NURSING STUDY OF PERIMENOPAUSAL INSOMNIA

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Insomnia or poor sleep is said to affect from 15-30% of the general population and predominantly midlife women, leading to substantial use and misuse of hypnotics. Inadequate sleep impairs daytime function, may be an early sign of some psychiatric disorders, and contributes to cardiovascular disease and premature mortality. Studies of the objective sleep patterns of insomniacs have shown that some people have definite sleep changes and others do not but assessment over short times and in an unnatural environment (the laboratory) may lead to false assumptions about the extent or type of insomnia exhibited. Excessive stress arousal and learned behaviors incompatible with good sleep are believed to be major contributing factors to insomnia. Preliminary studies have shown that insomniac women with and without objective sleep disturbances based on one night of assessment have higher psychological distress and evidence of somatic stress arousal than women who are good sleepers. Refined assessment of general stress arousal and stress reactivity to a challenge situation in relation to objective sleep patterns is proposed. Supportive results would guide therapeutic prescriptions and reveal assessment indicators based on stress responses. The specific aims of this proposal are to: 1) validate insomnia subtypes with and without objective sleep disturbances by monitoring over longer times at home, 2) test for negative environmental conditioning as a contributing factor to insomnia, 3) compare insomnia subtypes on stress response indicators, 4) examine the relationships among stress response indicators, psychological distress, stress exposure, and coping strategies as contributing factors to insomnia with objective sleep disturbances, and 5) begin testing 2 therapies tailored for 2 of the subtypes of insomnia. The purposes of this study are to assess objective sleep patterns over 6 nights at home, determine the effect of removing women with insomnia to the laboratory for one night of sleep, and assess for general stress arousal and reaction to laboratory stress application as a basis of determining subtypes. A preliminary test of 2 therapies for insomnia, environmental conditioning and stress self-management, as applied to subtypes based on assessment will be done.