JOURNAL OF WOMEN’S HEALTH

Volume 29, Number 3, 2020

ª Mary Ann Liebert, Inc.
DOI: 10.1089/jwh.2020.8327

Self-Hypnosis for Sleep Disturbances

in Menopausal Women

Julie L. Otte, RN, PhD, FAAN,1 Janet S. Carpenter, PhD, RN, FAAN,1
Lynae Roberts, MA,2 and Gary R. Elkins, PhD2

Abstract

Poor sleep is one of the most frequent health concerns among menopausal women. All stages of sleep can be
impacted by the menopause transition. Negative outcomes of poor sleep are multidimensional and include poor
physical, psychological, cognition, and social outcomes. Hypnosis is a nonpharmacological treatment for poor
sleep and hot flashes in menopausal women. The goal of hypnosis is to educate and train subjects to perform
self-hypnosis to alleviate the underlying symptom. The use of hypnosis as a treatment for poor sleep has shown
benefits for both acute and chronic insomnia. Initial findings from the National Center for Complementary and
Integrative Health (NCCIH) Hypnosis Intervention for Sleep in Menopause: Examination of Optimal Dose and
Method of Delivery randomized control trial of 90 women were presented. Results showed that program
and treatment satisfaction were high in all groups, adherence to daily practice met or exceeded adherence bench-
marks. There were significant reduction of poor sleep quality in all groups with a significant increase in minutes slept
in all groups. The majority of women also showed clinical improvements of duration. There were clinically
meaningful improvements in reducing the perception of poor sleep quality in 50%–77% of women across
time. Overall, the use of self-hypnosis as a treatment program for sleep problems related to menopause was
acceptable for women. Data further support that hypnosis is a promising technique to improve sleep in menopausal
women with sleep and hot flashes. Further research is ongoing on self-hypnosis delivery and implementation into
wider populations of women using clear definition and control groups.

Keywords: menopause, sleep, hypnosis, women, hot flashes

Background in women with and without hot flashes include insomnia,

sleep disordered breathing, restless leg syndrome, and cir-
cadian disruptions.4 There are both pharmacological and
P roblems with poor sleep increase during menopause
transition.1 Approximately 28%–63% of women report
sleep problems during menopause and postmenopausal
nonpharmacological treatment options; however, there are
problems with the over use and abuse of prescription of sleep
transitions. The underlying cause can be multifaceted and medications in women in this population. In the 2013 Dawn
complex. One common symptom that contributes to poor by the Substance Abuse and Mental Health Services Ad-
sleep during menopause transition is hot flashes. By defi- ministration report, females aged ‡45 years accounted for the
nition, hot flashes are sudden transient and recurrent sen- majority of emergency room visits from prescription reac-
sation of moderate-to-intense heat that usually begins in tions to sleep medications.5 The reason many women seek
the upper body2 with *80% of women experiencing hot treatment is due to the negative impact of poor sleep. Ne-
flashes during perimenopause and 90% when menopause is gative outcomes of poor sleep are multidimensional and in-
induced by surgery. Sleep disturbances have been noted to clude poor physical, psychological, cognition, and social
be one of the main reasons women seek treatment for hot outcomes. Physical outcomes include daytime sleepiness,
flashes. fatigue, and decreased immune function. Psychological out-
Research findings suggest that all stages of sleep are im- comes include impaired cognitive process, depression/anxiety,
pacted during menopause.3 Types of common sleep disorders and memory deficits.6

1
School of Nursing, Indiana University, Indianapolis, Indiana.
2
Mind-Body Medicine Research Laboratory, Department of Psychology and Neuroscience, Baylor University, Waco, Texas.

461
462 OTTE ET AL.

