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 Cognitive behavioral therapy, or CBT, “is a widely-used, short-term,
problem-focused form of behavioral treatment that helps people see
the relationship between beliefs, thoughts, and feelings, and
subsequent behavior patterns and actions,” study leader Katherine
Guthrie told Reuters Health by email. “CBT for insomnia (CBT-I)
focuses on behavior around sleep.”
CBT outperformed both exercise and medication, Guthrie and
colleagues found.
Sleep problems are common just before, during and after menopause.
Even women who don’t technically have insomnia often wake up in the
middle of the night and have trouble getting back to sleep.
As reported in the journal Sleep, the researchers studied more than
500 menopausal or postmenopausal women, ages 40 to 72, in Boston,
Indianapolis, Oakland, Philadelphia, or Seattle. All of the women
had sleep problems and hot flashes, and all were participating in
randomized trials as part of the Menopausal Strategies: Finding
Lasting Answers to Symptoms and Health (MsFLASH) studies.
Participants kept sleep diaries and talked to a sleep coach by phone
six times over an eight-week period, receiving detailed personalized
advice and tools to tweak their sleep habits, including information
on proper sleep hygiene, maintaining a good “sleep window,” and how
to practice “constructive worry” when ruminating thoughts keep them
awake at night, said Guthrie, who is a researcher at the Fred
Hutchinson Cancer Research Center in Seattle, Washington
The researchers compared different interventions, including CBT, the
antidepressant drug escitalopram, aerobic exercise, daily omega-3
fatty acids, hormone therapy with estradiol, and a drug for nerve
pain called venlafaxine XR.
The participants filled out Insomnia Severity Index (ISI) and the
Pittsburgh Sleep Quality Index (PSQI) surveys at the start and again
two to three months after the CBT.
About half of the women had baseline ISI scores of 12 or above, on a
scale of 0 to 28, with higher scores indicating worse problems
sleeping. CBT produced the greatest reduction in ISI from baseline
compared to placebo or control groups with an average reduction of
5.2 points.
Exercise and venlafaxine reduced ISI scores by about 2 points, while
hormone therapy, escitalopram, and yoga led to only modest decreases
in scores.
The average PSQI baseline scores ranged from 9.2 to 10.4, on a scale
of 0 to 21. CBT reduced PSQI scores by an average of 2.7 points.
Escitalopram, exercise, yoga, estradiol and venlafaxine resulted in
an average drop of 1.2 to 1.6 points, but omega-3 supplements did
not improve insomnia symptoms at all.
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“If (a woman) has menopause-associated insomnia symptoms and
moderately bothersome hot flashes, it is definitely worth the time
to try a course of CBT as a treatment before trying antidepressant
medications or low-dose estrogen,” Guthrie said.
This is good news because this type of therapy involves no
medication, is low-cost, non-invasive and there’s a fairly
small-time commitment, said Guthrie.
Dr. Shelby Harris, director of Behavioral Sleep Medicine at the
Sleep-Wake Disorders Center of Montefiore Health System in New York
City said this is a great study that looks at a number of
interventions for the vasomotor symptoms during menopause, both
pharmacological and nonpharmacological.
“The field has been quite limited in the past in its ability to help
insomnia suffers during this phase of life, and research is really
beginning to show that there are methods to help one sleep better
during menopause, without necessarily having to rely on medication,”
Harris told Reuters Health by email.
Harris, who wasn’t involved in the study, said CBT for Insomnia not
only targets the reasons for waking up in the middle of the night
but also addresses maladaptive behaviors after awakening, which
often worsen the problem and prolong the awakenings.
“Such behaviors might include: lying in bed tossing and turning,
worrying, watching TV in the middle of the night in bed, spending
excessive time in bed, and doing work just before bed without any
wind-down,” she said.
CBT may help deepen sleep and also help reduce the length of time
awake after an awakening because it changes the maladaptive
behaviors over time to more sleep-appropriate ones, said Harris.
“It is also important to note that as women transition into
menopause, their rates of obstructive sleep apnea rise significantly
and if a woman’s sleep becomes disturbed or broken and she has
snoring or pauses/choking or gasping at night, she should seek a
consultation with a sleep specialist to have any sleep-disordered
breathing ruled out,” Harris said.
SOURCE: http://bit.ly/2kphM3D Sleep, online November 20, 2017.
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