Abstract and Introduction
Abstract
Objective: The aim of this study was to examine the relationship between menopausal transition status and self-reported sleep difficulty.
Methods: With the use of data on women participating in the Medical Research Council National Survey of Health and Development who have been followed up from birth in March 1946 (n = 962), relationships between menopausal transition status and self-reported sleep difficulty were assessed annually in women between ages 48 and 54 years.
Results: Menopausal transition status was related to severe self-reported sleep difficulty. The odds of reporting severe self-reported sleep difficulty were increased approximately by 2- to 3.5-fold (95% CI ranges from 1.08–3.27 to 1.99–6.04) for women in most menopausal transition statuses compared with women who remained premenopausal. After adjustment for current psychological, vasomotor, and somatic symptoms and waking frequently at night to use the toilet, only women who had a hysterectomy remained at an increased risk for moderate sleep difficulty.
Conclusions: The modest relationship between menopausal transition status and moderate sleep difficulty may be related to greater variation in individual definitions of moderate difficulty. Attention to the level of sleep difficulty in this group of women will assist in the decision to address current health symptoms versus sleep itself. Women without prior health problems may experience severe self-reported sleeping difficulty during the menopausal transition and require tailored care from health professionals.
Introduction
Sleep difficulty is a common problem for women during midlife. Approximately 40% of women between ages 40 and 64 years in the United Kingdom, Australia, and the United States report difficulty with sleep. Understanding the nature of this symptom is complicated by the dynamic features of both sleep disturbance and potential correlates of sleep. It is not clear whether midlife is a period of increased onset of new sleep problems or whether most problems during these years reflect an exacerbation of existing symptoms. Midlife is a period of the convergence of multiple risk factors concerning menopause, overall health, and stress that may influence sleep.
Evidence concerning the relationship between the menopausal transition and sleep has been mixed. The menopausal transition, as indicated through hormonal levels or characteristics of menstruation, has been shown to be related to sleep disturbance. However, some studies have not identified this relationship between characteristics of menstruation and sleep disturbance. Other concurrent factors that may be chronic or acute may also play a role in sleep. For example, psychological distress and life stress have been shown consistently to be related to poor sleep during the menopausal transition. From a management perspective, it is important to understand whether sleep difficulty during midlife is related to the menopausal transition, these other risk factors, or other age-related changes.
Evaluation of these complexities of sleep at midlife requires longitudinal data that begin earlier in adulthood and include multiple risk factors. Most studies evaluating self-reported sleep during the menopausal transition have been cross-sectional or had a limited sample size. One central consequence of these study characteristics is the limited ability to distinguish age and menopause effects. Two recent large, longitudinal American studies have not been subject to these drawbacks, but no similar analysis has been carried out among a British sample. Previous studies have not included risk factors for sleep difficulty from earlier in life, which could indicate longitudinal patterns in propensities for sleep disturbance and related health characteristics before menopause. The Medical Research Council National Survey of Health and Development (NSHD) provides the opportunity to consider risk factors from earlier adult life and from the present to study sleep during the menopausal transition. Analysis of this cohort has shown that psychological and physical health symptoms at age 43 years were related to duration of poor sleep during the menopausal transition, suggesting the importance of examining sleep longitudinally. Longitudinal analysis of the cohort is required to validate previous cross-sectional analysis that showed an increase is trouble sleeping during the menopausal transition.
With the use of longitudinal and repeat data from a nationally representative British cohort study, the purpose of this study was to examine the relationship between the menopausal transition and self-reported sleep difficulty. To isolate the associations between menopausal transition status and sleep from other concurrent and longitudinal risk factors, the study also accounts for age; current somatic, vasomotor, and psychological symptoms; and prior measures of socioeconomic status, physical and mental health, health behaviors, and history of trouble sleeping.