Difficulty falling asleep. Waking abruptly in the night. Battling exhaustion in the day. These symptoms of insomnia strike 15%-60% of women during menopause . Several menopause-related factors, including hot flushes, mood changes, and stress are linked to the onset of insomnia. Estrogen replacement therapy can help relieve a number of menopausal symptoms that may contribute to insomnia. Many physicians, however, question its use to improve sleep due to mixed study results and concerns about the safety of long-term estrogen replacement .
The search for nonhormonal treatment options led researchers to take a closer look at eszopiclone (Lunesta), which is approved by the US Food and Drug Administration (FDA) for insomnia. In a study in the December 2006 issue of Obstetrics and Gynecology, women with menopause-related insomnia given eszopiclone for four weeks reported significant improvements in sleep quality compared with those given placebo.
About the Study
Researchers from McMaster University in Canada, Harvard Medical School, and the Ford Sleep Center in Michigan studied the sleep quality of 410 menopausal women, ages 40-60, who developed insomnia during menopause. The women were randomly assigned to take eszopiclone (3 mg) or placebo daily for four weeks. Each day, the women described the previous night’s slumber, including time to fall asleep and the incidence of nighttime awakenings. They also described daytime functioning and occurrence of hot flushes.
Compared with placebo, eszopiclone produced significant improvements in several measures of sleep quality. Women taking eszopiclone fell asleep 26 minutes faster than before the study (vs.10 minutes faster with placebo), were awake less often during the night (31 minutes less vs.16 minutes less with placebo), and enjoyed a 57-minute increase in total sleep time (vs. 34 minutes with placebo). After four weeks, the number of women with clinical insomnia dropped by 58% in the intervention group (vs. 35% in placebo group). Women taking eszopiclone also reported improvements in daytime function and nighttime hot flushes.
A bias in this study is that data on sleep quality and hot flushes were reported by patients, rather than measured in a sleep laboratory. Use of objective measures is necessary to further validate these findings.
How Does This Affect You?
While eszopiclone improved sleep quality and daytime symptoms in this study, the efficacy of this drug beyond four weeks for menopausal women is unknown. However, eszopiclone is already approved for the long-term treatment of insomnia in adults. An important consideration with any sleep aid is the risk of becoming dependent on the drug to fall asleep. The risk of dependency with eszopiclone is considered low to medium.
If you are dealing with insomnia, talk with your doctor. The best treatment depends on your medical history and symptoms. Good sleep habits are essential to any treatment plan; this includes the following:
- Go to bed and wake up at the same time every day
- Keep your bedroom cool
- Keep a cloth in a bucket of ice close to your bed to quickly treat a hot flush
- Establish a 20- to 30-minute relaxing bedtime routine
- Try deep breathing and meditation exercises
- Keep a notebook near the bed to write down any worries
- Take part in daily physical activity
- Avoid vigorous exercise within two hours of bedtime
- Avoid napping
- Avoid nicotine, caffeine, alcohol, and drugs
- Don’t watch the clock while in bed
- Keep lights low or off in the bedroom and bathroom at night
- Don’t use the bed for activities other than sleeping, such as watching TV
- Reviewer: Richard Glickman-Simon, MD
- Review Date: 02/2007 -