NURSING STUDY OF PERIMENOPAUSAL INSOMNIA

Insomnia or poor sleep is said to affect from 15-30% of the general
population and predominantly midlife women, leading to substantial use and
misuse of hypnotics. Inadequate sleep impairs daytime function, may be an
early sign of some psychiatric disorders, and contributes to cardiovascular
disease and premature mortality. Studies of the objective sleep patterns
of insomniacs have shown that some people have definite sleep changes and
others do not but assessment over short times and in an unnatural
environment (the laboratory) may lead to false assumptions about the extent
or type of insomnia exhibited. Excessive stress arousal and learned
behaviors incompatible with good sleep are believed to be major
contributing factors to insomnia. Preliminary studies have shown that
insomniac women with and without objective sleep disturbances based on one
night of assessment have higher psychological distress and evidence of
somatic stress arousal than women who are good sleepers. Refined
assessment of general stress arousal and stress reactivity to a challenge
situation in relation to objective sleep patterns is proposed. Supportive
results would guide therapeutic prescriptions and reveal assessment
indicators based on stress responses. The specific aims of this proposal
are to: 1) validate insomnia subtypes with and without objective sleep
disturbances by monitoring over longer times at home, 2) test for negative
environmental conditioning as a contributing factor to insomnia, 3) compare
insomnia subtypes on stress response indicators, 4) examine the
relationships among stress response indicators, psychological distress,
stress exposure, and coping strategies as contributing factors to insomnia
with objective sleep disturbances, and 5) begin testing 2 therapies
tailored for 2 of the subtypes of insomnia. The purposes of this study are to assess objective sleep patterns over 6
nights at home, determine the effect of removing women with insomnia to the
laboratory for one night of sleep, and assess for general stress arousal
and reaction to laboratory stress application as a basis of determining
subtypes. A preliminary test of 2 therapies for insomnia, environmental
conditioning and stress self-management, as applied to subtypes based on
assessment will be done.