Open Access Research article

Postmenopausal hormones and sleep quality in the elderly: a population based study

Gregory J Tranah1*, Neeta Parimi1, Terri Blackwell1, Sonia Ancoli-Israel2, Kristine E Ensrud345, Jane A Cauley6, Susan Redline7, Nancy Lane8, Misti L Paudel3, Teresa A Hillier9, Kristine Yaffe10, Steven R Cummings1 and Katie L Stone1

Author Affiliations

1 CPMC Research Institute, San Francisco, CA, USA

2 Department of Psychiatry, University of California San Diego, San Diego, CA, USA

3 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA

4 Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, USA

5 Department of Medicine, University of Minnesota, Minneapolis, MN, USA

6 Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

7 Department of Medicine and Center for Clinical Investigation, Case Western Reserve University, Cleveland, OH, USA

8 Department of Medicine, University of California Davis Medical School, Sacramento, CA, USA

9 Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, OR, USA

10 Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, CA, USA

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BMC Women's Health 2010, 10:15  doi:10.1186/1472-6874-10-15

Published: 4 May 2010



Sleep disturbance and insomnia are commonly reported by postmenopausal women. However, the relationship between hormone therapy (HT) and sleep disturbances in postmenopausal community-dwelling adults is understudied. Using data from the multicenter Study of Osteoporotic Fractures (SOF), we tested the relationship between HT and sleep-wake estimated from actigraphy.


Sleep-wake was ascertained by wrist actigraphy in 3,123 women aged 84 ± 4 years (range 77-99) from the Study of Osteoporotic Fractures (SOF). This sample represents 30% of the original SOF study and 64% of participants seen at this visit. Data were collected for a mean of 4 consecutive 24-hour periods. Sleep parameters measured objectively included total sleep time, sleep efficiency (SE), sleep latency, wake after sleep onset (WASO), and nap time. All analyses were adjusted for potential confounders (age, clinic site, race, BMI, cognitive function, physical activity, depression, anxiety, education, marital status, age at menopause, alcohol use, prior hysterectomy, and medical conditions).


Actigraphy measurements were available for 424 current, 1,289 past, and 1,410 never users of HT. Women currently using HT had a shorter WASO time (76 vs. 82 minutes, P = 0.03) and fewer long-wake (≥ 5 minutes) episodes (6.5 vs. 7.1, P = 0.004) than never users. Past HT users had longer total sleep time than never users (413 vs. 403 minutes, P = 0.002). Women who never used HT had elevated odds of SE <70% (OR,1.37;95%CI,0.98-1.92) and significantly higher odds of WASO ≥ 90 minutes (OR,1.37;95%CI,1.02-1.83) and ≥ 8 long-wake episodes (OR,1.58;95%CI,1.18-2.12) when compared to current HT users.


Postmenopausal women currently using HT had improved sleep quality for two out of five objective measures: shorter WASO and fewer long-wake episodes. The mechanism behind these associations is not clear. For postmenopausal women, starting HT use should be considered carefully in balance with other risks since the vascular side-effects of hormone replacement may exceed its beneficial effects on sleep.