Insomnia Treatment in Menopausal Women

Diagnosis and Assessment

• The American Geriatrics Society recommends that diagnosis of insomnia requires difficulty falling or staying asleep for at least 1 month with resulting daytime impairment 2
• Evaluation of insomnia should include assessment for other contributing factors, such as medical conditions, medications that may disrupt sleep, including β-blockers, bronchodilators, corticosteroids, decongestants, diuretics, SSRIs, and SNRIs 2 3

Treatment Approach

• The American Geriatrics Society suggests that Cognitive Behavioral Therapy for Insomnia (CBT-I) is the first-line treatment for chronic insomnia in all populations, including menopausal women 1
• CBT-I has been shown to be highly effective with sustained effects for up to 2 years in older adults 3
• Key components of CBT-I include sleep restriction/compression, stimulus control, sleep hygiene education, and cognitive therapy 4 5

Pharmacological Options

• The American Geriatrics Society recommends that for short-term management of insomnia, FDA-approved medications include benzodiazepines, non-benzodiazepine receptor agonists, and melatonin receptor agonists 5
• Low-dose trazodone or doxepin may be considered for patients with insomnia not responding to CBT-I alone 1

Follow-up and Monitoring

• The American College of Cardiology is not relevant here, however, reassess sleep patterns using sleep logs after 2-4 weeks of intervention 1
• Evaluate improvement in sleep efficiency, total sleep time, and daytime functioning 1
• If insomnia persists despite these interventions, consider referral to a sleep specialist 1