WHEN DOES ESTROGEN REPLACEMENT THERAPY IMPROVE SLEEP QUALITY

OBJECTIVE: Our purpose was to evaluate the effect of estrogen replacem ent therapy on sleep complaints by postmenopausal women and to assess the predictive factors involved. STUDY DESIGN: Sixty-three postmenopau sal women entered a 7-month prospective,randomized, double-blind cross over study consisting of two 3-month treatments with estrogen and plac ebo with a 1-month washout period between. Eight Visual Analogic Scale statements about different sleep complaints, the Basic Nordic Sleep Q uestionnaire, scoring of climacteric symptoms, The Beck Depression Inv entory, and serum estradiol and follicle-stimulating hormone level con trols were the main outcome measures. RESULTS: Estrogen replacement th erapy improved sleep quality, facilitated falling asleep, and decrease d nocturnal restlessness and awakenings (p < 0.001). The subjects were less tired in the mornings and in the daytime (p < 0.001) when taking estrogen replacement therapy Estrogen-induced sleep improvement was a ssociated with alleviation of vasomotor symptoms (r range 0.27 to 0.55 ), alleviation of somatic symptoms (palpitations and muscular pain, r range 0.26 to 0.36), and alleviation of mood symptoms (r range 0.28 to 0.37) on estrogen replacement therapy The severity of initial insomni a predicted only one estrogen-induced sleep improvement effect: the mo re the subjects experienced insomnia, the better the estrogen replacem ent therapy facilitated falling asleep (r = 0.26, p = 0.040). Estrogen -induced sleep improvement was also reported by the 15 climacterically asymptomatic subjects. In these subjects initial insomnia scores stro ngly predicted estrogen-induced sleep improvement (r range 0.50 to 0.7 5). CONCLUSIONS: Estrogen replacement therapy significantly diminished sleep complaints among post-menopausal women. Alleviation of climacte ric symptoms was the most important predictive factor for the benefici al effect of estrogen replacement therapy on sleep complaints. The use of estrogen replacement therapy in women without self-reported climac teric symptoms could also be considered because women do not always re cognize their climacteric symptoms or they ignore them.