Estrogen Treatment Restores Normal Sleep Patterns in Menopausal Women
Patients were either already on a patch that delivers estrogen through the skin before the study began or were prescribed one. Patches were changed twice weekly and released daily doses of estrogen.
The study confirmed that ERT had subtle but specific effects on sleep. For instance, ERT significantly increased the amount of time patients had REM sleep and reduced the time spent awake from 20 to 12 minutes during the first two sleep cycles of the night. A sleep cycle is a period of non-REM sleep followed by a minimum of five minutes of REM sleep. A sleep cycle can last approximately 70 to 120 minutes and be repeated four to six times a night.
The authors noted changes in deep sleep that mimicked the deep sleep patterns seen in younger, healthy individuals. People with sleep difficulties and depressed people do not have such patterns. They also found evidence that ERT appeared to play a role in the improvement of cognitive functioning, according to Antonijevic.
Without ERT, 10 of the 11 women rated their sleep as dissatisfying and reported three to five awakenings per night. That ratio changed dramatically after ERT, as 10 of the 11 women rated the quality of their sleep as very or quite satisfying, with only one or two awakenings per night.
"The improvement of sleep with ERT in menopausal women was documented in the late 1970s in England and we documented it in 1980," Quentin Regestein, MD, of the psychiatry department at Harvard Medical School, tells WebMD. "We also found the women got to sleep faster and had more REM -- but we didn't show some of the details, like the decrease in [deep] sleep these people have found." Regestein, however, was quite impressed with the reported change in sleep satisfaction after ERT, a finding he says is "extremely telling."
Menopausal patients with sleep problems should keep track of their sleep with a sleep diary, Trupin says. Then "they should have a general evaluation with a health care provider to rule out other medical causes of insomnia. If the patient is postmenopausal and a candidate for estrogen, most physicians would then probably recommend ERT as the next step."