Patient and Clinician Perspectives on Treating Perimenopausal Sleep Problems
Recommended Citation
Sharkey K, Redline S, Baron K, Drake CL, Singer C, McCullough B, Bertisch S. Patient and Clinician Perspectives on Treating Perimenopausal Sleep Problems. Sleep Med 2026; 138.
Document Type
Conference Proceeding
Publication Date
2-1-2026
Publication Title
Sleep Med
Abstract
Introduction: Up to 60% of females experience transient perimenopausal sleep difficulties, and an estimated 30% develop chronic insomnia around the time of menopause. Patients seeking treatment for vasomotor symptoms report that improving sleep is their top priority when selecting among treatment choices. From the clinician’s perspective, insomnia is one of the leading reasons for initiating therapy for menopausal symptoms. To inform an upcoming randomized clinical trial (RCT) comparing treatments for menopause-associated insomnia, we surveyed clinicians who treat midlife patients and individuals with current or past menopausal sleep difficulties about their treatment experiences and preferences. Materials and methods: In April-May 2024, we used e-mails to colleagues and public social media posts to circulate two IRB-approved Qualtrics survey initiations: one geared toward clinicians (20 items) and the other aimed at individuals who may have experienced perimenopausal insomnia (17 items). Participants were not compensated, but the investigators donated $1US to one of three participant-selected charities for each completed survey. Results: Of those who initiated a survey, completion rates were 77.2% for clinicians (n=61 of 79) and 70.2% for perimenopausal individuals (n=92 of 131). Most clinicians were physicians (75%), and 56% specialized in internal medicine or family medicine; 92% identified as women, and 25% identified as historically underrepresented in medicine. Most perimenopausal persons identified as women, and one identified as gender non-conforming; 16% reported a racial/ethnic minority identity; 48% were perimenopausal, and 42% were postmenopausal. Perimenopausal insomnia was rated as a “moderate-to-severe problem” by 88.7% of perimenopausal people and 98.3% of clinicians. Sleep hygiene , melatonin , and hormone replacement therapy were the most common treatments used by those with perimenopausal insomnia, but only 18.6% reported that their symptoms were treated “fairly well-to-very well.” Perimenopausal people identified the most important treatment goals as not waking up at night , falling back to sleep quickly , feeling refreshed upon waking , and clearer thinking . At least half of clinicians reported using the following treatment modalities with their patients: sleep hygiene (95%), trazodone (68%), melatonin (63%), cognitive-behavioral therapy for insomnia (62%), and antidepressants such as venlafaxine (51%). In terms of efficacy, clinicians ranked sleep hygiene , hormone replacement therapy , and cognitive-behavioral therapy for insomnia as the “treatments that work the best.” With respect to our upcoming RCT for perimenopausal insomnia treatment, 75.3% of perimenopausal people reported they would be “somewhat-to-very likely” to participate, and 98% of clinicians reported that they would be “somewhat-to-very likely” to refer their patients. Among potential participants and clinicians, opposition to pharmacologic treatment was the main reason for lack of interest in the RCT. Conclusions: In this convenience sample, perimenopausal insomnia was rated as an important problem by patients and clinicians. Most perimenopausal people reported experiencing insufficient treatment of their insomnia symptoms and identified the need to address sleep maintenance and daytime functioning as the top treatment targets. Sleep hygiene was the most common therapy used in both groups. Although hormone replacement therapy was identified as one of the most effective treatments by clinicians and potential patients, clinicians were more likely to prescribe medications that were ranked as less effective.
Volume
138
