Research articles

By Dr. Donna Falsetti , Dr. Susan Sereika , Ms. Chelsea Lang , Ms. Morganne LaRocco , Dr. Susan M Cohen
Corresponding Author Dr. Susan M Cohen
Health Promotion and Development , University of Pittsburgh, - United States of America
Submitting Author Dr. Susan M Cohen
Other Authors Dr. Donna Falsetti
Waynesburg University, Nursing, - United States of America

Dr. Susan Sereika
University of Pittsburgh, Health and Community Systems, - United States of America

Ms. Chelsea Lang
University of Pittsburgh, Nursing, - United States of America

Ms. Morganne LaRocco
University of Pittsburgh, Nursing, - United States of America


Menopause, Sleep, Acupuncture, women, Hot Flashes, Integrative Therapies, Breast Cancer

Falsetti D, Sereika S, Lang C, LaRocco M, Cohen SM. Sleep Disruptions and Hot Flashes in Post Menopausal Women with Breast Cancer. WebmedCentral ALTERNATIVE MEDICINE 2011;2(2):WMC001478
doi: 10.9754/journal.wmc.2011.001478
Submitted on: 18 Jan 2011 07:20:51 PM GMT
Published on: 01 Feb 2011 12:57:52 PM GMT


Purpose:The purpose of this secondary analysis was to explore the associations between the frequency of hot flashes and sleep disruptions experienced by post menopausal women with the diagnosis of breast cancer and received acupuncture treatments for hot flashes.
Data Sources: Data were gathered for this secondary analysis from 47 African-American, Hispanic, and Caucasian women experiencing hot flashes after receiving treatment for breast cancer who were enrolled in an intervention study of acupuncture for menopausal hot flash reduction.
Conclusions:Strong correlations were found between sleep disruptions, total hot flashes, daytime hot flashes, and night sweats at the conclusion of treatment and over the entire 12 weeks of follow-up. The results suggest that hot flashes and sleep disruptions are strongly correlated and that both acupuncture interventions resulted in a concomitant reduction in sleep disruptions.
Implications for Clinical Practice:Nurses involved in holistic practice can recommend and/or provide the safe and effective alternative treatment of acupuncture for hot flash reduction and concomitant sleep disruptions. As a result, the quality of life for these women can be greatly improved.

