Insomnia During Menopause

  • Helena Hachul
  • Daniel Ninello Polesel
  • Sergio Tufik
Part of the Current Clinical Neurology book series (CCNEU)


Menopause is a period in a woman’s life that starts from a year after the date of the last menstrual cycle. It can only be confirmed after 12 consecutive months of amenorrhea, associated with changes in luteinizing hormone and follicle-stimulating hormone levels. Global life expectancy has increased and now women spend nearly one third of their lives in the climacteric period, and therefore experience the consequences of hypoestrogenism for longer than before. The hypoestrogenism, resulting from ovarian failure promotes a series of negative consequences in relation to women’s health, like insomnia, anxiety, irritability, hot flashes, sleep-disordered breathing, qualitative alterations in the skin and hair. In addition, there is a modification in fat distribution, with more abdominal after menopause. Vasomotor symptoms, as hot flashes and excessive sweating, which affect and impair sleep quality, are frequently associated with anxiety, irritability and depressive symptoms. Some evidence suggests that there is a bidirectional interaction between psychological distress and decreased estrogen levels. Hormonal therapy can be an effective treatment; however, the potential side effects of hormone therapy (especially thromboembolic events) must be taken in account before it is prescribed. In older women, the risks associated with oral hormone therapy exceed the benefits. Cognitive-behavioral therapy for insomnia has been shown to be the main non-pharmacological treatment, particularly for chronic insomnia. There is strong evidence that multidisciplinary teams can provide an individualized evaluation of the patient as a whole. The best therapeutic approach is a holistic one taking into consideration both the body and the mind and putting the therapy in both pharmacological and biopsychological contexts in order to promote better health and a better quality of life.


Insomnia Menopause Quality of life Sleep Women 


  1. 1.
    Organization WSGoRotMitsWH. Research on the menopause in the 1990s: report of a WHO scientific group. Geneva: World Health Organization; 1996.Google Scholar
  2. 2.
    Meeta DL, Agarwal N, Vaze N, Shah R, Malik S. Clinical practice guidelines on menopause: an executive summary and recommendations. J Midlife Health. 2013;4(2):77–106.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Vahidroodsari F, Ayati S, Yousefi Z, Saeed S. Comparing serum follicle-stimulating hormone (FSH) level with vaginal PH in women with menopausal symptoms. Oman Med J. 2010;25(1):13–6.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Kim J, Lee H, Lee O, et al. Isoflavone supplementation influenced levels of triglyceride and luteunizing hormone in Korean postmenopausal women. Arch Pharm Res. 2013;36(3):306–13.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012;19(4):387–95.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Society IM. Menopause terminology 2019.
  7. 7.
    Tsigkou A, Luisi S, Reis FM, Petraglia F. Inhibins as diagnostic markers in human reproduction. Adv Clin Chem. 2008;45:1–29.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Cobellis L, Luisi S, Pezzani I, Reis F, De Leo V, Petraglia F. Serum inhibin A, inhibin B, and pro-alphaC levels are altered after surgically or pharmacologically induced menopause. Fertil Steril. 2002;77(4):745–9.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Sammel MD, Freeman EW, Liu Z, Lin H, Guo W. Factors that influence entry into stages of the menopausal transition. Menopause. 2009;16(6):1218–27.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Global Health Observatory (GHO) data – Life expectancy. World Health Organization. Published 2019. Accessed 20 Feb 2019.Google Scholar
  11. 11.
    Rannevik G, Carlström K, Jeppsson S, Bjerre B, Svanberg L. A prospective long-term study in women from pre-menopause to post-menopause: changing profiles of gonadotrophins, oestrogens and androgens. Maturitas. 1986;8(4):297–307.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441–6.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Sands-Lincoln M, Loucks EB, Lu B, et al. Sleep duration, insomnia, and coronary heart disease among postmenopausal women in the Women’s Health Initiative. J Womens Health (Larchmt). 2013;22(6):477–86.CrossRefGoogle Scholar
  14. 14.
    Glantz H, Thunström E, Johansson MC, et al. Obstructive sleep apnea is independently associated with worse diastolic function in coronary artery disease. Sleep Med. 2015;16(1):160–7.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Mirmirani P. Hormonal changes in menopause: do they contribute to a ‘midlife hair crisis’ in women? Br J Dermatol. 2011;165(Suppl 3):7–11.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    de Oliveira Ferreira N, da Silva RB, Arthuso M, Pinto-Neto AM, Caserta N, Costa-Paiva L. Prevalence of vertebral fractures and quality of life in a sample of postmenopausal Brazilian women with osteoporosis. Arch Osteoporos. 2012;7:101–6.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Cao Y, Zhang S, Zou S, Xia X. The relationship between endogenous androgens and body fat distribution in early and late postmenopausal women. PLoS One. 2013;8(3):e58448.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Baracat EC, Barbosa IC, Giordano MG, et al. A randomized, open-label study of conjugated equine estrogens plus medroxyprogesterone acetate versus tibolone: effects on symptom control, bleeding pattern, lipid profile and tolerability. Climacteric. 2002;5(1):60–9.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Chlebowski RT, Anderson GL, Gass M, et al. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA. 2010;304(15):1684–92.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th edition (DSM-5). Washington, DC: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  21. 21.
