1. Introduction
daytime impairment, impaired cognitive, sleep disturbance, fatigue, mood disturbance, amenorrhea, underdiagnosis, sleepiness, insomnia, Insomnia, insomniacs
DISORDER, DISORDERS, CHRONIC INSOMNIA, INFLAMMATION, PERSISTENT INSOMNIA, CHRONIC INSOMNIA, SECONDARY, OXIDATIVE STRESS
Chronic insomnia disorder is one of the most common problems in postmenopausal women, exacerbated by underdiagnosis and improper treatment. This double-blinded, randomized, placebo-controlled trial was conducted to evaluate the potential of vitamin E to treat chronic insomnia as an alternative to sedative drugs and hormonal therapy. The study enrolled 160 postmenopausal women with chronic insomnia disorder, divided randomly into two groups. The vitamin E group received 400 units of mixed tocopherol daily, while the placebo group received an identical oral capsule. The primary outcome of this study was sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI), a self-evaluated and standardized questionnaire. The secondary outcome was the percentage of participants using sedative drugs. There were no significant differences in baseline characteristics between the study groups. However, the median PSQI score at baseline was slightly higher in the vitamin E group compared with the placebo (13 (6, 20) vs. 11 (6, 20); Postmenopausal women are defined as women with amenorrhea for at least 12 consecutive months due to the cessation of ovarian function. The average age of natural menopause is marginally different across ethnicity and is 49.5 years old for Thai women [Insomnia involves hyperarousal stages during sleep and wakefulness with increased arousal levels in the cognitive, emotional, and physiologic domains. This manifests as an elevated, whole-body metabolic rate during sleep and wakefulness, elevated cortisol and adrenocorticotropic hormone during the early sleep period, and reduced parasympathetic tone in heart rate variability. Moreover, there is evidence that insomniacs have increased power in fast electroencephalographic (EEG) frequencies during non-rapid eye movement (NREM) sleep and an increased frequency of microarousals during rapid eye movement (REM) sleep, leading them to perceive parts of REM sleep to be wakefulness [The prevalence of insomnia among the general population is about 10%, with a female and increasing-age preponderance. This places menopausal women at high risk. Sleep complaints increased dramatically during the menopausal transition, with the prevalence increasing from 12 to 40% from late reproductive age (around the late 40s) into perimenopause (in the early 50s) [The available modalities to evaluate sleep disturbance are subjective insomnia rating scales or questionnaires and objective devices, such as wrist actigraphy and polysomnography [Chronic insomnia disorder is diagnosed based on the American Academy of Sleep Medicine’s International Classification of Sleep Disorders, Third Edition, which defines diagnostic criteria as a disturbance of nocturnal sleep at least three times a week for at least three months. Disturbances include difficulty in the initiation or maintaining of sleep or waking up earlier than desired and related daytime impairment such as fatigue, sleepiness, mood disturbance, and impaired cognitive and work performance [Insomnia symptoms are often neglected by both patients and doctors, especially in gynecological practice. As a result, patients are not receiving effective treatment, which leads to persistent insomnia. Not only does chronic insomnia produce numerous ill-health outcomes, but it also affects the quality of life of menopausal women. Yazdi and colleagues evaluated the effect of insomnia on the quality of life among menopausal women through the Menopause-Specific Quality of Life (MENQOL) Questionnaire, a 29-item questionnaire that assesses the effects of menopausal symptoms on four categories of quality of life: vasomotor, psychosocial, physical, and sexual. The study showed that postmenopausal women with chronic insomnia disorder had significantly worse quality of life across all domains of their score [The roles of oxidative stress and chronic sleep deprivation have been evaluated in many studies. This complex relationship works both ways; while oxidative stress may cause sleep disturbance by breaking the sleep–wake cycles, poor sleep quality also increases oxidative stress and lowers antioxidant levels [Vitamin E, which can be found in beans, vegetable oil, or supplement drugs, is an antioxidant that acts to reduce the destruction of cell membranes in the body by eradicating free radicals and reducing inflammation. Two main isoforms of vitamin E are tocopherol and tocotrienol. Each isoform is divided into four distinct analogs, including alpha (α), beta (β), gamma (γ), and delta (δ), which all have antioxidating properties and act as free radical scavengers [There are several different approaches to treating chronic insomnia disorder including menopause hormone therapy, Cognitive Behavioral Therapy for Insomnia (CBT-I), and alternative herbal medicines such as Valerian and isoflavones, according to a 2016 publication by the North American Society of Menopause [