Which is a behavioral therapy for sleep changes in menopause?

• A. Daily napping
• B. Cognitive behavioral therapy for insomnia (CBT-I)
• C. Alternative medicine herbs
• D. Pharmacologic sedatives

Answer: (C)

Behavioral therapies for sleep problems focus on changing routines, thoughts, and activities around sleep rather than using medications. The best-supported behavioral option for insomnia in menopausal patients is cognitive behavioral therapy for insomnia (CBT-I). CBT-I combines practical strategies (stimulus control—going to bed only when sleepy and getting out of bed if unable to sleep; sleep restriction—limiting time in bed to match actual sleep time to boost efficiency) with sleep hygiene education and cognitive techniques to reduce worry about sleep, plus relaxation training. This approach directly targets the patterns that keep sleep from being restorative in menopause—such as night awakenings, anxiety about sleep, and disrupted routines—and has robust evidence showing improvements in sleep onset, total sleep time, wake after sleep onset, sleep quality, and daytime functioning. Daily napping can disrupt nighttime sleep, herbs are not a behavioral therapy, and sedatives are pharmacologic treatments, so they don’t carry the same behavioral, non-drug approach as CBT-I.