    Castro LS, Poyares D, Leger D, Bittencourt L, Tufik S. Objective prevalence of insomnia in the São Paulo, Brazil epidemiologic sleep study. Ann Neurol. 2013;74(4):537–46.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Bittencourt LR, Santos-Silva R, Taddei JA, Andersen ML, de Mello MT, Tufik S. Sleep complaints in the adult Brazilian population: a national survey based on screening questions. J Clin Sleep Med. 2009;5(5):459–63.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Hachul H, Bittencourt LR, Soares JM, Tufik S, Baracat EC. Sleep in post-menopausal women: differences between early and late post-menopause. Eur J Obstet Gynecol Reprod Biol. 2009;145(1):81–4.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995;18(6):425–32.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Hachul H, Frange C, Bezerra AG, et al. The effect of menopause on objective sleep parameters: data from an epidemiologic study in São Paulo, Brazil. Maturitas. 2015;80(2):170–8.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    von Mühlen DG, Kritz-Silverstein D, Barrett-Connor E. A community-based study of menopause symptoms and estrogen replacement in older women. Maturitas. 1995;22(2):71–8.CrossRefGoogle Scholar
  27. 27.
    Campos HH, Bittencourt LRA, Haidar MA, Tufik S, Baracat EC. Sleep disturbance prevalence in postmenopausal women. Rev Bras Ginecol Obstet. 2005;27(12):6.Google Scholar
  28. 28.
    Vigeta SM, Hachul H, Tufik S, de Oliveira EM. Sleep in postmenopausal women. Qual Health Res. 2012;22(4):466–75.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Young T, Rabago D, Zgierska A, Austin D, Laurel F. Objective and subjective sleep quality in premenopausal, perimenopausal, and postmenopausal women in the Wisconsin Sleep Cohort Study. Sleep. 2003;26(6):667–72.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Smith RL, Flaws JA, Mahoney MM. Factors associated with poor sleep during menopause: results from the Midlife Women’s Health Study. Sleep Med. 2018;45:98–105.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Okun ML, Kravitz HM, Sowers MF, Moul DE, Buysse DJ, Hall M. Psychometric evaluation of the Insomnia Symptom Questionnaire: a self-report measure to identify chronic insomnia. J Clin Sleep Med. 2009;5(1):41–51.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Calleja-Agius J, Brincat MP. The urogenital system and the menopause. Climacteric. 2015;18(Suppl 1):18–22.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Furtado D, Hachul H, Andersen ML, Castro RA, Girão MB, Tufik S. Nocturia × disturbed sleep: a review. Int Urogynecol J. 2012;23(3):255–67.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Ensrud KE, Stone KL, Blackwell TL, et al. Frequency and severity of hot flashes and sleep disturbance in postmenopausal women with hot flashes. Menopause. 2009;16(2):286–92.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Cray L, Woods NF, Mitchell ES. Symptom clusters during the late menopausal transition stage: observations from the Seattle Midlife Women’s Health Study. Menopause. 2010;17(5):972–7.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Da Fonseca AM, Bagnoli VR, Souza MA, et al. Impact of age and body mass on the intensity of menopausal symptoms in 5968 Brazilian women. Gynecol Endocrinol. 2013;29(2):116–8.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Sandilyan MB, Dening T. Mental health around and after the menopause. Menopause Int. 2011;17(4):142–7.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Guilleminault C, Palombini L, Poyares D, Chowdhuri S. Chronic insomnia, postmenopausal women, and sleep disordered breathing: part 1. Frequency of sleep disordered breathing in a cohort. J Psychosom Res. 2002;53(1):611–5.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Guilleminault C, Palombini L, Poyares D, Chowdhuri S. Chronic insomnia, premenopausal women and sleep disordered breathing: part 2. Comparison of nondrug treatment trials in normal breathing and UARS post menopausal women complaining of chronic insomnia. J Psychosom Res. 2002;53(1):617–23.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Wesstrom J, Nilsson S, Sundstrom-Poromaa I, Ulfberg J. Restless legs syndrome among women: prevalence, co-morbidity and possible relationship to menopause. Climacteric. 2008;11(5):422–8.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3 Pt 1):608–13.PubMedCrossRefGoogle Scholar
  42. 42.
