Night Sweats

Night sweats are essentially nighttime hot flashes. Many women experience night sweats before experiencing their first hot flash, while for others, hot flashes come first. Night sweats are one of the most common symptoms of perimenopause (the first stage of menopause) and often appear even before periods become irregular. While the exact cause is not known definitively, night sweats are caused by fluctuating hormone levels, especially estrogen.

For some women, night sweats occur more frequently during a particular phase of their menstrual cycle, recurring with regularity month after month and then subsiding as estrogen levels rise. For other women, night sweats come and go, with no obvious internal or external trigger.

In addition to causing intense sweating, night sweats can lead to interrupted sleep, low-quality sleep, irritability and mood swings caused by lack of sleep, and fogginess or drowsiness during the day.
Behavior:
  • Try going to bed a little cold. Reduce the temperature in your bedroom (but not too cold, as you will then have the shivers), use low thread count sheets and try going to bed barefoot. Layer your bedding so you can remove layers once you’ve gotten cozy under the covers.
  • Consider taking a cold shower right before bed to help lower your core temperature.
  • Reduce or eliminate stress. Some proven strategies include deep breathing, journaling, mindfulness meditation, tai chi and yoga. Even something as simple as taking five slow, deep breaths before going to bed has been shown to activate the parasympathetic nervous system, giving your body a chance to rest and recalibrate.

Diet:
  • Avoid alcohol and reduce sugar intake, especially after dinner. Sugar in all forms is a major trigger for hot flashes and night sweats.
  • Dehydration can trigger a night sweat, so drink plenty of water throughout the day, with the goal of 60-80 ounces per day. If you do wake up with a night sweat, sipping some cold water can help cool your body’s core and calm your nervous system, making it easier for you to fall back to sleep.
  • Avoid caffeine.
  • Try increasing your soy intake. Bean paste, edamame, soy milk, soy sauce, tempeh and tofu all contain isoflavones, which the body converts into phytoestrogens during digestion.

Exercise:
  • Maintain a healthy weight. Fat adds insulation, making it harder for your body to adjust to temperature swings. Every woman’s body is different, but for some, losing even as little as 5 pounds can help reduce the frequency and severity of night sweats.
  • Regular exercise also helps maintain healthy sleep cycles and improve quality and quantity of sleep.

Lifestyle Factors:
  • If you’re a smoker, please quit. This is one of the most positive steps you can take for your overall health. Smoking interferes with circulation and inhibits the body’s ability to warm and cool itself. Women who smoke are more likely to get both night sweats and hot flashes.
For around 80% of perimenopausal or menopausal women, night sweats occur occasionally and don’t cause too much distress. For around 20%, however, night sweats are severe enough to disrupt their sleep and cause tiredness during the day. For patients who seek relief of night sweats, there are many effective options, including hormone and non-hormone therapies.

Treatments for Night Sweats
  • Hormone Therapy (HT): While HT is not for every woman, many patients are great candidates. Estrogen therapy comes in many forms, including pills, patches, gels and vaginal rings. Women taking estrogen therapy usually show a significant improvement of symptoms within 10 days of starting therapy.
  • SSRIs and SNRIs: Another option is the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). These medications are FDA-approved for helping with depression and anxiety but have also been shown to relieve symptoms of menopause.
  • Other Nonhormonal Medications:
    • Gabapentin is a medication approved by the FDA to treat epilepsy and nerve pain. This medication can also help with hot flashes and has a sedative effect.
    • Clonidine is a blood-pressure-lowering medication. Clonidine can modify how blood vessels respond to the body’s instruction to release heat quickly, thereby alleviating hot flashes and night sweats.
  • Alternative Therapies: Many studies have shown that acupuncture and yoga can be effective in reducing hot flashes and night sweats.
What is a night sweat?
A night sweat is essentially a hot flash that occurs during sleep. Night sweats can be very mild (waking up with slight perspiration) or very severe (waking up with drenched sheets, pillow, pajamas and hair).

What causes night sweats?
Night sweats are caused by fluctuating hormone levels, especially estrogen and, to a lesser extent, progesterone. These fluctuations impact the functioning of the hypothalamus, the part of the brain responsible for regulating body temperature, appetite, sex hormones and sleep.

I don’t have hot flashes during the day, but I do have night sweats. Is this normal?
This is perfectly normal. Many women experience night sweats before ever experiencing a hot flash, and some women with night sweats never experience hot flashes at all.

How long will I continue to have night sweats?
That will depend, in part, on how long your body takes to transition through perimenopause and menopause. The menopausal transition usually lasts about seven years but can last as long as 14 years.

Can night sweats be damaging to my long-term health?
On their own, night sweats are not damaging—they are just instances of the body’s natural response to an increase in internal temperature. However, severe and recurring night sweats can impact relationships, sleep, mood, work and even cognition.

What can I do to avoid night sweats?
Many times, making lifestyle adjustments (for example, avoiding wine and sweets at dinner) is enough to ward off night sweats. Other times, medical intervention might be necessary to obtain relief. Unless you’re the rare woman who breezes through menopause, it’s worth tackling symptoms sooner, before they have a negative impact on your life, mood and functioning.