Insomnia and hot flashes.

The increasedprevalence of sleepdisordersassociated with menopause hasbeenemphasized by multiple internationalstudies. Manyfactors are associated with insomniaduring menopause, amongthem: hot flashes (HF), anxiety and depression, othermedicalconditions, behavioral and psychosocialfactors and primitive sleeppatterns. The domino hypothesisconnectsvariousfactors and suggeststhat HF disturbsleep, therebycausinginsomnia, which in turn increasesvulnerability to depression. Nevertheless, sleepdisorderspredict mood disturbances more robustlythanvasomotorsymptoms (VMS), indicatingthatsleepalsoinfluences mood via othermechanisms. The medicalconditionsthatmay compromise sleep in thisagegroup are common; they include obesity, gastroesophagealreflux, cancer, urinaryincontinence and nocturia, thyroiddysfunction, chronicpain, fibromyalgia (oftenstarting or worsening in menopause), and hypertension. Common causes of sleepdisorders in middle-agedwomen include poorsleephygiene, volitionalfactors, environmentaldisturbances, alcoholintake, maritaldissatisfaction, requests for care from children, grandchildren and/or elderlyparents, and financialworries. Evidence from otherpopulationssuggeststhatifinsomniaisnottreated, itmaynegativelyaffect the outcome of comorbidconditions. Takentogether, theseobservationssuggestthatinsomniashould be considered a disorderrequiringspecificattention and treatment. Moreover, recent cross-sectional data link sleep with subclinicalmarkers of cardiovascularrisk. Itshouldalso be notedthatinsomniais common in patients with mild to moderate obstructivesleep apnea syndrome (OSAS).