Trauma’s relation to poor sleep and health in midlife women


Poor sleep occurs frequently among midlife women, which is significantly linked to childhood and adult trauma, according to a prospective study presented at the 2020 Virtual Annual Meeting of the North American Menopause Society (NAMS).

This article is based on information presented at the 2020 Virtual Annual Meeting of the North American Menopause Society (NAMS). According to NAMS, all presentations have been pre-recorded and now are available for on-demand viewing beginning Sept. 28 through Sept. 21, 2021. For more information, click here.

The findings are independent of sleep risk factors and depressive symptoms.

“I have a longstanding interest in understanding how trauma is related to poor sleep and health,” said first author Karen Jakubowski, PhD, a postdoctoral scholar in psychiatry at the University of Pittsburgh in Pennsylvania.

Karen Jakubowski, PhD

“Although some past studies have found that trauma is connected to poor sleep, these studies measured sleep at only one time point. We realized there was a gap in our knowledge of whether trauma is related to poor sleep measured at multiple points over time, particularly in midlife women.”

The investigators used both objective and self-report measures of sleep, “which makes this research even more novel and exciting,” Dr. Jakubowski told Contemporary OB/GYN.

The ongoing study, which is being conducted at the University of Pittsburgh, consists of a cohort of midlife women, aged 40 to 60 at baseline, who had participated in a previous study on menopausal hot flashes and cardiovascular health from 2012 to 2015.

The women were invited to return to the laboratory 5 years later for a follow-up visit between 2017 and 2020.

Of the 296 women assessed at baseline, 72% were White and 28% Black, with an average age of 54. For the follow-up visit, 166 women were evaluated.

At both baseline and follow-up, women reported adult trauma (Brief Trauma Questionnaire), demographics, depressive symptoms, sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and apnea.

They also provided physical measures of height/weight, as well as a 3-day objective sleep assessment via actigraphy: duration and wake after sleep onset (WASO).

At baseline only, women reported childhood trauma (Child Trauma Questionnaire).

Linking childhood trauma (any/none) and adult trauma (any/none) at baseline with poor sleep (duration <7 hours, WASO ≥31 minutes, PSQI >5) across both baseline and follow-up visits were then assessed.

At baseline, 44% of women reported childhood trauma, compared to 60% who reported adult trauma.

Persistently poor sleep duration, WASO and sleep quality was observed in 61%, 60%, and 33% of women, respectively, at both baseline and follow-up visits.

Childhood trauma was related to persistently poor WASO: odds ratio (OR) 2.32; 95% confidence interval (CI): 1.11 to 4.84 (P = 0.025).

Adult trauma also was connected to persistently poor sleep quality: OR 2.13; 95% CI: 1.01 to 4.52 (P = 0.048).

However, trauma was unrelated to persistently poor sleep duration.

“We were surprised that trauma was unrelated to women’s sleep duration,” Dr. Jakubowski said. “Our results suggest that trauma history is more connected to disrupted and poor-quality sleep in midlife women, rather than how long women are sleeping.”

To improve sleep quality in this population, Dr. Jakubowski said she believes it is important that women allow themselves time to wind down at night, prior to going to bed. “This may involve doing an activity that they find restful or relaxing, without phones or screens if possible, to help promote the transition from our busy lives to sleep,” she said.

The authors hope that their work inspires further research on the lasting effects of trauma on sleep and health in midlife women, “and aids in the development of future interventions that can tailor and improve sleep in women who have experienced trauma,” Dr. Jakubowski said.


Dr. Jakubowski reports no relevant financial disclosures.

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