title: Treatment of chronic insomnia disorder in menopause: evaluation of literature.
abstract: OBJECTIVE
  Insomnia both as a symptom and as part of chronic insomnia disorder is quite common in menopause. Comorbid conditions, such as restless legs syndrome and obstructive sleep apnea, occur with high prevalence among perimenopausal women with insomnia. Insomnia in this population group is associated with adverse health outcomes, and there are no clear standards on how to treat it.
  
  
  METHODS
  Based on extensive literature search, 76 articles were identified. Two authors independently graded evidence according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence.
  
  
  RESULTS
  Evaluation and treatment of other comorbid sleep disorders are recommended, as is cognitive-behavioral therapy for insomnia. Hormone therapy, eszopiclone, escitalopram, gabapentin, isoflavones, valerian, exercise, and hypnosis are suggested. Zolpidem, quiteiapine XL, citalopram, mirtazapine followed by long-acting melatonin, ramelteon, Pycnogenol, Phyto-Female Complex, yoga, and massage may be considered. Kampo formulas are not recommended. Acupuncture may not be suggested, and cognitive-behavioral therapy that is not tailored for insomnia probably should not be considered.
  
  
  CONCLUSIONS
  Although a variety of interventions are shown to be helpful in improving sleep in menopause, there is a need for well-designed head-to-head trials with uniform outcome measures.
authors.affiliation: From the 1Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL; 2Departments of Psychobiology and Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil; 3Department of Neurology, University at Buffalo School of Medicine, State University of New York, Buffalo, NY; and 4Department of Medicine, University of Kentucky College of Medicine, Lexington, KY.
authors.forename: Hrayr
authors.initials: H
authors.lastname: Attarian
authors.forename: Helena
authors.initials: H
authors.lastname: Hachul
authors.forename: Thomas
authors.initials: T
authors.lastname: Guttuso
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D015444:Exercise; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008405:Massage; D008517:Phytotherapy / Q000379:methods; D012148:Restless Legs Syndrome / Q000453:epidemiology / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000628:therapy*; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000628:therapy*; D015013:Yoga
chemical_list: D018687:Antidepressive Agents, Second-Generation; D006993:Hypnotics and Sedatives