Declines in the activity of the somatotrophic axis have been implicated in the age-related changes observed in a number of physiological functions, including cognition. Such age-related changes may be arrested or partially reversed by hormonal supplementation. We examined the effect of 6 months treatment with daily growth hormone releasing hormone (GHRH) or placebo on the cognition of a group of 89 healthy older (68.0±0.7) adults. GHRH resulted in improved performance on WAIS-R performance IQ (p<0.01), WAIS-R picture arrangement (p<0.01), finding A's (p<0.01), verbal sets (p<0.01) and single–dual task (p<0.04). GHRH-based improvements were independent of gender, estrogen status or baseline cognitive capacity. These results demonstrate that the age-related decline in the somatotrophic axis may be related to age-related decline in cognition. Further they indicate that supplementation of this neuro-hormonal axis may partially ameliorate such cognitive declines in healthy normal older adults and potentially in individuals with impaired cognitive function (i.e., mild cognitive impairment and Alzheimer's disease).

Many midlife women obtain inadequate sleep, and sleep problems are common during the menopause transition. This article reviews the research literature on sleep and sleep disorders during menopause. Few studies have included subjective and objective measures of sleep quality or studied women during different menopause stages. Potential mechanisms associated with the emergence of insomnia and sleep-disordered breathing during menopause are discussed along with effects of estrogen and progesterone on sleep. It is argued that sleep quality is an important determinant of health status and quality of life for women during and beyond menopause.

OBJECTIVE:The sleep of a large group of healthy older men and women was studied in an effort to better understand the relationship between self-reported subjective and objectively measured sleep quality. METHODS:We examined the baseline subjective and objective sleep quality of 150 healthy older (67.5+/-0.5) men (n=55) and women (n=95). Subjects were carefully screened to exclude sleep disorders and did not complain of significant sleep disturbance. RESULTS:Despite their noncomplaining status, significant proportions of both women (33%) and men (16%) endorsed Pittsburgh Sleep Quality Index (PSQI) scores of >5, a criterion indicative of significant sleep disturbance. When examined as a function of this criterion, objective sleep was significantly impaired with longer sleep latency, less total sleep time, and lower sleep efficiency, for the high-PSQI (H-PSQI) men compared to low-PSQI (L-PSQI) men. These L-PSQI versus H-PSQI differences were much weaker for women and disappeared completely in women on estrogen replacement therapy. CONCLUSIONS:This large group of healthy, noncomplaining older adults manifested significantly disturbed sleep relative to healthy younger subjects, indicating that while aging results in significant changes in sleep, it does not of necessity result in complaints of insomnia and that many healthy older individuals apparently adapt their perception of what is "acceptable" sleep. A considerable correspondence between subjective and objective sleep quality was observed for men but not for women, despite women more frequently endorsing the presence of significant sleep disturbance. This finding is provocative and suggests that what we consider objective measures of good-quality sleep may be appropriate for older men but that older women may be evaluating their sleep quality using other criteria.

THE PERIMENOPAUSAL YEARS ARE ASSOCIATED WITH A SHARP INCREASE IN THE FREQUENCY OF SLEEP COMPLAINTS BY WOMEN.1,2 Although the exact prevalence of self-reported sleep problems varies widely across studies,3-5 perimenopausal women typically cite insomnia, disturbed sleep, and fatigue as some of their most frequent and pressing health concerns. The initiation of these sleep difficulties is usually attributed to the presence of hot flashes and related perimenopausal symptoms.2 This hypothesis is supported by laboratory sleep studies,6,7 though there is at least one contradictory report.8 Perimenopausal women experiencing hot flashes have more arousals during sleep and more sleep stage changes compared with women of equivalent age and hormonal status who are not experiencing hot flashes.7 Estrogen replacement therapy (ERT) has been widely prescribed for the alleviation of hot flashes and consequent sleep disruption. Numerous studies have shown that ERT reduces hot flashes and improves self-reported sleep quality (e.g., 9). Only a few of these studies examined ERT effects on objective sleep measures (e.g., polysomnography). These studies found that ERT could reduce wakefulness6,10 and movement arousals,11 and increase REM sleep.10,12 Collectively these studies suggest that estrogen may be of use in alleviating the sleep complaints of older women, especially those who are experiencing hot flashes.13,14 Sleep complaints do not subside after the menopausal transition years. Many older postmenopausal women continue to report significant sleep disturbance, including nighttime awakenings, long sleep onset latencies, and overall poor sleep quality.1 Little is known about the impact of ERT on the sleep of older, postmenopausal women who are not experiencing hot flashes. Previous studies using polysomnography to assess ERT effects were typically based on women experiencing hot flashes. One purpose of this study was to examine the effect of long-term oral ERT on objective and subjective sleep measures in postmenopausal women who were not experiencing hot flashes and who were well past the hormonal fluctuations that occur during the three to four years on either side of menopause.15,16 The other purpose of this study was to determine whether long-term oral ERT might ameliorate the impact of stress or environmental disruption on the sleep of older women. Sleep quality can be negatively affected by a variety of stressors or environmental disruptions: noise,17 change in ambient temperature,18 sleeping in a novel environment,19 and periodic blood sampling through an intravenous catheter.20 However, the sleep impact of these circumstances varies significantly among individuals. This

Rats with bilateral electrolytic lesions of the ventromedial hypothalamus were maintained at either 80% of their preoperative lean weights or 80% of their postoperative obese weights. Unlike sham-operated rats maintained at 80% of their weights, neither group of lesioned rats acquired schedule-induced polydipsia after 15 daily 1-h sessions on a free variable-interval 1-min food schedule with water continuously available. The results are consistent with previous findings of reduced drinking responses of ventromedially lesioned rats to a variety of conditions which increase drinking in normal rats.