle-aged women. Maturitas, 30: 41–50, 1998.

Polesel D.N., Hirotsu C., Nozoe K.T., Boin A.C., Bittencourt L., Tufik S., Andersen M.L., Hachul H. Waist circumference and postmenopause stages as the main associated factors for sleep apnea in women: a cross-sectional population-based study. Menopause, 22: 835-844, 2015.

Polo-Kantola P., Erkkola R., Irjala K., Helenius H., Pullinen S., Polo O. Climacteric symptoms and sleep quality. Obstet Gynecol, 94: 219-224, 1999.

Riemann D., Berger M., Voderholzer U. Sleep and depression—results from psychobiological studies: an overview. Biol Psychol, 57: 67–103, 2001.

Soares C.N. Insomnia in women: an overlooked epidemic? Arch Womens Ment Health, 4: 205-213. 2005.

Taavoni S, Ekbatani N.N., Haghani H. Postmenopausal women’s quality of sleep and its related factors. Midlife Health, 6: 21-25, 2015.

Walters A.S., LeBrocq C., Dhar A. et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med, 4: 121–132, 2003.

Walters A.S., Moussouttas M., Siddiqui F., et al. Prevalence of stroke in restless legs syndrome: initial results point to the need for more sophisticated studies. Open Neurol J, 4: 73–77, 2010.

Walters A.S., Rye D.B. Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension, heart disease, and stroke. Sleep, 32: 589–597, 2009.

Woodward S., Freedman R.R. The thermoregulatory effects of menopausal hot flashes on sleep. Sleep, 6: 497-501, 1994.

Xu Q., Lang C.P., Rooney N. A systematic review of the longitudinal relationships between subjective sleep disturbance and menopausal stage. Maturitas, 79: 401-412, 2014.

Young T. Analytic epidemiology studies of sleep disordered breathing-what explains the gender difference in sleep disordered breathing?. Sleep., 8 Suppl: S1-2, 1993.

Young T., Skatrud J., Peppard P.E. Risk factors for obstructive sleep apnea in adults. JAMA, 16: 2013-2016, 2004.



  • There are currently no refbacks.