Naturally fluctuating hormones (menstrual cycle, through pregnancy or menopausal transition) are not related to marked sleep disturbances in women. It is likely, however, that subsets of women will display a central nervous system vulnerability to hormonal fluctuations so that sleep disturbances manifest as a part of a complex of discomforting symptoms. Sleep is impacted directly through the circadian system or brain sleep regulation or through the development of concurrent functional changes and symptoms. Women are susceptible to sleep-related disorders that are also common in men, such as primary insomnia and SBD although the contributing factors and manifestations may not be the same. General summary of practice implications: The prevalence of sleep problems, especially in midlife women, warrants attention to assessment. It is important to rule out possible primary sources of insomnia, such as medical (eg, chronic illness), psychiatric (eg, mental illness) and pharmacologic types, as well as contextual factors (eg, divorce, job loss, bereavement). Screening for insomnia, sleep-related breathing disorders, narcolepsy, and other sleep-related disorders can be done quickly, but gender differences in common manifestations must be considered. Effective nursing interventions for sleep problems fall into the realms of behavioral coaching, or education for self-care sleep improvement, and screening for referral of serious sleep-related disorders. Treatments for insomnia will depend on the type (acute or chronic, primary or secondary), context within which the insomnia occurs (social and menopausal status), and the severity of the daytime functional impairment. Acute insomnia treatments can include short-term prescriptions of sleeping pills, eg, zolpidem tartrate (Ambien®, Searle, Chicago) or short acting benzodiazepines, to break a cycle of sleeplessness, but behavioral treatments are foundational for sustained improvements. Behavioral treatments can be readily incorporated into primary or tertiary care nursing practice for insomnia unrelated to SDB or other sleep disorders. These include counseling people to engage in good sleep hygiene and to ritualize the bedtime routine, or in more severe cases of insomnia, to practice stimulus control or sleep restriction (see Table 1 for summary). Screening and recognition of chronic, severe insomnia, SDB, narcolepsy, or periodic limb movements during sleep warrant referral to an accredited sleep disorders center to help prevent the negative health outcomes that can emanate from disturbed sleep.
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