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reference
Abbaspoor Z, Siahposh A, Javadifar N, Faal Siahkal S, Mohaghegh Z, Sharifipour F. The effect ofCitrus aurantiumAroma on sleep quality in postmenopausal women: a randomized controlled trial.Int J Community Based Nurses Midwifery. 2022;10(2):86-95.
Study objective
To determine whether inhalation ofCitrus aurantium(Bitter Orange) daily for 4 weeks would improve sleep in postmenopausal women
Key to take away
Inhale fromCitrus aurantium5 minutes, twice daily, 4 days per week for 4 weeks resulted in significant sleep improvement in postmenopausal women. A significant proportion of this subpopulation is affected by sleep problems.
design
Randomized controlled trial in which both participants and researchers were blinded to treatment condition
Participant
This study involved 80 postmenopausal women aged 45 to 60 years. Inclusion criteria were ability to read and write, absence of menstruation for 12 months or longer, 5 or more on the Pittsburgh Sleep Quality Index questionnaire, no medical or mental disorder, available medical records, no alcohol, and no stressful events in the previous 6 months.
intervention
Participants placed 2 drops of oil on their forearm twice daily (10 a.m. and 10 p.m.) and inhaled the aroma from a distance of 30 cm while breathing normally for 5 minutes. The treatment group received 10%Citrus aurantiumoil (mixed with odorless almond oil diluted with propylene glycol), while the control group received odorless almond oil also diluted with propylene glycol. They inhaled the aroma four consecutive days a week for four weeks.
Evaluated study parameters
The Pittsburgh Sleep Quality Index was the only outcome measure. The PSQI is a well-validated and widely used measure of subjective sleep used worldwide.
Primary outcome
This study determined whether sleep subjectively improved with bitter orange inhalation treatment.
Key findings
The postmenopausal women who used thisCitrus aurantiumOil resulted in a statistically significant improvement in their subjective sleep, with the PSQI decreasing from 12.08 to 5.75 (P<0.001). The PSQI was unchanged in the control group.
transparency
The Research Center of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran funded this study.
Implications and limitations for practice
People around the world suffer from sleep problems, and the number has been increasing in recent years.2Sleep problems contribute to a variety of other medical disorders, from anxiety and depression to cardiovascular disease, inflammatory disease and obesity, to name a few.3Given the high prevalence and consequences, finding effective sleep treatments that are easy to implement is a high priority for researchers and clinicians.
Inhalation aromatherapy for sleep has historical precedent and research in this area is increasing.4Reviews have found evidence of the use of bergamot, cedar, lemon, rose, sweet orange, valerian and other essential oils.5When you smell the essential oil, molecules stimulate the olfactory system, which in turn sends signals to the limbic system and autonomic nervous system. Essential oil molecules in the respiratory tract can directly stimulate the central nervous system.6
A meta-analysis in 20217found that aromatherapy has different effects on different sleep disorders. Lavender is the most commonly used aromatherapy for sleep, especially for insomnia. The effect was greater when only a single oil was used rather than a mixture of several essential oils. The results were also better for people with insomnia than for people with general sleep problems.
The bitter orange essential oil used in this study, which is made from the flowers, is also called neroli oil. The main ingredient (35%) is linalool, which has several properties including anti-anxiety, antioxidant, antimicrobial, cytotoxic and antidiabetic properties.8Linalool is also found in lavender essential oil.
The advantage of inhalation aromatherapy for sleep is that it is easy to self-administer, does not take much time, and is relatively inexpensive. A challenge can be integrating this treatment into everyday life; Taking the 10 a.m. dose can be particularly difficult for working people.
Reviews have found evidence of the use of bergamot, cedar, lemon, rose, sweet orange, valerian and other essential oils.”
Sleep problems in women increase with age. The estimated prevalence of moderate to severe sleep-disordered breathing is 4 to 50% in women, with the prevalence in postmenopausal women being three to six times higher than in younger women. 26% to 42% of women report unrefreshing sleep.9However, far fewer women are diagnosed with a sleep disorder. In a 2012 study, 34% of participants (mostly women) previously diagnosed with primary insomnia were diagnosed with another sleep disorder, such as sleep apnea syndrome or periodic limb movement disorder.10
In this study, the Pittsburgh Sleep Quality Index (PSQI) was the primary outcome measure. The PSQI is a well-validated questionnaire in many population groups.11The 24 questions are assessed using 7 subscales. The threshold for sleep disorders is 5 or more.
Although the PSQI is a well-validated subjective measure of sleep, it cannot diagnose specific sleep disorders. There are over 60 sleep disorders.12Unfortunately, the vast majority of sleep disorders go undiagnosed, resulting in increased personal health risks and societal costs. The concern of simply relying on subjective sleep improvement is that an underlying sleep disorder may go undiagnosed and untreated. Although this bitter orange aromatherapy treatment significantly reduced the PSQI after four weeks of treatment, the score was still above the threshold for sleep disturbance at 5.75 ± 1.33 (P<0.001). This indicates that participants still experience clinically significant sleep disturbances.
Therefore, in the clinical setting, it would be appropriate to conduct further screening and assessment of all 60 sleep disorders and then provide treatment. Given the large number of people with subjective sleep complaints and the simplicity of inhalation aromatherapy, this is a welcome addition to the clinical armamentarium. Bitter orange aromatherapy could be used for subjective relief while ruling out other sleep disorders.