Когнитивно-поведенческая терапия эффективнее образования для лечения бессонницы и приливов у женщин в менопаузе

Cognitive behavioral therapy may improve insomnia, hot flashes during menopause Key takeaways: - A pilot cognitive behavioral therapy program lowered insomnia severity more than menopause education. - Interference from hot flashes improved more with cognitive behavioral therapy vs. menopause education. A specially tailored cognitive behavioral therapy intervention may reduce insomnia and hot flashes among perimenopausal and postmenopausal women, researchers reported from a small pilot trial published in Menopause. Sara Nowakowski, PhD, associate professor and psychologist at Baylor College of Medicine, said several clinical trials have found that cognitive behavioral therapy (CBT) may benefit women experiencing insomnia during menopause. Nowakowski said vasomotor symptoms and sleep disturbances are among the most common complaints from women during menopause, leading researchers to assess whether CBT could provide a wide range of benefits. “We adapted CBT for insomnia to address both insomnia and nighttime vasomotor symptoms,” Nowakowski told Healio. “[The intervention] produced meaningful improvements in insomnia severity, hot flash interference, sleep self-efficacy and depressive symptoms.” Nowakowski and colleagues enrolled 43 perimenopausal and postmenopausal women who were diagnosed with insomnia and reported at least one vasomotor symptom per night over a 7-day period (mean age, 53.6 years). Participants were randomly assigned to a CBT group with four 50-minute sessions conducted over an 8-week period or to a control group participating in a single 50-minute menopause education session. Nowakowski said CBT was conducted by psychologists, nurses and social workers. Questionnaires assessing insomnia, sleep quality, sleep self-efficacy, hot flash severity and menopause-related quality of life were conducted at baseline, immediately after the intervention, 1 month and 3 months after intervention. Insomnia severity was lower in the CBT group compared with the control group immediately after the intervention (4.9 points vs. 8.8 points; P = .01) and 1 month after intervention (4.1 points vs. 8.5 points; P = .01). The percentage of women with no clinically significant insomnia after intervention was 69% in the CBT group and 30% in the control group. Researchers broke down insomnia severity scores into three categories: sleep symptoms, daytime symptoms and perception symptoms. Nowakowski said CBT did not improve daytime symptoms of insomnia compared with menopause education, which researchers found surprising. “This suggests that CBT for menopausal insomnia may be further expanded to include behavioral strategies targeting daytime functioning,” Nowakowski said. Women receiving CBT had higher sleep self-efficacy scores than those in the menopause education control group 1 month after intervention (36.8 points vs. 30.5 points; P = .01). There were no differences in the scores at other time points. The CBT group had lower scores for hot flash interference than the control group at postintervention (0.9 points vs. 2.2 points; P = .01) and 1 month (1.2 points vs. 2.3 points; P = .04) . Menopause-related quality of life scores improved for the full study group during the study but did not differ between CBT and menopause education at any follow-up. There was also no difference in depressive symptoms between the two groups at any time point. Nowakowski said the CBT intervention used in the trial could be implemented in real-world settings by a wide range of health care professionals. “Providers may opt to use CBT for menopausal insomnia when women are presenting with insomnia and bothersome vasomotor symptoms, particularly at night that disrupts sleep,” Nowakowski said. “This study demonstrated the feasibility of different health care professionals delivering CBT for menopausal insomnia in a women’s health care setting and has implications to be scaled as part of routine care in women’s health care clinics.” For more information: Sara Nowakowski, PhD, an associate professor and psychologist in department of medicine at Baylor College of Medicine, can be reached at [email protected] or on X @Sara_Sleep.