North American Menopause Society
North American Menopause Society
October 13, 2017
2 min read

Targeted cognitive-behavioral therapy alleviates insomnia, depressive symptoms in midlife women

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Sara Nowakowski
Sara Nowakowski

PHILADELPHIA — Women participating in a cognitive-behavioral therapy intervention aimed at reducing menopausal hot flashes and insomnia reported improved sleep and a decline in severity of depressive symptoms, according to findings from two studies presented at the Annual Meeting of the North American Menopause Society.

“Cognitive-behavioral therapy for menopausal insomnia (CBTMI) combines CBT interventions for insomnia and hot flashes,” presenter Sara Nowakowski, PhD, assistant professor in obstetrics and gynecology at the University of Texas Medical Branch at Galveston, told Endocrine Today. “The intervention led to clinically meaningful improvements in sleep with added benefit of improving mood for midlife women and is equally beneficial to women experiencing more-severe depressive symptoms.”

In a pilot study of the CBTMI intervention, Nowakowski and colleagues randomly assigned 40 perimenopausal or postmenopausal women (mean age, 55 years) reporting at least one hot flash per night who met diagnostic criteria for insomnia disorder to CBTMI or a control group receiving menopause education. For 8 weeks, the CBTMI group participated in four individual 50-minute meetings with social workers or psychologists in gynecology clinics focused on treating hot flashes and insomnia. The menopause education group attended a 1-hour meeting about menopausal symptoms and sleep hygiene and left with a pamphlet on the topic. The women were administered the Insomnia Severity Index, Self-Efficacy for Sleep Scale, and kept daily sleep diaries. Researchers calculated averages for the sleep diary data collected for nights 5 through 30 before and after the intervention.

The women also were administered the Center for Epidemiologic Studies Depression (CES-D) scale and the Hamilton Depression Rating Scale (HDRS). Researchers categorized participants according to “high” or “low” depression severity based on cutoff scores of 8 on the CES-D scale and 16 on the HDRS.

Researchers found that the CBTMI improved sleep: time-by-treatment arm

interaction for insomnia severity (P = .003), sleep self-efficacy (P = .021), sleep diary

wake after sleep onset (P = .005) and sleep diary sleep efficiency (P = .01). Compared with the menopause education group, the CBTMI group also demonstrated significantly greater improvements from baseline in all sleep parameters.

CBTMI also decreased depressive symptoms during the study: time-by-treatment arm interaction for subjective complaint of depression (P = .019) and objective rating of depression (P = .01) with significant main effects for time (P < .001 for both).

Compared with the menopause education group, the CBTMI group also demonstrated significantly greater improvements from baseline in depression rating scales.

No differences in insomnia improvement were observed between participants with high or low depression scores.

“An intervention targeting symptoms of insomnia and hot flashes has the added benefit to improve mood/depressive symptoms,” Nowakowski said. “There are similar fully automated CBTMI interventions focusing solely on treating insomnia online at Sleepio [] and SHUTi [].” – by Jill Rollet


Nowakowski S, et al. Abstracts S-12 and S-24. Presented at: Annual Meeting of the North American Menopause Society; Oct. 11-14, 2017; Philadelphia.

Disclosure: The study was funded by NIH Grants K23NR014008 and K24HL123565. Nowakowski reports no relevant financial disclosures.