Improvement of Depressive and Fatigue Symptoms under Dupilumab Therapy in Atopic Dermatitis Patients: Results from the TREATgermany Registry.

Sleep health is crucial for overall well-being, particularly for middle-aged women undergoing significant hormonal transitions []. Although the definition of middle age varies across studies, the period comprising the ages of 45 to 55 years represents a pivotal transitional phase for women. It is marked by profound physical and psychosocial changes, including the onset and progression of menopause, shifts in family and work roles, and increased vulnerability to chronic health conditions [-]. This stage is characterized by fluctuations in reproductive hormones as well as by heightened psychosocial stressors, such as caregiving responsibilities for both aging parents and children transitioning to adulthood, career demands, and changes in social support networks []. Collectively, these factors may adversely affect women’s sleep quality and overall health outcomes. Research suggests that 46.5% to 54.7% of menopausal women experience clinically substantial sleep disturbances []. The Study of Women's Health Across the Nation has demonstrated that fluctuations in follicle-stimulating hormone and estradiol levels during menopause are linked to nocturnal awakenings, as well as difficulties in sleep initiation and maintenance, with vasomotor symptoms and mood disturbances further exacerbating these sleep issues [,]. Sleep misperception, which refers to the discrepancy between objective and subjective sleep assessments, is a critical concern in sleep health management []. Underestimating sleep duration or quality may lead to the unnecessary use of sleep aids, increasing the risk of dependency and adverse effects []. Prolonged sleep underestimation can eventually lead to objective sleep disorders, including sleep deprivation []. Overestimation of sleep can mask underlying sleep disorders and delay timely diagnosis and intervention. A longitudinal study showed that the overestimation of sleep duration was to a decrease in rapid eye movement (REM) sleep and a higher risk of all-cause mortality, emphasizing the potential long-term health risks associated with this issue []. Therefore, thorough evaluation and targeted interventions for sleep misperception are paramount to prevent long-term sleep pathology and its associated health risks.