When menopause hits “insomnia”
”I’ve tried all kinds of sleeping pills, but nothing works.”
”When I can’t sleep, I get so irritable that I feel like banging my head against the wall. I’ve been to several hospitals, had an ECG, brain CT, imaging and other tests done, but nothing was found!
”The first 30 years of sleeplessness, the next 30 years of sleeplessness, sleeplessness is really too painful!”
”I think I am not able to sleep well, all the problems have come out”
Menopause clinics often receive these types of women with poor sleep, most of whom have sleep disorders due to menopause .
Women have more sleep disorders than men, and menopause is the most common age group for sleep disorders. The incidence of sleep disorders in perimenopausal women is about 40%, which means that nearly half of middle-aged women are suffering from insomnia. The main symptoms are difficulty in falling asleep, easy to wake up at night, sleep disorders, poor sleep efficiency, short sleep time, and the resulting mood swings, fatigue, dizziness, chest tightness, reduced concentration, slow reaction, reduced interest, etc., which seriously affect women’s psychosocial activities and quality of life.
Why does the shadow of “sleeplessness” haunt especially menopausal women for the rest of their lives? The cause can be attributed to the post-menopausal decline in estrogen in women’s bodies. After women enter perimenopause, ovarian function declines, and the secretion of sex hormones such as estradiol and luteinizing hormone decreases significantly, causing the central regulation of sleep-wake, 5hydroxytryptamine and melatonin neurotransmitters, biological rhythms, and stress response to change at the same time, women entering perimenopause will produce hot flashes vasodilatory symptoms and depression, anxiety and other mental symptoms, these symptoms are undoubtedly for sleep disorders These symptoms are undoubtedly “worse” for sleep disorders.
Poor sleep, careful of cardiovascular disease?
A large number of studies have shown the close relationship between sleep disorders and cardiovascular disease. 2014, a meta-analysis of 17 cohort studies with 310,000 subjects showed that insomnia increases the risk of cardiovascular disease and increases cardiovascular mortality, and the risk of cardiovascular disease increases 1.5-3.9 times after insomnia, which is comparable to the risk of cardiovascular disease caused by smoking, diabetes and obesity. The risk is comparable to that of cardiovascular disease caused by smoking, diabetes and obesity.
Women are known to be at less risk of cardiovascular disease (CVD) than men of the same age, and the incidence increases dramatically after menopause, reaching levels similar to or even exceeding that of men at age 64. In addition to hyperglycemia, hypertension, dyslipidemia, estrogen decline, and obesity, which are known risk factors for CVD in menopausal women, are sleep disorders associated with the development of CVD in perimenopausal women? Are there markers that affect atherosclerosis in menopausal women? Can it be used as a predictor of atherosclerosis in menopausal women independent of other cardiovascular risk factors? These deserve to be explored.
Research results
A team of professors has been working on perimenopause and hormone replacement therapy for more than 10 years, and recently studied the effect of sleep disturbance on atherosclerosis in different menopausal states, and published the results in scientific
reports.
A total of 1904 Chinese Han women aged 40-60 years were recruited and their sleep status was assessed by a self-administered basic demographic questionnaire using the PSQI scale (Pittsburgh Sleep Quality Index, PSQI), and the study population was divided into 2 groups according to the poor sleep quality classification criteria PSQI ≥ 8, namely the sleep disorder group and the no sleep disorder group The study participants were divided into two groups, namely the sleep disorder group and the no sleep disorder group. The predictive value of different menopausal states and sleep quality on arterial stiffness was investigated by measuring ankle-brachial pulse wave velocity (baPWV), a reliable and non-invasive objective index for assessing arterial stiffness.
After correction for confounding factors (triglycerides, cholesterol, HDL, LDL, body mass index, waist-hip ratio, fasting glucose, heart rate, height, diabetes, hypertension, urine microalbumin, education level, income, and number of births) by multifactorial logstic regression analysis, sleep disturbance (PSQI ≥ 8 points) was (peri-)postmenopausal women with increased arterial stiffness (baPWV ≥ 1465.5 cm/s, upper quartile) as an independent risk factor (OR 2.83, 95% CI2.00-4.00, p < 0.001), whereas in premenopausal women this factor was not statistically significant (OR 1.67, 95% CI 0.71 -3.90, p = 0.223).
In addition, multivariate regression analysis showed that age (OR 1.16, 95% CI 1.12 – 1.20), systolic blood pressure (OR 1.10, 95% CI 1.09 – 1.12), heart rate (OR 1.05 95% CI 1.03 – 1.06), body mass index (OR 0.91, 95% CI 0.87 – 0.97), triglycerides (OR 1.22, 95% CI 1.06 – 1.41), fasting glucose, (OR 1.15, 95% CI 1.01 – 1.06) were also independent risk factors for increased arterial stiffness. factor.
Compared to the group without sleep disorders, women in the sleep disorders group were older, had a larger body mass index, a larger waist-to-hip ratio, a faster heart rate, disturbed lipid metabolism, a higher proportion of positive urine microalbumin, a higher prevalence of hypertension and diabetes, more people in (peri)menopause, fewer people in working status, lower income, and more children (all p < 0.05).
Our study suggests that sleep disorders can have a direct effect on vascular stiffness through certain pathways independently of other risk factors, and the potential mechanisms can be summarized as endocrine or metabolic disorders, sympathetic activation, inflammation and coagulation pathway activation. In contrast, decreased estrogen levels after menopause can directly affect cardiovascular regulation, and decreased estrogen levels affect sleep-wake regulation, thermoregulation, stress response, and regulation of 5hydroxytryptamine and melatonin neurotransmitters, causing sleep disturbances. Thus, menopause exacerbates the increase in arterial stiffness caused by sleep disturbances by acting in two ways: by itself directly causing an increase in arterial stiffness, and by causing sleep disturbances that further increase the effect of sleep disturbances on the increase in arterial stiffness.
Conclusion
For (peri)menopausal women, sleep disturbance predicts the risk of atherosclerosis in women and increases the risk 2.83-fold. In addition, age, systolic blood pressure, heart rate, body mass index, triglycerides, and fasting glucose are independent risk factors for increased arterial stiffness. Therefore, we need to pay close attention to sleep problems in (peri)menopausal women and provide a clinical predictive basis for the prevention of adverse cardiovascular events in (peri)menopausal women by assessing sleep quality, such as improving sleep problems in menopausal women through some interventions, such as hormone replacement therapy (MHT).