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    How telephone therapy can improve sleep quality in menopausal women

    Women who are menopausal may be able to improve their sleep quality if they have access to telephone-based cognitive behavioral therapy for insomnia (CBT-I), according to results from a single-site, randomized clinical trial in JAMA.

    From September 2013 to August 2015, the researchers looked at women in western Washington State aged 40 to 65 years who were perimenopausal or postmenopausal who had moderate insomnia symptoms and 2 or more daily occurrences of vasomotor symptoms. Assessments were blinded and conducted at baseline, 8 weeks, and 24 weeks following randomization. Intent-to-treat analysis was also conducted. The 106 women underwent either 6 telephone sessions of CBT-I or menopause education control (MEC) sessions over 8 weeks that provided information about menopause and women’s health.

    After those 8 weeks, Insomnia Severity Index (ISI) scores had fallen by 9.9 points in the 53 women who received CBT-I (mean [SD] age, 55.0 [3.5] years) and by 4.7 points among the women in the control group (age, 54.7 [4.7] years), representing a 5.2-point difference between the groups (95% CI, –6.1 to –3.3; P < .001). Using the Pittsburgh Sleep Quality Index, the scores decreased 4.0 points in women who received CBT-I and 1.4 points in the control group, representing a between-group difference of 2.7 points (95% CI, –3.9 to –1.5; P < .001). At 24 weeks, the significant group differences were sustained.

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    At 8 weeks, 33 of 47 (70%) in the CBT-I therapy had an ISI score in the non-insomnia range and 10 of 41 (24%) in the control group had a score in the non-insomnia range. At 24 weeks, 37 of 44 (84%) in the CBT-I group had an ISI score in the non-insomnia range versus 16 of 37 (43%) in the control group.

    No between-group differences were seen in the frequency of daily vasomotor symptoms. However hot flash interference was significantly less at 8 weeks in the intervention group (–15.7; 95% CI, –20.4 to –11.0) when compared to the control group (–7.1; 95% CI, –14.6 to 0.4) (P = .03). After 24 weeks, the differences were maintained in the intervention group (–22.8; 95% CI, –28.6 to –16.9) and the control group (–11.6; 95% CI, –19.4 to –3.8) (P = .003).

    The researchers concluded that the telephone-based therapy did help women in menopause with their insomnia and vasomotor symptoms. They believe that their results support further testing and development of CBT-I for insomnia in menopause.

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

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