Clinical and therapeutic aspects of sleep disorders in menopause

Violations of night sleep during the menopause are nonspecific manifestations of mental disadaptation. According to some authors (A. McGhil, S. M. Russell, C. B. Ballinger), insomnia disorders occur in 50% of women of the corresponding age. Despite the urgency, a small number of studies have been devoted to this problem.

Sleep disorders and the symptoms of menopause are the result of the influence of many factors. There are two main factors contributing to the occurrence of sleep disorders in women in menopause.

Firstly, these are “hot flashes” (cardiovascular disorders in the sympathetic-adrenal or vago-insular type), which often lead to multiple awakenings.

Secondly, these are nighttime episodes of apnea. Women suffer less often than men (J. A. Leech, E. Onal, C. Dulberg). Obviously, this is due to the hormonal factor, since nocturnal apneas become more frequent in the climacteric period (A. J. Bloch, J. W. Wynne, P. G. Boysen). Reduction in the level of progesterone, which is a respiratory stimulant, contributes to the increase in the occurrence of respiratory disorders during sleep. Obese, snoring or overly sleepy women have a risk of developing respiratory disorders during sleep.

Of the 56 women surveyed, we selected 32 patients with menopausal manifestations with insomnia disorders that did not take hormonal drugs. The phenomenology of sleep disorders was composed of three types of disorders.

Presumptive disorders

Patients complained about the difficulties of falling asleep, accompanied by unpleasant thoughts, ideas, fears, fear of falling asleep, heightened sensitivity to sensory stimuli, myoclonias of falling asleep, inability to find a comfortable pose.

Intrasomnicheskie disorders noted in 25 women were presented by night awakenings, caused by frequent “tides” of blood to the head and upper body with profuse sweating, palpitations, a sense of lack of air. Patients noted the difficulty of falling asleep after them and feeling not enough deep sleep.

Postmodern disorders were detected in 13 women. The shortening of sleep was due to an early awakening. It came suddenly, more often between 4 and 6 o’clock in the morning. Patients complained of weakness, lethargy, lack of a sense of rest, sometimes “drunken sleep” with a slow onset of active wakefulness. Some noted the need for daytime sleep to restore normal health.

Various types of sleep disorders sometimes combined with each other. This circumstance should be taken into account when treating insomnia disorders.

It should be noted that the quality of sleep, not the quantitative indicators (duration or frequency of awakenings) had a greater impact on the well-being of women the next day, on their normal social functioning.

Therapy of insomnia disorders was carried out taking into account the type of these disorders against the background of elimination of menopausal manifestations and mental disorders. The drugs of choice were chalcion (triazolam), manufactured by Pharmacia Upjohn, and imovane (zopiclone) manufactured by Rhone-Poulenk Rorer.

Chalcion is a powerful hypnotic for short-acting, most effective in the presence of intrasomal disorders. The dose was selected individually. The usual single dose of the drug is 0.25 mg at bedtime. We noted that it is more appropriate to start treatment with a dose of 0.125 mg due to the presence of somatic troubles in women in menopause. With this approach, the patients noted an increase in the duration of sleep without any phenomena of cardiovascular or respiratory system depression. The next day after receiving the chalcon, women felt rested, they retained the speed of mental and motor functions.

Imovane was used by us to correct night awakenings and post-somnolence disorders. A good effect was observed in patients with asthenic and depressive disorders. The drug was given in a dose of 7.5 mg for 10 days. Sleeping effect came in 20-30 minutes. All women noted that the dream became calm, without dreams. In the mornings, the patients felt cheerful, rested, and noted a rise in mood and confidence in their abilities.

Thus, sleep disorders in women in menopause are quite common. There is a combination of different types of insomnia. Therapy of these disorders should be comprehensive, conducted taking into account the severity of menopausal manifestations and the nature of mental disorders. The experience of the use of chalco and imovane for the treatment of sleep disorders in menopause confirms their effectiveness and almost complete absence of side effects.