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Sleep Disorder Linked to Menopause

Hormone Therapy May Reduce Sleep Apnea but Isn't Recommended
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WebMD Health News

April 25, 2003 -- Nightly snoring and breathing-related sleep disturbances are rare in young women but common in older ones. Now, new research suggests the hormonal changes that occur during menopause may be to blame.

Compared with premenopausal women, those who had been through menopause were more than three times as likely to have had severe sleep-disordered breathing in a study from the University of Wisconsin-Madison. Sleep disordered-breathing is characterized by snoring and repeated breathing pauses during sleep, known as sleep apnea. The condition is a common cause of daytime fatigue, and may also increase the risk of high blood pressure and cardiovascular disease.

"It is important for women to know if they have this condition because it is very treatable," lead researcher Terry Young, PhD, tells WebMD. "I think a lot of women and their doctors think of sleep problems as an inevitable part of menopause."

Young adds that the findings should serve as a wake-up call to physicians and their patients that sleep problems and complaints in menopausal women "need to be looked at with as much suspicion as they are in men or premenopausal women."

The investigation involved 589 women participating in a larger, ongoing sleep study. All were evaluated for menopausal status, and sleep patterns were determined in a sleep lab. Compared with premenopausal women, postmenopausal women were 2.6 times more likely to experience sleep-disordered breathing of five or more breathing pauses per hour. They were 3.5 times as likely to have severe sleep disturbances, defined as 15 or more breathing interruptions per hour.

The findings are reported in the May issue of the American Journal of Respiratory and Critical Care Medicine. A second study, reported in the same issue of the journal, found that postmenopausal women were up to 50% less likely to experience severe sleep-disordered breathing when they took hormone replacement therapy (HRT). The study involved 2,852 women aged 50 or over, also evaluated in sleep labs. The protective benefits of HRT were particularly strong for women between the ages of 50 and 59.

The researchers concluded that HRT might be an effective treatment for sleep apnea in menopausal and postmenopausal women. But in an editorial accompanying the two studies, a Harvard Medical School sleep expert writes that the widely publicized studies linking hormone therapy to cardiovascular disease strongly argue against this.

David P. White, MD, tells WebMD that there are established treatments for sleep-disordered breathing that probably work better than HRT, without the potential risks. Masks worn during sleep, for example, apply positive pressure to the inside of the throat to prevent it from collapsing. The masks work well, but many people find them uncomfortable to wear, and long-term compliance is poor. White is director of the sleep disorders program at Harvard's Brigham and Women's Hospital.

"These two papers clearly link sleep-disordered breathing to menopause," White says. "Physicians need to be aware that this is a common problem in postmenopausal women and they need to look for it and treat it when they find it."

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