Sleep is fundamental to our mental and physical health, well-being and every aspect of our waking lives. Whilst sleep changes are normal and expected during the perimenopause and beyond (see my previous blog here), sleep medicine practitioners have evidence-based tools for addressing these (see my other blog on this here). There is an ever-growing research community aiming to understand more about sleep during the menopausal transition and beyond, and to develop novel therapeutic tools. Whilst we have some evidence-based knowledge of the sleep changes to be expected during this time, this field is in its infancy compared to what we know about sleep in other populations. Below I outline some of my thoughts on where research needs to turn next, and ways that society needs to adapt to increase the chances of a good night sleep during the perimenopause and beyond:
Research agenda:
- A comprehensive characterisation of the neurochemical/ neurobiological/ hormonal changes in sleep during perimenopause and post-menopause;
- Exploration of circadian rhythm alterations during the perimenopause and post-menopause;
- Larger studies with standardised research methods to tease apart the mechanisms underlying the increased prevalence of SDB and RLS in women during the perimenopause and beyond; to determine the role of reproductive hormones vs. the general ageing process;
- Better controlled and powered RCTs examining the effects of HRT (combined and singular preparations) on insomnia, sleep quality and sleep disordered breathing during perimenopause and beyond;
- Better controlled and powered studies examining novel non-hormonal treatments for hot flushes in perimenopause and beyond;
- Understanding of novel therapeutic targets for hot flushes
Societal/clinical agenda:
- Better identification and management of other sleep disorders during these life phases (such as OSA, Restless Legs Syndrome, Circadian Rhythm Sleep-Wake Disorders) that may be overlooked and underdiagnosed
- Increasing accessibility to in-person delivered CBT-I
- Decreasing costs and increasing accessibility of digital CBT-I
- Increasing access to HRT for those suitable for its use
- Introduction of novel non-hormonal therapeutics to the clinical toolbox
This list may seem long, and it will take time and research to instigate change. But I’m confident that increasing awareness of the sleep disturbances that present during the perimenopause and post-menopause will facilitate discussions in the research and clinical communities. These discussions will be essential to drive further research to enhance our understanding of the mechanisms at play, lead to breakthroughs in novel therapies, and increase accessibility of existing therapies that will enable us to all sleep that little bit sounder.