Insomnia, Menopause
Conditions
Keywords
Perimenopause, Insomnia, Cognitive Behavioral Therapy, Hormone Replacement Therapy
Brief summary
The goal of the clinical trial is to learn if Hormone Replacement Therapy (HRT) and Cognitive Behavioral Therapy (CBT-I) can treat insomnia in menopausal women. The main questions it aims to answer are: * Are HRT and CBT-I effective in reducing insomnia in menopausal women? * Are HRT and CBT-I comparable in terms of reducing insomnia severity in this population? Researchers will compare HRT and CBT-I to an active control group, receiving sleep hygiene instructions. Participants will: * Complete a screening and baseline assessment * Receive Hormone Replacement Therapy (as prescribed), Cognitive Behavioral Therapy (1/week), or sleep hygiene instructions (1/week) for 8 weeks. * Keep a daily diary (sleep e-diary), to assess sleep-quality. * Wear an electroencephalogram (EEG) during 6 nights (3 at baseline & 3 post-intervention), to assess deep sleep cycles and waking episodes. * Receive a phone call for intervention compliance * Complete a post-intervention assessment.
Interventions
CBT-I is conducted in an individual setting according to the manual used in McCurry (1). Factors at the level of behavior, cognitions, and physiology that perpetuate sleep onset and sleep maintenance disorders are addressed. In addition, psychoeducation on sleep and sleep hygiene, stimulus control, sleep restriction, relaxation, structured worry time, cognitive restructuring, and relapse prevention are part of the training. Each session will include homework.
Standard-dose continuously-combined bio-identical HRT containing transdermal estradiol 1.5 mg/d (= 2 strokes of Oestrogel® Dispenser) and oral micronized progesterone (= 1 capsule of Utrogestan® 200). This combination is the most popular HRT regimen, as it has a neutral effect on lipids, glucose, haemostasis. Participants will receive a conventional prescription for the 2 products that are covered by all health insurances in Switzerland.
BEHAVIORALSleep Hygiene
Sleep hygiene refers to healthy sleep habits, e.g. food and drink choices, a regular sleep schedule, evening routine. Although being widely used in daily practice, sleep hygiene shows no significant effect as monotherapy in patients with an established insomnia. The sleep hygiene condition in this study is matched to CBT-I in frequency and intensity of contact.
Sponsors
Insel Gruppe AG, University Hospital Bern
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
45 Years to 69 Years
Healthy volunteers
Yes
Inclusion criteria
* Late menopausal transition according to Stages of Reproductive Aging criteria (STRAW+10) * Pittsburgh Sleep Quality Index (PSQI) score \> 5 * Insomnia Severity Index (ISI) score \> 7 * Somato-vegetative domain of the Menopause Rating Scale (MRS)-II ≥ 4 points * Willingness to use HRT for menopausal symptom reliefs
Exclusion criteria
* Other sleep-wake disorders according to DSM-5, assessed with validated questionnaires (Sleep-Health Questionnaire, Epworth Sleepiness Scale (ESS)) * Untreated hormonal disorder * Obesity (BMI ≥ 30) * Current psychotherapy * Current psychopharmacological therapy including regular sleep medication * History of unsuccessful CBT-I * Psychiatric illness * Substance abuse (≥ 7 cigarettes/day, no more than 2 standard WHO drinks per day, other drugs) * Shift work * Long-haul flights across different time zones in the past 3 months * Pregnancy and lactation * Contraindications to HRT according to drug information (https://www.swissmedicinfo.ch/) * Inability to follow procedures or insufficient knowledge of project language * Inability to give consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Reduction of Insomnia Severity | Week 10 | Change from baseline in Insomnia Severity Index (ISI). The ISI is a seven-item questionnaire, asking respondents to rate the severity of sleep-related symptoms on 5-point Likert scales (Ranging between 0 = not applicable and 4 = very strong). Total values may range between 0 and 28, where 0 indicates no presence of sleep-related symptoms and 28 indicates very severe symptoms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Improvement in Climacteric Syndrome | Week 10 | Change from baseline in Menopause Rating Scale (MRS-II) The MRS-II is an eleven-item questionnaire, asking respondents to rate the severity of climcteric syndrome-related symptoms on 5-point Likert scales (Ranging between 0 = not applicable and 4 = very strong). Total values may range between 0 and 44, where 0 indicates no presence of symptoms and 44 indicates very severe symptoms. |
| Changes in bio-functional age | Week 10 | Change from baseline in biofunctional status (i.e. differences between chronological age and biofunctional age). |
| Changes in maladaptive sleep-related cognitions | Week 10 | Change from baseline in Dysfunctional Attitudes and Beliefs about Sleep Scale (DBAS). The DBAS is a sixteen-item questionnaire, asking respondents to rate their attitudes/beliefs about sleep on 10-point numerical rating-scales (discrete intervals), ranging between 0 (I do not agree at all) and 10 (I agree completely). Total values may range between 0 and 160, where 0 indicates no presence of dysfunctional attitudes and 160 indicates very severe levels of maladaptive sleep-related cognitions. |
Countries
Switzerland
Contacts
Primary ContactPetra Stute, Prof.
Outcome results
None listed