Sleep Medicine Reviews, Vol. 2, No. 4, pp 243-253, 1998 REVIEW ARTICLE SLEEP MEDICINE pzq Sleep in peri-menopausal and post-menopausal women Andrew D. Krystal, Jack Edinger, William Wohlgemuth and Gail R. Marsh The Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA Despite the fact that a large number of women report sleep disturbances associated with peri-menopausal and post-menopausal periods, there is a surprising lack of literature related to this issue. In fact, there has not been enough work in this area to even definitively establish whether there is a sleep disorder that is specifically related to these life-stage changes. Herein we review the available literature which suggests that insomnia may be directly linked to the changes that occur during the perilpost-menopausal periods. This insomnia appears to be due to night sweats caused by the hormonal changes which occur and which lead to an increase in arousals. Persistence of insomnia symptoms after adequate hormone replacement therapy may indicate that behavioral conditioning of the insomnia initially triggered by the night sweats may have occurred. Alternatively, such an insomnia in a perilpost-menopausal woman could be due to unresolved grief related to going through menopause or could reflect an independent sleep disorder, suck as periodic movements of sleep, sleep apnea, depression, anxiety, etc. Whereas menopausal changes do not directly lead to an increase in sleep apnea they seemingly contribute to an increased risk for this disorder. In view of these considerations, we provide guidelines for the proper diagnosis and treatment of perilpost-menopausal women with sleep complaints. Key words: Insomnia, menopause, sleep, peri-menopause, night sweats The menopause is the cessation of cyclic ovarian function as manifested by the occurrence of the final menstrual period [1,2]. This occurs at a mean age of 51 years, however, a decrease in ovarian function precedes the menopause and is termed the climacteric (also referred to as the peri-menopausal period) [2]. The climacteric is generally accompanied by changes in the menstrual cycle and vasomotor symptoms which are often gradual in onset, typically begin long before menses cease, and may sometimes be more severe than post-menopausal symptoms [3,4]. Thus, women typically live over one-third of their life after the onset of the climacteric and the occurrence of menopause wherein they may suffer from a number of symptoms 141. The symptoms typical of the climacteric and post-menopausal periods are thought to be due to Correspondence to be addressed to: Andrew D. Krystal, Box #3309 Duke University Medical Center, Durham, NC 27710, USA. (e-mail:krystal@cs.duke.edu) 1087-0792/98/040243+11$12.00/0 0 1998 W.B. Saunders Company Ltd