Ask Dr. Pat · Menopause

Hot Flashes, Night Sweats and Sleep Disruption Before Menopause

Hot flashes are the most frequent symptom of menopause and perimenopause. More than two-thirds of North American women who are heading into menopause have hot flashes. Many women want to understand what a hot flash is and why it occurs. Scientists and physicians continue to work on refining the answers to these common questions; but currently we can describe your collection of symptoms as vasomotor symptoms (VMS), the most common symptom of the menopausal transition. General terms that describe VMS are hot flashes/flushes, day and night sweats. A hot flash is a quick feeling of heat and sometimes produces a red, flushed face and sweating. The exact cause of hot flashes is not known, but they may be related to changes in circulation. Hot flashes happen when the blood vessels near the skin’s surface dilate to cool, making you break out in a sweat. Some women have a rapid heart rate or chills. Hot flashes with sweating can also happen at night. These are called night sweats and may make it harder to sleep. A hot flush is a hot flash plus redness in the face and neck.

Women have sought medical treatment for vasomotor symptoms associated with menopause for over half a century. There continues to be active investigation into the biological processes involved in hormone-dependent temperature regulation, which is a crucial component in the cause of VMS. We do know that changes in ovarian hormone levels during the menopausal transition have an impact on multiple components involved in temperature regulation including neurotransmitters (brain chemicals) implicated in this thermoregulatory dysfunction.

You are fortunate to be naturally resilient and to have strengths in problem solving. Assume that your problem with unpredictable flashes, flushes, and sweating, along with sleep disruption, is a problem that is your new project that you have to manage. “Fix this because I can’t continue to commute and work effectively if I don’t get some sleep and learn how to respond to these embarrassing symptoms at work.” These suggestions may help you through this difficult late perimenopausal stage.

Insomnia, even without vasomotor symptoms is very common. (Ohayon and Lichstein et. al) It is a problem that affects 20-25% of the adult population, and up to 10% on a chronic basis. Obviously, hot flashes, sweats and chills make insomnia even worse. Here are some suggestions that often help:

Change what and when you eat and drink at night.
1. Give up that glass of red wine with your dinner (that is only two hours before bedtime). Alcohol, especially red wine, causes hot flashes for many women and worsens insomnia.
2. Find a way to eat your smallest meal of the day before 7:30 p.m. This will be good for weight loss as well as the sleep disturbance. And, it will prevent the snacking that occurs on the bus because you are hungry.

Change your pre-bedtime attitude with Cognitive Behavioral Therapy.
You are fortunate that you are resilient and naturally have a good attitude. Use these traits to train yourself to be an effective manager of your night sweats and resulting sleep disorder. Changing the way you think about these unpleasant symptoms will change how you respond to them. This is called Cognitive Behavioral Therapy or CBT. If you can find the time and money to see a CBT therapist, I am certain that you would benefit from this generally brief training. An intervention for management of menopausal symptoms based on cognitive behavioral therapy has been studied over the last decade and we are now getting information about how this can be used for patients in the real world. CBT is short-term treatment that teaches clients specific skills. This form of therapy focuses on the ways a person’s thoughts (cognition), emotions, and behaviors are connected and affect one another. In this form of therapy, the therapist helps the client discover that he/she is capable of choosing positive thoughts and behaviors. Since this therapy is short-term, the clients actively participate in and out of sessions. Homework assignments often are included in this therapy, for the skills that are taught in these therapies require practice. Treatment is goal-oriented to resolve present-day problems. Therapy involves working step by step to achieve goals. CBT for hot flushes focuses on the links between physical symptoms, thoughts, feelings and behavior. The way we think about symptoms in certain situations tends to affect the emotions we feel and what we do, and these reactions can in turn increase intensity of the hot flushes. For example, you wrote, ” Many of my nights are totally disrupted from hot flashes and night sweats. I get up to change clothes, throw cold water on my face and try to fall asleep again but mostly I ruminate about the disaster facing me in the morning when I will be exhausted. I need my sleep or I can not function.” This leads you to feel that terribly disrupted sleep is inevitable and that you have no control over the events of the night, leading to increased anxiety. This leads to the release of those adrenal hormones and chemicals that intensify and prolong the hot flash experience. CBT can help you to find ways to reduce these negative reactions to hot flashes. Learning calmer more neutral responses will help you to feel in control and more able to cope. Like many others who could benefit from CBT but have neither time nor financial resources for a one-on-one CBT therapist, you might derive significant benefit from a guided self-help book, from participation in a CBT class in a community college, through a web-based CBT portal or telephone based consultation and training. (McCurry) If you do not have access to a cognitive behavioral therapist, a four-week self-help guide is available on Amazon, Managing Hot Flushes with Group Cognitive Behavior Therapy: An evidence-based treatment manual for health professionals by Myra Hunter and Melanie Smith.

Create a hot flash control environment in your bedroom.
1. Sleep in nightgown made of natural fibers.
2. Put ice water in a thermos on bedside table.
3. Stack “Instant Ice Packs” on bedside table.
4. Take off heavy comforters and replace with several light cotton blankets.

When you have a hot flash with night sweats that wake you up, drink small amount of ice water and just squeeze and shake an Instant Ice Pack for immediate relief. Put on the back of the neck and your body temperature drops quickly.

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  • Pamela Yew Schwartz January 17, 2019 at 12:36 pm

    30 years ago yesterday, Dr.
    Allen and I together, gave birth to my daughter, who has grown into this very special and wonderful woman. She has some of Dr. Allen’s characteristics of determination, fortitude and caring. Watching my daughter grow up has been a most profound and life affirming experience.  I want to thank Dr. Allen for bringing my daughter into the world and am most grateful to her for taking care of me these last 30 years.

  • Patricia Yarberry Allen MD January 14, 2019 at 11:13 pm

    Dear ABS,
    Thank you for reading and commenting!! Our goal in 2019 is to encourage the development of a virtual community. Your co-hort is in the sweetspot for our core mission: to inspire women 40 and over to become educated about the perimenopausal-menopausal transition, the options for management that allow each of you to move on and through this transition to make the second half of life your best half! Find friends to join you in comments to our posts so we can hear what interests you and continue to improve our going on 13 year old site!
    Thanks again for the thoughtful post
    Dr Pat

  • ABS January 14, 2019 at 8:52 am

    Dr. Pat, your knowledge coupled with empathy never ceases to amaze me. Thanks to women like you, I think my generation of urban women (mid to late 40’s) who are starting to experience menopause are more open and unguarded with girlfriends about the signs and symptoms. That said, as the writer notes, work situations or any interaction with males still carries some stigma. Thank you for helping share ways in which we can alleviate any negativity with a natural life event.