Sleep and the menopause.

Sleep problems and their consequences are a serious public health issue, imposing a substantial burden on the individual and society. Although sleep occupies one-third of our lives and can be considered to be an important subject, sleep medicine is a young speciality and problems are poorly investigated. Sleeping problems are frequently reported during the menopausal transition. Subjectively women find that hormone replacement therapy (HRT) significantly improves sleep quality. Thus, HRT can be considered as a first-line therapy for insomnia. However, in some cases insomnia coincides with the menopause transition and cannot be considered to result from ovarian failure. Depressive mood, stress and behavioural factors, as well as restless legs and periodic limb movement syndromes may be the underlying cause. Thus, if no relief with HRT has been achieved after a few months, other aetiologies should be explored.