How do you approach pharmacologic treatment of sleep disturbances in perimenopausal or menopausal patients with vasomotor symptoms?

CBT-I is still the gold standard approach in this population, and sleep hygiene, relaxation, and sleep efficiency would likely be helpful whether you are also addressing vasomotor or other contributing factors. But it can be so helpful to directly treat vasomotor symptoms. I use gabapentin 100-400 m...

For sleep disturbance related to vasomotor symptoms, I had success using 0.1 mg clonidine at night for one patient who did not respond to SSRIs, doxepin, or trazodone and wasn't interested in hormone replacement therapy. Clonidine is worth considering if other options failed trying but certainly not...

This comes up a lot in my practice, especially with patients who already have longstanding problems with anxiety and sleep. Everything has to be individualized based on the person's age and prior history. Though hormones may relieve symptoms even in the absence of vasomotor symptoms, they aren't my ...