    Andersen ML, Bittencourt LR, Antunes IB, Tufik S. Effects of progesterone on sleep: a possible pharmacological treatment for sleep-breathing disorders? Curr Med Chem. 2006;13(29):3575–82.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Moraes W, Piovezan R, Poyares D, Bittencourt LR, Santos-Silva R, Tufik S. Effects of aging on sleep structure throughout adulthood: a population-based study. Sleep Med. 2014;15(4):401–9.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Yusuf S, Hawken S, Ounpuu S, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366(9497):1640–9.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med. 2003;163(4):427–36.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49(5):565–71.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Hachul de Campos H, Brandão LC, D’Almeida V, et al. Sleep disturbances, oxidative stress and cardiovascular risk parameters in postmenopausal women complaining of insomnia. Climacteric. 2006;9(4):312–9.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Frange C, Banzoli CV, Colombo AE, et al. Women’s sleep disorders: integrative care. Sleep Sci. 2017;10(4):174–80.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Parish JM. Sleep-related problems in common medical conditions. Chest. 2009;135(2):563–72.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Martínez-Jauand M, Sitges C, Femenia J, et al. Age-of-onset of menopause is associated with enhanced painful and non-painful sensitivity in fibromyalgia. Clin Rheumatol. 2013;32(7):975–81.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Lizcano F, Guzmán G. Estrogen deficiency and the origin of obesity during menopause. Biomed Res Int. 2014;2014:757461.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Polesel DN, Hirotsu C, Nozoe KT, et al. Waist circumference and postmenopause stages as the main associated factors for sleep apnea in women: a cross-sectional population-based study. Menopause. 2015;22(8):835–44.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Zargarian N, Lindquist R, Gross CR, Treat-Jacobson D. Outcome measures of behavioral weight loss programs in perimenopause. South Med J. 2014;107(8):486–96.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Terauchi M, Hiramitsu S, Akiyoshi M, et al. Associations between anxiety, depression and insomnia in peri- and post-menopausal women. Maturitas. 2012;72(1):61–5.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Brown JP, Gallicchio L, Flaws JA, Tracy JK. Relations among menopausal symptoms, sleep disturbance and depressive symptoms in midlife. Maturitas. 2009;62(2):184–9.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Stuenkel CA. Menopausal hormone therapy: current considerations. Endocrinol Metab Clin N Am. 2015;44(3):565–85.CrossRefGoogle Scholar
  58. 58.
    Attarian H, Hachul H, Guttuso T, Phillips B. Treatment of chronic insomnia disorder in menopause: evaluation of literature. Menopause. 2015;22(6):674–84.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Cho NY, Kim S, Nowakowski S, Shin C, Suh S. Sleep disturbance in women who undergo surgical menopause compared with women who experience natural menopause. Menopause. 2019;26(4):357–64.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Hachul H, Polesel DN. Insomnia pharmacotherapy: a review of current treatment options for insomnia in menopause. In: Attarian H, Kay-Stacey M, editors. Current sleep medicine reports, vol. 32017:299–305.Google Scholar
  61. 61.
    Zaw JJT, Howe PRC, Wong RHX. Postmenopausal health interventions: time to move on from the Women’s Health Initiative? Ageing Res Rev. 2018;48:79–86.CrossRefGoogle Scholar
  62. 62.
    Kao CH, Sun LM, Liang JA, Chang SN, Sung FC, Muo CH. Relationship of zolpidem and cancer risk: a Taiwanese population-based cohort study. Mayo Clin Proc. 2012;87(5):430–6.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012;2(1):e000850.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Joffe H, Petrillo L, Viguera A, et al. Eszopiclone improves insomnia and depressive and anxious symptoms in perimenopausal and postmenopausal women with hot flashes: a randomized, double-blinded, placebo-controlled crossover trial. Am J Obstet Gynecol. 2010;202(2):171.e171–11.CrossRefGoogle Scholar
  65. 65.