Article Text

It is well known that sleep plays a major role in the maintenance of good health. Sleep is as essential to health as diet and exercise.[1] Most people will spend approximately one-third of their life sleeping. The literature provides a mixed view of the relationship between hot flashes/night sweats and sleep. Initially, research supported the view that hot flashes occurring during sleep were the source of interruptions in sleep; however, some recent work has called the view into question. External measurement of hot flashes and interruptions in sleep over time would provide a clearer picture. Examination of data from hot flash intervention trials may provide information of symptom management.
The primary function of sleep is still unknown but researchers have identified that adults require a minimum of 7 hours of sleep per night to maintain both behavioral and physiological homeostasis.[2] Normal human sleep consists of rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep, both of which are necessary to maintain and/or restore optimal physical, emotional, and mental health. The cognitive and emotional benefits of sleep include improved alertness, greater ability to learn new tasks and retain new skills, improved word recall, and lower incidence of depression.[3] The lack of adequate sleep, either as sleep loss or sleep disruptions, has been associated with compromised immune function, relationship disturbances, depression, hypertension, diminished alertness, a higher number of falls in older adults, and a greater risk of accidents while driving.[3]
Several physical and psychosocial factors can adversely affect the quality of sleep for both men and women. For women, the symptoms of perimenopause and menopause, specifically hot flashes, have been implicated in the development of sleep difficulties such as insomnia and frequent awakening, which are common complaints during this life transition. Hot flashes are described as a sudden sensation of heat which is centered in the face and upper chest that are often accompanied by perspiration and, occasionally, palpitations.[4] They are multifactorial in nature but primarily result from the alterations in estrogen due to the level and type of change in ovarian function.[5] On average, hot flashes last from 0.5 to 5.0 years, but they may persist for as long as 15 years in some women.[5]
Research conducted to examine the relationship between hot flashes and sleep disturbances has yielded contradictory findings. In a community-based survey conducted by Kravitz, Ganz, Bromberger, Powell, Sutton-Tyrrell, and Meyer, vasomotor symptoms, along with psychological symptoms, ethnicity, self-perceived health and health behaviors, arthritis, and education were found to be significantly associated with difficulty sleeping.[6] A cross-sectional survey by Fortner, Stepanski, Wang, Kasprowicz, and Durrence studied 72 women with breast cancer. A total of 61% of study participants were found to have significant sleep difficulties with sleep being interrupted by pain, nocturia, coughing, loud snoring, and feelings of being too hot.[7]
In a telephone survey study conducted by Ohayon, a sample of 3,243 female subjects was randomly sampled. Included in this sample were 982 women aged 35 to 65 years of age. Approximately 422 or 42.8% of these were included in the perimenopausal and postmenopausal groups. Bivariate analysis of the data found a strong association between hot flashes and chronic insomnia in midlife women.[8]
Carpenter, Gautam, Freedman, and Andrykowski conducted a study examining the patterns of hot flashes in postmenopausal breast cancer survivors. The frequencies of daily hot flashes were measured using validated 24 hour skin conductance monitoring. Statistical analysis revealed 21% of hot flashes experienced by the study participants occurred during the nighttime hours and 48% of study participants experienced as many as 3 to 7 hot flashes during night time hours. It was concluded that hot flashes may contribute to sleep disruptions among women with breast cancer.[9]
Freedman and Roehrs conducted several studies examining the relationship between hot flashes and sleep disruptions under controlled laboratory conditions. One study included 31 subjects who were separated into 3 groups; 12 symptomatic postmenopausal women, 8 asymptomatic postmenopausal women, and 11 cycling women.[10] The sleep patterns of these participants were studied over a 4-day period. Methods used for this included electroencephalography, electrooculography, and chin electromyography. An abdominal belt containing a piezoelectric crystal was used to record respiratory effort. Two thermocouples were used to measure nasal/oral air flow. In addition, left tibialis electromyography was recorded to detect leg movements. Results showed the majority of hot flashes preceded arousals and awakenings during the first half of the night. It was suggested that some or all measures of sympathetic activation produce the arousals and awakenings that follow hot flashes. During the second half of the night the hot flashes followed the arousals and awakenings. A possible cause is the physiological activation that accompanies the arousals and awakenings. It was suggested that this reversal of mechanisms was due to the increased prevalence of REM sleep in the second half of the night.[10]
Two other studies conducted by Roehrs and Freedman [11-12] looked at pre-, peri-, and postmenopausal women in controlled laboratory environments. Information was obtained through electroencephalogram recordings, sternal skin conductance, multiple sleep latency tests, simple and divided attention performance tests, and questions on sleep and fatigue (Freedman & Roehrs, 2004). The Pittsburgh Sleep Quality Index, the Hamilton Anxiety and Depression Rating Scales, polysomnography, and sternal skin conductance were used as well.[12] Neither study found evidence that study participants’ sleep disruptions were caused by hot flashes. It was found, however, that reduced sleep efficiency was related to primary sleep disorders, apneas, and periodic limb movements.[12] Given the mixed results from previous studies, an examination of the data from a previous study of breast cancer survivors looking at hot flash reduction by acupuncture will provide additional information.
Acupuncture is viewed by the Chinese medical philosophers as a holistic approach to stimulating the Qi or Chi (energy) in humans. Acupuncture is used to balance the body’s energy by increasing the energy flow by opening the blocked gates along the meridians to balance the Yin and Yang. This enables a person to achieve optimal health[13-14] The use of acupuncture in the treatment of menopausal symptoms is designed to correct what is known as Deficient Heat. This is a deficiency in Yin energy that is characterized by Five Palm sweats, night sweats, and general mental agitation.[13] Acupuncture points are selected that will help to correct the deficiency and balance the Yin and Yang.
Western view of acupuncture is that it is based on the temporal relationship between hot flashes and luteinizing hormone (LH), most likely related to a gonadotropin-releasing hormone (GnRH) pulse. Beta- endorphin inhibits the release of GnRH. It is postulated that acupuncture will decrease hot flashes by regulating temperature control through increasing beta-endorphin level and, thus, inhibiting GnRH. Beta-endorphin levels are important in the process of pain control and have been observed to increase in the brains of animals after acupuncture.


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Source(s) of Funding

National Cancer Institute, National Institutes of Health, RO1 CA80625

Competing Interests



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