More Research Needed on Sleep Issues for Postmenopausal Women With Schizophrenia

Alexandre Gonzalez-Rodriguez

While there is a known link between schizophrenia and sleep disturbances, it remains understudied in postmenopausal women with schizophrenia.

A team, led by Alexandre Gonzalez-Rodriguez, Department of Mental Health, Mutua Terrassa University Hospital, University of Barcelona, identified the effects of melatonin, sex hormones, and raloxifene for the treatment of insomnia in postmenopausal women with schizophrenia.

Identifying insomnia early in patients with schizophrenia has been considered crucial, but the use of specific compounds to treat insomnia has not been studied in postmenopausal women with schizophrenia.

“Although melatonin treatment improved the quality and efficiency of the sleep of patients with schizophrenia, few studies have explored its use in postmenopausal women with schizophrenia,” the authors wrote. “The estrogen and progesterone pathways are dysregulated in major psychiatric disorders, such as in schizophrenia.”

Schizophrenia and Sleep

Sleep disorders have not been considered a diagnostic criterion for schizophrenia, but the majority of studies show that this patient population suffers from sleep disturbances in at least 80% of cases.

Patients with schizophrenia who suffer from sleep disorders may also present higher frequencies of psychotic experiences, depressive symptoms, and anxiety, and lower quality of life.

The Research

In the non-systematic narrative review, the investigators identified studies between 2000-2021 that focus on the treatment effects of melatonin, raloxifene, progesterone, estradiol, or other sexual hormones, on sleep disorders in patients with schizophrenia in postmenopausal women.

Overall, melatonin was 1 of the more effective treatments to improve sleep quality and efficacy in patients with schizophrenia compared to placebo. However, there was no specific mentions of the use of melatonin in this patient population.

A high testosterone-to-estradiol ratio has been associated with higher rates of depressive symptoms, but the effects of estradiol and other sex hormones on sleep disorders has also been understudied in this patient population. Raloxifene, a selective estrogen receptor modulator, has also shown positive effects on sleep disorders for postmenopausal women.

In general, estrogen and progesterone exposure has an effect on sleep regulation in women and estrogen levels vary across the menstrual cycle in premenopausal women. Variations have also been described during pregnancy and postpartum periods.

There were also research into the effect contraceptives have, but there were few high-quality studies available.

Another potential impact on sleep is hormonal changes during the menopausal transition, including those diagnosed with psychosis.

In a study focusing on progesterone, serum progesterone levels were negatively associated with psychotic symptoms. This represents a correlation between the hormone levels and the severity of schizophrenia.

The Future

While melatonin has stood out in research as the treatment with the most potential, most research is likely needed to prove efficacy for any sleep medication for postmenopausal women with schizophrenia.

“A large amount of research indicates that sleep problems are prevalent and severe in patients with schizophrenia,” the authors wrote. “Melatonin treatment improves the quality and efficiency of the sleep of patients with schizophrenia, compared to treatment with a placebo. However, to the best of our knowledge, there were no specific mentions with regard to the use of melatonin in postmenopausal women with schizophrenia, who are our target population.”

The study, “Hormone Targets for the Treatment of Sleep Disorders in Postmenopausal Women with Schizophrenia: A Narrative Review,” was published online in Clocks & Sleep.