    Greenblatt DJ, Harmatz JS, Roth T, et al. Comparison of pharmacokinetic profiles of zolpidem buffered sublingual tablet and zolpidem oral immediate-release tablet: results from a single-center, single-dose, randomized, open-label crossover study in healthy adults. Clin Ther. 2013;35(5):604–11.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Martinez-Cengotitabengoa M, Diaz-Gutierrez MJ, Besga A, et al. Benzodiazepine prescriptions and falls in older men and women. Rev Psiquiatr Salud Ment. 2018;11(1):12–8.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Suvanto-Luukkonen E, Koivunen R, Sundström H, et al. Citalopram and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized, 9-month, placebo-controlled, double-blind study. Menopause. 2005;12(1):18–26.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Davari-Tanha F, Soleymani-Farsani M, Asadi M, Shariat M, Shirazi M, Hadizadeh H. Comparison of citalopram and venlafaxine’s role in treating sleep disturbances in menopausal women, a randomized, double-blind, placebo-controlled trial. Arch Gynecol Obstet. 2016;293(5):1007–13.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Defronzo Dobkin R, Menza M, Allen LA, et al. Escitalopram reduces hot flashes in nondepressed menopausal women: a pilot study. Ann Clin Psychiatry. 2009;21(2):70–6.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Ensrud KE, Joffe H, Guthrie KA, et al. Effect of escitalopram on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flashes: a randomized controlled trial. Menopause. 2012;19(8):848–55.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Yurcheshen ME, Guttuso T, McDermott M, Holloway RG, Perlis M. Effects of gabapentin on sleep in menopausal women with hot flashes as measured by a Pittsburgh Sleep Quality Index factor scoring model. J Womens Health (Larchmt). 2009;18(9):1355–60.CrossRefGoogle Scholar
  72. 72.
    Guttuso T. Nighttime awakenings responding to gabapentin therapy in late premenopausal women: a case series. J Clin Sleep Med. 2012;8(2):187–9.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Mucci M, Carraro C, Mancino P, et al. Soy isoflavones, lactobacilli, Magnolia bark extract, vitamin D3 and calcium. Controlled clinical study in menopause. Minerva Ginecol. 2006;58(4):323–34.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Hachul H, Brandão LC, D’Almeida V, Bittencourt LR, Baracat EC, Tufik S. Isoflavones decrease insomnia in postmenopause. Menopause. 2011;18(2):178–84.PubMedPubMedCentralGoogle Scholar
  75. 75.
    Holzl J, Godau P. Receptor bindings studies with Valeriana officinalis on the benzodiazepine receptor. Planta Med. 1989;55:642.Google Scholar
  76. 76.
    Sarris J, Byrne GJ. A systematic review of insomnia and complementary medicine. Sleep Med Rev. 2011;15(2):99–106.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Taavoni S, Ekbatani N, Kashaniyan M, Haghani H. Effect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trial. Menopause. 2011;18(9):951–5.PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Drake CL, Kalmbach DA, Arnedt JT, et al. Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep. 2019;42(2):zsy217.CrossRefGoogle Scholar
  79. 79.
    Guthrie KA, Larson JC, Ensrud KE, et al. Effects of pharmacologic and nonpharmacologic interventions on insomnia symptoms and self-reported sleep quality in women with hot flashes: a pooled analysis of individual participant data from four MsFLASH trials. Sleep. 2018;41(1):zsx190.PubMedCentralCrossRefGoogle Scholar
  80. 80.
    Garcia MC, Kozasa EH, Tufik S, Mello LEAM, Hachul H. The effects of mindfulness and relaxation training for insomnia (MRTI) on postmenopausal women: a pilot study. Menopause. 2018;25(9):992–1003.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Fu C, Zhao N, Liu Z, et al. Acupuncture improves peri-menopausal insomnia: a randomized controlled trial. Sleep. 2017;40(11):zsx153.CrossRefGoogle Scholar
  82. 82.
    Morgenthaler T, Kramer M, Alessi C, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep. 2006;29(11):1415–9.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Smith MT, Perlis ML, Park A, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry. 2002;159(1):5–11.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Morin CM, Vallières A, Guay B, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009;301(19):2005–15.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Morin CM, Beaulieu-Bonneau S, Bélanger L, et al. Cognitive-behavior therapy singly and combined with medication for persistent insomnia: impact on psychological and daytime functioning. Behav Res Ther. 2016;87:109–16.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Kalmbach DA, Cheng P, Arnedt JT, et al. Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education. Sleep Med. 2018;55:124–34.PubMedPubMedCentralCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Helena Hachul
    • 1
    • 2
    • 3
  • Daniel Ninello Polesel
    • 4
  • Sergio Tufik
    • 4
  1. 1.Departamento de Ginecologia e Psicobiologia, Head of the Women’s Sleep DivisionUniversidade Federal de São PauloSão PauloBrazil
  2. 2.Departamento de GinecologiaCasa de Saude Santa MarcelinaSão PauloBrazil
  3. 3.School of Medicine at Faculdade de Ciências da Saúde Albert EinsteinSão PauloBrazil
  4. 4.Departamento de PsicobiologiaUniversidade Federal de São PauloSão PauloBrazil

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