A cognitive behavioural therapy (CBT) intervention adapted for menopausal insomnia (CBT-MI) yields meaningful short-term improvements in insomnia severity, hot flash interference, and self-efficacy related to sleep, as shown in a small pilot study.
Within 7 days of completion of treatment (post-treatment), Insomnia Severity Index (ISI) score decreased by 10.2 points with CBT-MI vs 6.2 points with menopause education control (p=0.007), while Hot Flash Daily Interference Scale (HFDIS) score decreased by 1.3 vs 0.5 points (p=0.01), respectively. Sleep Self-Efficacy Scale (SES) score increased by 10.2 points with CBT-MI vs 5.9 points with menopause education control (p=0.03). [Menopause 2026;doi:10.1097/GME.0000000000002779]
The beneficial changes observed with CBT-MI vs control across the three outcomes were maintained through the 1-month follow-up (ISI score: −10.9 vs −6.5; p=0.003; HFRDIS score: −1.1 vs −0.4; p=0.047; SES score: 11.9 vs 5.6; p=0.003).
Analysis of the ISI factors showed that compared with menopause education control, CBT-MI was associated with significantly decreased night-time sleep symptoms and patient perception of insomnia at post-treatment and 1-month follow-up.
“Our findings are consistent with previous studies that reported CBT for insomnia can be used in [middle aged women] to treat insomnia and improve non-sleep symptoms such as vasomotor symptom interference, depression, and daytime effects,” the authors noted. [JAMA Intern Med 2016;176:913-920; Sleep Med 2019;55:124-134; J Clin Sleep Med 2019;15:999-1010]
The CBT-MI used in the study was a combination of CBT for insomnia and CBT for hot flashes. CBT for insomnia consisted of education about sleep, sleep restriction, stimulus control, strategies for reducing hyperarousal, cognitive restructuring of sleep interfering thoughts, and relapse prevention. On the other hand, CBT for hot flashes involved education about menopause, guided relaxation, and cognitive restructuring of negative beliefs about symptoms of menopause.
“Although CBT-MI produced robust short-term improvements, treatment gains were not sustained at the 3-month follow-up,” according to the authors, who offered potential explanations.
“As a pilot study, the trial was powered to detect acute but not long-term effects. Attrition at follow-up reduced power further… The four-session format may also have been insufficient for maintaining skills beyond the structured intervention period,” they pointed out. “Future work should evaluate maintenance strategies, such as brief follow-up sessions, digital tools, or integration into routine primary-care follow-up to sustain benefits.”
The pilot study included 43 peri- or postmenopausal women (mean age 53.6 years) who reported at least one episode of nocturnal hot flash per night and met diagnostic criteria for insomnia disorder. These participants were randomly allocated to either the CBT-MI group (n=25) or the menopause education control group (n=18).
The CBT-MI intervention was delivered in four individual 50-min sessions over 8 weeks, whereas the control intervention was delivered in one individual 50-min session. The CBT-MI and control interventions were conducted by different therapists. Assessments were performed at baseline, post-treatment, and at 1 month and 3 months after completion of treatment.