Identifying a Hypnosis Intervention tional Center for Complementary and Integrative Health
Despite widespread prevalence, there are few available [NCCIH]; Gary Elkin-Principle Investigator) was a ran-
effective and accessible nonpharmacological interventions to domized control trial of 90 postmenopausal women that
manage poor sleep in women during the menopausal transi- tested four delivery schedules to determine which one is more
tion. Uses of hypnosis have been found to be efficacious for effective. The groups were randomized into one of four
women with hot flashes.7 The traditional model of hypnosis groups including five in-person sessions (n = 23), three in-
delivery is conducted by a trained provider and consists of two person sessions (n = 20), five phone calls with self-hypnosis
components. First is the induction initial phase of focus, re- (n = 23), and three phone calls with self-hypnosis (n = 23).
laxation, and concentration. Second is providing suggestions- Subjects were followed for 8 weeks. Measures of sleep in-
directed words toward specific goals (relaxation/symptom cluded Pittsburgh Sleep Quality Index,14 Epworth Sleepiness
alteration).8,9 The mechanism of action continues to be de- Scale,15 Insomnia Severity Index,16 sleep environment as-
veloped but thought to be a mixture of neurological mecha- sessment, wrist actigraphy (Respironics), and nighttime sleep
nisms but largely remains unknown. diary. Other outcomes included satisfaction and adherence
Hypnosis is defined as a state of consciousness involving with the intervention, menopausal symptom severity, hot
focused attention and reduced peripheral awareness charac- flash dairy, and pain.
terized by a capacity for response to suggestion.10 The goal of
Overview of Findings for Sleep Outcomes
hypnosis is to educate and train subjects to perform self-
hypnosis to alleviate the underlying symptom. The following Initial findings were presented during the conference; the
are the standard accepted definitions that constitute the pro- results of all primary and secondary outcomes are pending
cess of hypnosis. Other important definitions include: final analysis (planned submission fall 2019). Initial demo-
graphics included postmenopausal women aged 41–65 years
(1) Hypnotic induction: A procedure designed to induce
mainly Caucasian, from south central Texas area. Overall
hypnosis.10
program and treatment satisfaction were high in all groups
(2) Hypnotizability: An individual’s ability to experience
with no group differences. The use of hypnosis for sleep
suggested alterations in physiology, sensations, emo-
improvement was moderate to high with no group differ-
tions, thoughts, or behavior during hypnosis.10
ences. In-person and phone-delivered methods rated high in
(3) Hypnotherapy: The use of hypnosis for treatment of a
both groups. Self-delivery rated high regarding ease of de-
medical or psychological disorder or concern.10
livery. Adverse event-only one hypnosis related to suggestion
(4) Self-hypnosis: Training subjects to be able to do
during session that included water and fish.
hypnosis on their own. The goal for hypnosis training
Adherence to daily practice (seven times per week) met or
should be self-hypnosis.10
exceeded adherence benchmarks with no differences in at-
home practice between groups. The highest ratings of ad-
Research on Hypnosis for Sleep herence were in five phone calls and home groups. For
menopausal symptom severity (e.g., hot flashes, night sweats,
The use of hypnosis as a treatment for poor sleep has shown and mood), reduction in overall severity of scores across all
benefits for both acute and chronic insomnia (inability to fall groups was noted with clinically meaningful improvements.
asleep, stay asleep, and feel rested).11 Researchers suggest hyp- Sleep outcomes were as follows. There were significant
nosis can help treat hyperarousal (overactive mind and body) and reduction of poor sleep quality in all groups with a significant
it is suggested that hypnosis is best when coupled with cognitive increase in minutes slept in all groups with largest sustained
behavioral therapy (sleep hygiene) for maximum benefit. The decrease in three phone calls/self-hypnosis groups at week 8
hypnotic relaxation or induction includes deepening suggestions using actigraphy findings. The majority of women also
such as imagery of a dolphin swimming down to the ocean floor. showed clinical improvements of duration based on analysis
In one study that used polysomnography to determine im- of sleep diary entries. There were noted clinically meaningful
pact of hypnosis on sleep patterns, the researchers found that improvements in reducing the perception of poor sleep
slow wave sleep increased by 57% among high-hypnotizable quality (bothersomeness) in 50%–77% of women across
participants.12,13 The study used progressive mental imagery time. The largest effect size was noted in the five phone calls
of hypnosis suggestions and found a reduction in number of treatment group.
nighttime awakenings (sleep disturbances), reduction in the
time to fall asleep (sleep latency), and an increase in deep sleep Conclusions
phase (slow wave sleep).12 When the study was replicated in
an older population that included elderly women, there was a Overall, the use of self-hypnosis as a treatment program for
noted increase in slow wave sleep using this type of deepening sleep problems related to menopause was acceptable for
hypnotic suggestion.13 These findings coupled with the sig- women. Phone delivery with self-hypnosis is just as effective
nificant increase in global sleep quality in menopausal women as doing in-person sessions, suggesting that intervention can
with hot flashes were the premise of an intervention study to be more widely accessed and valuable. Data further support
test the efficacy and delivery of hypnosis for sleep problems in that hypnosis is a promising technique to improve sleep in
postmenopausal women with hot flashes. menopausal women with sleep and hot flashes. Further re-
search is ongoing on self-hypnosis delivery and implementa-
tion into wider populations of women using clear definition
Self-Hypnosis for Sleep in Menopausal Women
and control groups. The use of hypnosis to treat symptoms
Hypnosis Intervention for Sleep in Menopause: Ex- clusters such as pain, hot flashes, and sleep is needed along
amination of Optimal Dose and Method of Delivery (Na- with better integration as a treatment into practice settings.
SELF-HYPNOSIS FOR SLEEP DISTURBANCES 463

Author Disclosure Statement 8. Elkins GR, Fisher WI, Johnson AK. Hypnosis for hot fla-
shes among postmenopausal women study: A study proto-
No competing financial interests exist.
col of an ongoing randomized clinical trial. BMC
Complement Altern Med 2011;11:92.
Funding Information 9. Elkins GR, Fisher WI, Johnson AK, Carpenter JS, Keith
TZ. Clinical hypnosis in the treatment of postmenopausal
National Institutes of Health; National Center for Com- hot flashes: A randomized controlled trial. Menopause
plementary and Integrative Health 1R34AT008246-01. 2013;20:291–298.
10. Elkins GR, Barabasz AF, Council JR, Spiegel D. Advancing
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