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Sexual function and distress in postmenopausal women with chronic insomnia: exploring the role of stress dysregulation

Authors Kalmbach DA, Kingsberg SA, Roth T, Cheng P, Fellman-Couture C, Drake CL

Received 30 April 2019

Accepted for publication 24 June 2019

Published 22 August 2019 Volume 2019:11 Pages 141—153


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Sutapa Mukherjee

David A Kalmbach,1 Sheryl A Kingsberg,2 Thomas Roth,1 Philip Cheng,1 Cynthia Fellman-Couture,1 Christopher L Drake1

1Division of Sleep Medicine, Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA; 2Departments of Reproductive Biology and Psychiatry, Case Western Reserve University, Cleveland, OH, USA

Correspondence: Christopher L Drake 39450 W 12 Mile Road, Novi, MI 48377, USA
Tel +1 248 344 6672
Fax +1 248 344 8084

Objective: Menopause triggers changes in sexual function and many women develop sexual problems. Insomnia is common in postmenopausal women, and disturbed sleep has been linked to poor sexual health. Thus, postmenopausal women with insomnia may be especially vulnerable to developing sexual difficulties. This study estimated rates of sexual distress in postmenopausal women with chronic insomnia and explored associations between various facets of sexual health, insomnia symptoms, and insomnia-related stress dysregulation.
Design: Cross-sectional.
Setting: Large multi-site health system in the US.
Participants: 150 postmenopausal women diagnosed with DSM-5 chronic insomnia disorder (56.44±5.64 years) completed measures of sexual distress, sexual function, hot flashes, insomnia symptoms, depression, and stress dysregulation in the forms of cognitive-emotional arousal (worry, rumination), sleep reactivity, and somatic hyperarousal.
Results: Nearly half of the sample endorsed clinically significant sexual distress (46.9%). Insomnia symptoms were largely associated with poor sexual arousal, orgasmic dysfunction, sexual distress, and sexual dissatisfaction. Insomnia-related stress dysregulation was similarly associated with these facets of sexual health but was also linked to problems with low desire and greater vaginal pain during sex. Hot flashes and depression were negatively associated with sexual health.
Conclusion: Postmenopausal women with chronic insomnia endorse high rates of sexual distress. Although compromised sexual function appears directly related to poor sleep itself, our data suggest that stress dysregulation may play vital role in sexual problems endorsed by postmenopausal insomniacs, particularly regarding low desire and vaginal pain. Prospective research is needed to characterize the evolution of these co-occurring symptoms.

Keywords: menopause, sexual function, sexual distress, sleep, worry, rumination

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