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    • Studies indicate that sleep difficulties increase significan

    2018-11-07

    Studies indicate that sleep difficulties increase significantly during the menopausal transition [2–6]. However, data on sleep quality in postmenopausal women are limited [2]. Despite the high prevalence of insomnia and its significant consequences, insomnia is often not properly evaluated and treated [7]. The present research group has made a significant contribution to the body of data investigating the prevalence of insomnia in postmenopausal women [1,5,8]. Hormone therapy (HT), consisting of the exogenous replacement of hormones previously produced by the ovaries, has been traditionally used to reduce the symptoms of menopause [9]. However, the results of recent studies on the effects of HT have given rise to controversy in scientific circles. The Heart and Estrogen/Progestin Replacement Study (HERS) Research Group evaluated the protective effect of HT in menopausal women on a large scale and obtained conflicting results [10]. The Women׳s Health Initiative (WHI), a significant study involving HT trials, found increased incidence of coronary heart disease, breast cancer, stroke and thromboembolism in the study group that received HT. Consequently, the HT trials in the study were stopped in 2002. The WHI study also concluded that the risks of HT exceeded the benefits and that this therapy should not be initiated or continued to prevent chronic disease in postmenopausal women. Following publication of the WHI results, patients and physicians were reluctant to use long-term buspirone hcl therapy, particularly for women already at increased risk for cardiovascular disease or breast cancer. Therefore, demand for non-hormonal therapies for the management of the symptoms of menopause increased. This included the use of non-controlled drugs, antidepressants, and behavioral therapy [11–13]. Treatments such as behavioral therapy (sleep hygiene, sleep restriction, stimulus control, and relaxation) and cognitive therapy have shown positive effects on the factors that predispose and maintain insomnia [7]. Alternative therapies and complementary medicines are commonly used by women in several different countries, with many women seeking help for menopausal symptoms from sources such as soy-based food, medicinal herbs, acupuncture, and yoga. In most European countries and in Australia, more than 50% of the population reported they used alternative methods [14]. In 1990 in the United States, it was estimated that 425 million people (37.8% men and 48.9% women) sought some type of unconventional therapy [14]. It is noteworthy that the search for alternative therapies or complementary medicines often occurs because of the symptoms of menopause, and research into the benefits of these non-conventional and non-pharmacological resources is being conducted [12]. A pilot study on the use of complementary and alternative medicine undertaken in New York City found that 50% of study participants used a complementary therapy as treatment, and it was considered effective in women [15]. Studies undertaken by the present research group have also shown that herbal medicines have potential benefits for postmenopausal women [13,16]. The increased demand for non-pharmacological interventions adds weight to the potential of massage as a therapeutic resource, particularly as massage is thought to contribute to health, is safe [17], and is accepted by women. Massage is commonly regarded as a therapeutic tool with no scientific basis. However, it is known to effect the activation of arterial and venous blood flow in the lymphatic system and in the connective tissue and muscles, and is regarded as a treatment option for edema [18]. The muscle-cutaneous stimuli act on receptors for touch, pressure, heat, vibration, and pain and are transduced via the peripheral and autonomic nervous systems to the central nervous system (spinal cord and brain). The triggering of neurochemical reactions [19] such as relaxation, improved sleep, tranquility, wellbeing, decreased heart rate and breathing, peristalsis, increased diuresis, dysmenorrhea reduction, and restoration of homeostasis can be clinically observed [20,21].