0706 Impact of Behavioral Insomnia Treatment on Post-Menopausal Female Sexual Functioning

Abstract

Introduction: Sexual difficulties are commonly reported in post‐menopausal women, and can be worsened by insomnia. Although highly prevalent, insomnia can be effectively treated in post‐menopausal women, but few studies have examined the impact of insomnia treatments on sexual functioning. This study examined how self‐reported sexual functioning was impacted by two forms of behavioral intervention for insomnia compared to an attention control. Methods: 148 women who showed menopause‐related insomnia were randomized into three conditions: Cognitive Behavioral Therapy for Insomnia (CBT‐I; N=50), Sleep Restriction Therapy (SRT; N=49), and an Information‐Control condition (IC; N=49). Insomnia was diagnosed using DSM‐5 criteria. Sexual functioning was measured using the Female Sexual Functioning Index (FSFI) at baseline, post‐treatment, and at 6‐month follow up. Results: No group differences were found at baseline across all sexual functioning subscales. Independent sample t‐tests indicated that total sexual functioning at post‐treatment was significantly higher for CBT‐I compared to IC (p=0.05), but not compared to SRT. Further analysis revealed that this effect was most prominent in the lubrication subscale, specifically between CBT‐I and IC at post‐treatment (p=0.02). Additionally, the pain subscale revealed a marginally significant difference at post‐treatment (p=0.06) between CBT‐I and IC. However, improvements in these subscales were not sustained at follow‐ up. No significant differences were found between groups for the remaining subscales (desire, arousal, satisfaction, and orgasm). An additional sub‐analysis examining sexual activity found that of those who indicated not sexually active at baseline, 50% of those in the CBT‐I condition became sexually active at post‐treatment, compared to 12.5% and 25% of SRT and IC recipients respectively. At follow‐up, sexual activity was 27.3%, 25%, and 20% for CBT‐I, SRT, and IC respectively. Conclusion: While both CBT‐I and SRT reduce insomnia in post‐menopausal women, CBT‐I may suggest additional benefits for sexual functioning whereas SRT may not. However, these gains only appear acutely, as they were not maintained at 6‐month follow‐up. Future research should explore what factors unique to CBT‐I and not SRT may explain an increase in sexual functioning, and how these increases may be maintained over time.