Behavioral Treatment of Menopausal Insomnia; Sleep, Depression, Daytime Outcomes

描述(申请人提供)：失眠被认为是最普遍和最昂贵的睡眠障碍之一，并与相当大的发病率有关，包括显著降低的生活质量，工作表现受损，以及患严重抑郁障碍的风险增加。1-4失眠是绝经过渡的关键症状，40%-50%的绝经后妇女(&gt；1700万)患有失眠。5，6与更年期相关的失眠具有睡眠障碍的模式，主要特征是睡眠维持困难，包括频繁唤醒和唤醒，睡眠效率降低，以及睡眠总体支离破碎。最近的研究表明，这种睡眠障碍的模式，难以维持睡眠，在整个更年期过程中都会增加。7我们最近发现，更年期的睡眠维持问题与工作表现下降、医疗保健利用率增加和生活质量受损有关。8历史上，包括睡眠障碍在内的更年期症状都是使用激素替代疗法(HRT)来治疗的。然而，将HRT与心脏病和癌症风险增加联系起来的证据已经导致绝经后妇女使用性激素减少了40%，并强调了替代治疗方法的必要性。9重要的是，美国临床内分泌学家协会的更年期管理指南没有涉及更年期相关失眠的治疗，因为在这一领域缺乏研究结果。10失眠的认知行为疗法(CBT-I)具有与药物治疗失眠相同的短期疗效和更好的长期耐受性。然而，认知行为疗法对绝经合并失眠的疗效尚未得到测试，这是本提案的主要关注点之一。然而，传统的CBT-I有缺点，包括需要训练有素的治疗师和患者的大量时间投入。因此，多组分CBT-I的广泛应用受到CBT睡眠专科医生数量相对较少、治疗的复杂性和患者负担的限制。因此，该项目的另一个目标是测试单一成分行为疗法对更年期失眠的急性和长期疗效。考虑到绝经期失眠患者存在严重的日间损害，包括抑郁、生活质量和疲劳，本提案的最终目标是确定CBT-I对绝经相关失眠女性的这些措施的有效性。

DESCRIPTION (provided by applicant): Insomnia is recognized as one of the most prevalent and costly sleep disorders and is associated with considerable morbidity including significantly reduced quality of life, impaired work performance, and increased risk for major depressive disorder.1-4 Insomnia is a key symptom of the menopausal transition with 40-50% of postmenopausal women (> 17 million) having insomnia.5,6 Insomnia associated with menopause has a pattern of sleep disturbance predominantly characterized by sleep maintenance difficulties including frequent awakenings and arousals, reduced sleep efficiency, and overall fragmented sleep. It has recently been demonstrated that this pattern of sleep disturbance, difficulty maintaining sleep, increases throughout the progression of menopause.7 We have recently found sleep maintenance problems in menopause are associated with reduced work performance, increased healthcare utilization, and impaired quality of life.8 Historically, menopausal symptoms including sleep disturbance, were treated using hormone replacement therapy (HRT). However, evidence linking HRT to increased risks of heart disease and cancer have led to a 40% reduction in the use of sex steroid hormones by postmenopausal women and highlight the need for alternative approaches to treatment.9 Importantly, the American Association of Clinical Endocrinologists guidelines for management of menopause do not address treatment of menopausal-related insomnia due to the absence of research findings in this area.10 Cognitive-behavioral therapy for insomnia (CBT-I) yields equivalent short-term efficacy and superior long-term durability to pharmacological treatment of insomnia. However, the efficacy of cognitive behavioral therapy for insomnia comorbid with menopause, one of the primary focuses of the present proposal, has not been tested. Traditional CBT-I has disadvantages however, including the need for a trained therapist and significant time commitment on the part of the patient. Therefore, widespread availability of multicomponent CBT-I is limited by the relatively low number of CBT sleep specialists, complexity of therapy, and patient burden. Thus, another aim of this project is to test the acute and long-term efficacy of a single component behavioral therapy for menopausal-related insomnia. Given the significant daytime impairment present in insomnia comorbid with menopause including depression, quality of life, and fatigue, a final aim of this proposal is to determine the efficacyof CBT-I on these measures in women with menopausal-related insomnia.