Sleep Disorders

Premarin cream

04/11/2006 12:27PM

Question:

I was already doing what she suggested, and had gone off Premarin very slowly. My main concern is waking up about 4 times every night, and cannot get back to sleep, so I get about 3 or 4 hrs of sleep a night. What about Premarin cream?

Please refer to previous question for reference - Night Sweats

Question:

I had my uterus removed 20 yrs. ago and took Premarin for 19 1/2 yrs. I am 70 now. How much longer will I have night sweats? Taking Black Cohosh makes me sluggish during the day, and has made no difference in the night sweats. Is there anything else I can do? I hardly sleep at night. Awake every hr. Ambian makes me groggy, til the afternoon of the next day, so not an option.

Answer:

Dear Madam,

I understand that you have several awakenings during the night associated with sweating and inability to return back to sleep. I am not sure if your symptoms are still related to a post-menopause state, now that you are 70 years old. While I can not entirely exclude that, I think it is probably a good idea to look for other possible causes for your symptoms.

Sometimes, patients will develop insomnia while going through menopause and then their insomnia persists even after improvement in the menopause symptoms. This type of insomnia is called psychophysiological insomnia, or learned insomnia. This can often be managed with changes in your sleep habits and sleep related behaviors. Another possibility to consider is that postmenopausal women have an increased risk of Obstructive Sleep Apnea (OSA). OSA can cause multiple awakenings during the night associated with sweating. Other symptoms related to OSA include loud snoring, morning headaches, unrefreshing sleep and daytime sleepiness.

There are a number of sleep related disorders that are not necessarily associated with menopause but are common and could cause the symptoms you describe. These include, but are not limited to panic attacks and periodic limb movement of sleep. Abnormal thyroid function is a consideration. The symptoms you describe will require further information to determine if any evaluation or treatment should be considered.

I recommend you see a Sleep Specialist in your area. The work up will include assessment of your risk for sleep apnea, and most likely a sleep study. Specific treatments are available for all the conditions described and most can be successfully treated. As far as the premarin cream, I would refrain from taking till you get a confirmation that your symptoms are mainly due to estrogen deficiency.

If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need be. The website sleepeducation.com is also very patient friendly and offers plenty of information about sleep disorders.

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Response by:

Rami N. Khayat, MD
Assistant Professor - Clinical
Pulmonary, Allergy, Critical Care & Sleep Medicine
Department of Internal Medicine
College of Medicine
The Ohio State University