How can we treat the sleep disorders in ageing women?

Based on sociological studies we found that women use sleep management strategies, that are firmly embedded within the social context of their lives. This context defines not only the nature of women’s sleep patterns, but also their response to sleep disruption. For each woman, therefore, the choice of sleep management strategies is personalised; a strategy that is highly effective for one woman may be ineffective or simply not feasible for another. Evaluating the effectiveness and acceptability of sleep management strategies thus involves not only women’s subjective assessment of practices and treatments but also an appreciation of the constraints which frame strategy choice and may limit the uptake of otherwise effective strategies. These approaches involve e.g. preparation for sleep by using bedtime routines and/or relaxation techniques, restoring disturbed sleep during the night and the adoption of healthy lifestyle practices. Over the counter products are frequently used by women in our survey, but at the present time we do not have sufficient scientific arguments to recommend them. If these strategies fail to improve sleep, consultation of the general practitioner is suitable in order to assess the different factors involved in the sleep problem and to treat the underlying medical affections. The concept of sleep management can be used to describe the ways by which women can themselves actively improve their sleep (see the sleep management section). Daily administration of fast acting melatonin did not improve subjective sleep in postmenopausal women with self-reported sleep problems, and there was no correlation between an individual’s self-rated sleep problem and their melatonin rhythm, their response to light or their response to melatonin treatment. The findings show that the timing and amplitude of the 6-sulphatoxymelatonin rhythm is a poor predictor of self-reported sleep problems and a poor predictor of a positive response to melatonin treatment. We find this result important since melatonin is frequently used for treatment of sleep problems, though scientific evidence is contradictory. As negative results rarely get published, the bias for positive results is evident and encourages the use of ineffective medication.

Studies with hormone replacement therapy (HRT) showed that HRT gives no benefit regarding sleep quality or general quality of life for premenopausal women with still own hormone production or in late postmenopausal women with no or only mild vasomotor symptoms. We recommend that HRT should not be used for sleeping problems in climacterically asymptomatic or very low symptomatic perimenopausal, menstruating women or in climacterically asymptomatic or very low symptomatic late postmenopausal women if they have symptoms of insomnia.