The Prevalence of Insomnia in Perimenopausal Women Transitioning to Menopause

Open Access
Ciano, Colleen Lynn
Graduate Program:
Doctor of Philosophy
Document Type:
Date of Defense:
March 02, 2015
Committee Members:
  • Amy M Sawyer, Dissertation Advisor
  • Judith E Hupcey, Committee Chair
  • Tonya King, Committee Member
  • Kristen H Kjerulff, Committee Member
  • Robin Redmon Wright, Committee Member
  • Perimenopause
  • Insomnia
  • Sleep
  • Mid-life
  • Women
  • Surgical menopause
  • Sleep Latency
  • Wake After Sleep Onset
  • Sleep Quality
Background/Significance: Insomnia in adults contributes to poor health outcomes such as myocardial infarction and obesity. Evidence consistently suggests a predisposition to insomnia in women; yet, there is a paucity of research that addresses insomnia in a high-risk group of women – perimenopausal women transitioning to menopause. Perimenopause will affect 500 million women within the next decade. Studies of individual sleep symptoms in perimenopausal women are abundant; few studies, however, address such symptoms from the perspective of diagnosable insomnia in perimenopausal women. Study Purpose: The primary aim of the study was to describe the prevalence of insomnia in perimenopausal women progressing to menopause. Two secondary aims were also addressed; (1) to examine if there is a difference in self-reported insomnia/insomnia symptoms between perimenopausal stages, and (2) to identify independent predictors of influence on chronic insomnia among perimenopausal women. Theoretical Framework: The Perimenopausal Insomnia Symptom Management Model (PISMM), an adaptation of the Spielman 3 P Model of Insomnia and the Symptom Management Theory (SMT) was used to guide this study. The SMT and 3 P Model of Insomnia, when combined, address the essence of the subjective and objective experience of sleep symptoms and insomnia among perimenopausal women. Methods: A secondary analysis of publically-available data from the Study of Women’s Health Across the Nation, a multisite, longitudinal study of the natural history of menopause (N=3302) was conducted. The purpose of the Study of Women’s Health Across the Nation was to describe the chronology of the biological and psychological characteristics of the menopausal transition on health and risk factors for age-related chronic illnesses; survey and biophysical data were collected at baseline and 13 annual intervals. For the secondary analysis, survey data (baseline and 10 annual data points) were analyzed. Self-reported sleep symptoms survey data were used to examine the prevalence of insomnia as defined by American Academy of Sleep Medicine insomnia criteria. The primary outcome variables were four insomnia symptoms: difficulty falling asleep, sleep latency, awakenings from sleep, wake after sleep onset, and sleep quality. Descriptive analysis of all variables for each study interval was completed. Repeated measures logistic regression was used to identify if insomnia symptoms change over time by perimenopausal stage. Multivariable logistic regression models were used to identify predictors of influence on chronic insomnia defined in this study as the presence of insomnia symptoms for two consecutive data collection points. Results: The sample (n=3302) were middle aged (45.9 ± 2.69) women with high school or more education at baseline survey. Most of the sample was married (65%), mid-high income (78.1%), and of diverse race/ethnicity. Insomnia was present in at least one third or more of perimenopausal women at any point in the transition period (31%-42%). Awakenings were the most frequently reported insomnia symptom (31%); increased sleep latency was least frequently reported (14%); and wake after sleep onset (15%) was reported half as often as awakenings. Self-reported sleep quality (restless or very restless sleep) did not significantly worsen over the ten year study period. Insomnia symptoms were worse and more prevalent in the late stage of perimenopause compared to early perimenopausal stage (p<0.0001). The odds of having any one symptom of insomnia were 1.3 times greater for those in late stage versus early stage of perimenopause (95% CI [1.2, 1.5]; p<0.001). The odds of developing chronic insomnia were 1.5 times greater for those in perimenopause than pre-perimenopausal status at baseline (95% CI (1.3, 1.8); p<0.001). Other important factors of influence for chronic insomnia among PM were: night sweats (p<0.001), depression (p<0.001), higher body mass index (p<0.001), weekly exercise (p=0.005), and younger age (p=0.001). Conclusions & Implications: The study addressed the prevalence of insomnia in perimenopausal women transitioning to menopause specifically identifying insomnia as highly prevalent in perimenopausal women, significantly more severe insomnia in late stage perimenopausal women, and risk factors for chronic insomnia in perimenopausal women. Perimenopausal women are at risk for developing chronic insomnia when compared to pre-perimenopausal women. Insomnia in perimenopausal women is under-recognized and under-diagnosed; screening for insomnia symptoms by healthcare providers is a necessity to potentially reduce the burden of insomnia among perimenopausal women. The study findings highlight the importance of continued research addressing insomnia in this population and suggest new clinical implications for symptom management in perimenopausal women. Insights for designing/testing interventions to improve the sleep and long-term health of perimenopausal women are suggested.