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

flashes during perimenopause and 90% when
menopause is induced by surgery. Sleep disturbances
have been noted to be one of the main reasons
Background women seek treatment for hot flashes.
Research findings suggest that all stages of sleep

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

2
Mind-Body Medicine Research Laboratory, Department of Psychology and Neuroscience, Baylor University, Waco,

Texas. 461

462 OTTE ET AL.

Identifying a Hypnosis Intervention
Despite widespread prevalence, there are few
available effective and accessible nonpharmacological
interventions to manage poor sleep in women during
the menopausal transi tion. Uses of hypnosis have
been found to be efficacious for women with hot
flashes.7 The traditional model of hypnosis delivery is
conducted by a trained provider and consists of two
components. First is the induction initial phase of
focus, re laxation, and concentration. Second is
providing suggestions directed words toward specific
goals (relaxation/symptom alteration).8,9
mechanism of action continues to be de veloped but
thought to be a mixture of neurological mecha nisms
but largely remains unknown.
Hypnosis is defined as a state of consciousness
involving focused attention and reduced peripheral
awareness charac terized by a capacity for response
to suggestion.10 The goal of hypnosis is to educate and
train subjects to perform self hypnosis to alleviate the
underlying symptom. The following are the standard
accepted definitions that constitute the pro cess of
hypnosis. Other important definitions include:
cognitive behavioral therapy (sleep hygiene) for
maximum benefit. The hypnotic relaxation or induction
includes deepening suggestions such as imagery of a
dolphin swimming down to the ocean floor.
In one study that used polysomnography to
determine im pact of hypnosis on sleep patterns, the
researchers found that slow wave sleep increased by
57% among high-hypnotizable participants.12,13 The
study used progressive mental imagery of hypnosis
suggestions and found a reduction in number of
nighttime awakenings (sleep disturbances), reduction
in the time to fall asleep (sleep latency), and an
increase in deep sleep phase (slow wave sleep).12
The
When the study was replicated in an older population
that included elderly women, there was a noted
increase in slow wave sleep using this type of
deepening hypnotic suggestion.13 These findings
coupled with the sig nificant increase in global sleep
quality in menopausal women with hot flashes were
the premise of an intervention study to test the efficacy
and delivery of hypnosis for sleep problems in
postmenopausal women with hot flashes.
Self-Hypnosis for Sleep in Menopausal Women

(1) Hypnotic induction: A procedure designed to Hypnosis Intervention for Sleep in Menopause: Ex
10 amination of Optimal Dose and Method of Delivery (Na
induce hypnosis.
tional Center for Complementary and Integrative
(2) Hypnotizability: An individual’s ability to Health [NCCIH]; Gary Elkin-Principle Investigator) was
experience suggested alterations in physiology, a ran domized control trial of 90 postmenopausal
sensations, emo tions, thoughts, or behavior women that tested four delivery schedules to
during hypnosis.10 determine which one is more effective. The groups
(3) Hypnotherapy: The use of hypnosis for treatment were randomized into one of four groups including five
of a medical or psychological disorder or concern.10 in-person sessions (n = 23), three in person sessions
(4) Self-hypnosis: Training subjects to be able to do (n = 20), five phone calls with self-hypnosis (n = 23),
hypnosis on their own. The goal for hypnosis and three phone calls with self-hypnosis (n = 23).
training should be self-hypnosis.10 Subjects were followed for 8 weeks. Measures of
sleep in cluded Pittsburgh Sleep Quality Index,14
Epworth Sleepiness Scale,15 Insomnia Severity
Research on Hypnosis for Sleep
Index,16 sleep environment as sessment, wrist
The use of hypnosis as a treatment for poor sleep actigraphy (Respironics), and nighttime sleep diary.
has shown benefits for both acute and chronic Other outcomes included satisfaction and adherence
insomnia (inability to fall asleep, stay asleep, and feel with the intervention, menopausal symptom severity,
rested).11 Researchers suggest hyp nosis can help hot flash dairy, and pain.
treat hyperarousal (overactive mind and body) and it is
suggested that hypnosis is best when coupled with Overview of Findings for Sleep Outcomes
 groups with largest sustained decrease in three phone
Initial findings were presented during the
calls/self-hypnosis groups at week 8 using actigraphy
conference; the results of all primary and secondary
findings. The majority of women also showed clinical
outcomes are pending final analysis (planned
improvements of duration based on analysis of sleep
submission fall 2019). Initial demo graphics included
diary entries. There were noted clinically meaningful
postmenopausal women aged 41–65 years mainly
improvements in reducing the perception of poor sleep
Caucasian, from south central Texas area. Overall
quality (bothersomeness) in 50%–77% of women
program and treatment satisfaction were high in all
across time. The largest effect size was noted in the
groups with no group differences. The use of hypnosis
five phone calls treatment group.
for sleep improvement was moderate to high with no
group differ ences. In-person and phone-delivered
Conclusions
methods rated high in both groups. Self-delivery rated
high regarding ease of de livery. Adverse event-only Overall, the use of self-hypnosis as a treatment
one hypnosis related to suggestion during session that program for sleep problems related to menopause was
included water and fish. acceptable for women. Phone delivery with
Adherence to daily practice (seven times per week) self-hypnosis is just as effective as doing in-person
met or exceeded adherence benchmarks with no sessions, suggesting that intervention can be more
differences in at home practice between groups. The widely accessed and valuable. Data further support
highest ratings of ad herence were in five phone calls that hypnosis is a promising technique to improve
and home groups. For menopausal symptom severity sleep in menopausal women with sleep and hot
(e.g., hot flashes, night sweats, and mood), reduction flashes. Further re search is ongoing on self-hypnosis
in overall severity of scores across all groups was delivery and implementa tion into wider populations of
noted with clinically meaningful improvements. women using clear definition and control groups. The
Sleep outcomes were as follows. There were use of hypnosis to treat symptoms clusters such as
significant reduction of poor sleep quality in all groups pain, hot flashes, and sleep is needed along with
with a significant increase in minutes slept in all better integration as a treatment into practice settings.
SELF-HYPNOSIS FOR SLEEP DISTURBANCES 463
pi lot investigation of guided self-hypnosis in the
Author Disclosure Statement treatment of hot flashes among postmenopausal
women. Int J Clin Exp Hypn 2013;61:342–350.
No competing financial interests exist. 8. Elkins GR, Fisher WI, Johnson AK. Hypnosis for hot
fla shes among postmenopausal women study: A
Funding Information study proto col of an ongoing randomized clinical trial.
BMC Complement Altern Med 2011;11:92.
National Institutes of Health; National Center for
9. Elkins GR, Fisher WI, Johnson AK, Carpenter JS,
Com plementary and Integrative Health Keith TZ. Clinical hypnosis in the treatment of
1R34AT008246-01. postmenopausal hot flashes: A randomized controlled
trial. Menopause 2013;20:291–298.
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7. Elkins G, Johnson A, Fisher W, Sliwinski J, Keith T. A Julie Otte, RN, PhD, FAAN
 School of Nursing
Indiana University
600 Barnhill Drive NU W401
Indianapolis, IN 46202
E-mail: jlelam@iu.edu