I’m sitting at my desk trying to concentrate on my next project, but I can’t keep my eyes open. It’s only 1:00 p.m. and I want to crash. Instead, I make myself another cup of coffee, grab a bag of chips, and head back to my desk to finish the rest of the day.
I haven’t slept well in months. I wake up in the middle of the night drenched in sweat. Then I toss and turn until my hot flashes subside in the early hours of the morning. If I’m lucky, I get a good four hours of sleep. Most days I consume caffeine and comfort foods that I know are not healthy. It’s a downward spiral that leaves me feeling foggy and grumpy in the afternoon.
According to Menopause: The Journal of the Menopause Society, hot flashes and night sweats, also known as vasomotor symptoms (VMS) of menopause, cause sleep problems in up to three out of five perimenopausal and postmenopausal women.
Hot flashes are a sudden feeling of warmth in the face, neck, and chest that occurs when estrogen levels drop. They can cause heavy sweating, flushed skin, a feeling of cold when the hot flash subsides, and feelings of anxiety. All of this can lead to sleep disorders. “This may include sleeping for shorter periods of time or having trouble falling or staying asleep,” said Dr. JoAnn Pinkerton, Medical Director of Midlife Health Center and member of HealthyWomen’s Women’s Health Advisory Council. But waking up in the middle of the night to VMS doesn’t just ruin the next day. They can also have long-term consequences.
Read: Are there lasting health effects when hot flashes subside? >>
Why you need a good night’s sleep
When you don’t get enough sleep, both your mental and physical health can suffer. “Poor sleep can lead to fatigue, brain fog, difficulty concentrating, daytime sleepiness, irritability and lower productivity at work. It can also impact relationships,” Pinkerton said.
Lack of sleep can also have a negative impact on heart health. A study by the American Heart Association (AHA) showed that menopausal women who don’t sleep enough or sleep well are three times more likely to have poor cardiovascular health outcomes, including heart disease and stroke.
Lack of sleep can also contribute to the development of belly fat in midlife. “When women don’t sleep, the release of the stress hormone cortisol increases, making them more likely to accumulate belly fat,” Pinkerton said. It’s a vicious circle. Poor sleep leads to higher cortisol levels, which in turn leads to excess fat storage. And because you’re tired, you’re much less likely to exercise or make healthy eating choices.
How hot flashes and night sweats affect your sleep
The average age of menopause in the United States is 51, but VMS can begin in your 30s and last until your 70s. Falling estrogen levels during menopause lead to an imbalance between estrogen and a brain chemical called neurokinin B (NKB). Too much NKB causes the KNDy neurons in your brain to become overactive and disrupt your brain’s temperature control center. Your body thinks it’s getting hot, leading it to believe it’s overheating. This causes your blood vessels to dilate to cool your body and causes a hot flash, which can lead to hot flashes and sweats. The intensity of a hot flash in the middle of the night can vary. “People can experience anything from waking up easily, to feeling like they have to put on and take off their duvet, to profuse sweating, for example from soaking the bed or soaking their sleepwear,” Pinkerton said.
For white women, VMS generally lasts an average of seven years, while Hispanic and black women experience hot flashes for an average of 10 years. In people of color, hot flashes are often more intense and last longer, although more research is needed to understand why, Pinkerton said. One theory is that anxiety and stress can worsen VMS, and people of color may experience more anxiety and stress.
“Black women may have had more stress in their lives, and this stress may increase the duration and frequency of hot flashes,” Pinkerton added. People of color may also be less likely to seek help, talk about menopause, or seek treatment.
How to reduce the impact of hot flashes and night sweats on your sleep
Pinkerton said the first thing you can do to ensure you get a good night’s sleep is to pay attention to your sleep hygiene, which includes aiming for 7 to 9 hours of sleep per night. “That means sticking to a consistent sleep schedule, keeping your bedroom dark and cool, limiting screen time and avoiding stimulants before bed,” she said.
Be prepared for hot flashes and night sweats
- Lower the temperature in your bedroom to 68 degrees or lower or open a window
- Use a fan
- Add a cooling gel bed pad and/or cooling sheets to your mattress
- Wear moisture-wicking pajamas
- Sleep with a cool compress on your neck
Avoid dietary and environmental causes of hot flashes and night sweats
- Reduce caffeine consumption, especially in the evening
- Avoid spicy food
- Limit alcohol consumption
- Stop smoking cigarettes
You may also want to speak with your doctor about prescription hormonal or non-hormonal therapy options for VMS due to menopause.
How hormonal and non-hormonal therapy can help
Hormone therapy can help improve sleep by replacing estrogen in your body, which decreases during menopause. This allows the brain’s temperature control center to stabilize and reduce the frequency and intensity of VMS. Women under 60 and within 10 years of menopause who are healthy are good candidates for hormone therapy. “We have newer and safer options than we had 10 years ago,” Pinkerton said.
For women who cannot or do not want to take hormone therapy, non-hormonal options are available, such as neurokinin receptor antagonist therapies, which target the KNDy neurons in the brain. NK receptor antagonists help reduce hot flashes and night sweats due to menopause, and some women may experience fewer nighttime awakenings.
Other medications, such as certain antidepressants and certain anticonvulsants, may also help with VMS. You may even consider cognitive behavioral therapy, which can help change negative thoughts and sleep-related behaviors.
When should you talk to your doctor about hot flashes and night sweats?
If you’re experiencing symptoms that are affecting your quality of life, it’s time to talk to your doctor. Pinkerton suggested having a conversation with your doctor every year once you enter perimenopause, even if you don’t yet have bothersome symptoms.
If you feel like your concerns are not being addressed, or you are told that you are too young for perimenopause to be the cause of your symptoms, it may be helpful to see a doctor specifically trained in menopause. This way you can be sure that you are receiving accurate information. The Menopause Society has a section where you can find a certified specialist by zip code. Be honest about your symptoms and how they affect you. There’s no need to sugarcoat it.
Every person deserves treatment for their hot flashes and night sweats during menopause. And no one should have to struggle with changing pajamas in the middle of the night.
This educational resource was created with support from Astellas.
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