Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders

Insomnia, vasomotorsymptoms (VMS) and depressionoften co-occurafter the menopause, with consequenthealthproblems and reductions in quality of life. The aim of this position statement is to provideevidence-basedadvice on the management of postmenopausalsleepdisordersderived from a systematicreview of the literature. The latteryieldedresults on VMS, insomnia, circadianrhythmdisorders, obstructivesleep apnea (OSA) and restlesslegsyndrome (RLS). Overall, the studies show thatmenopausalhormonetherapy (MHT) improves VMS, insomnia, and mood. Severalantidepressants can improveinsomnia, either on theirown or in association with MHT; these include selectiveserotoninreuptakeinhibitors (SSRIs), serotonin and norepinephrinereuptakeinhibitors (SNRIs), and mirtazapine. Long-term benefits for postmenopausalinsomniamayalso be achieved with non-drugstrategiessuchas cognitive behavioraltherapy (CBT) and aerobicexercise. Continuous positive airway pressure (CPAP) and mandibularadvancementdevices (MADs) both reduce blood pressure and cortisollevels in postmenopausalwomensuffering from OSA. However, the data regarding MHT on postmenopausalrestlesslegssyndrome are conflicting.