Hot Flushes at Night: Why Menopause Causes Night Sweats and How to Treat Them
At 2am, you are lying there with your heart beating and your night clothes wet through. The papers are wet, the room is hot as an oven. You shake off the blankets, and wait till the heat has gone, and shiver as you cool. Half an hour later you are finally back to sleep. Then it happens again at 4am.
One of the most disturbing and least comprehended symptoms of menopause transition is night sweats. They occur in one out of every three or four women, and in a large proportion of them, they are not occasional inconveniences but daily occurrences that discontinue sleep and leave them exhausted during the day.
The majority of women are informed that they are a normal experience of menopause without much elaboration of the reasons why they occur or what can be done about them. This is the gap that this post fills.
Night sweats are actually hot flushes that occur during sleep. A hot flush is a burst of all-over body heat (usually involving the redness and sweating of the face, neck, and chest) that is sudden and diffuse. When it occurs during the day, you experience it and cope with it. It shocks you awake in the middle of the night when it occurs and you are usually already wet and then the cooling down process which may include, actual chilling, disrupts sleep even further.
The duration of a hot flush is between one to five minutes. However, the ensuing disturbance of sleep that comes after a night sweat can easily extend to 30 to 60 minutes of time as the body calms down and the mind awakens after being alert to drowsy. When this occurs twice or even thrice a night in months, the sleep debt is truly important.
This is what most women never get to hear and once you know this, the entire experience becomes much easier to comprehend.
The brain has an internal temperature control centre, which is located in an area known as the hypothalamus. Consider it the internal thermostat of the body. All of your life this thermostat has been functioning in a so-called comfort zone: the range of temperatures to which the body is comfortable and does nothing. Far too high on top of that zone and the body sweats to cool off. Too deep in the bottom the body shivers to get warm.
Oestrogen has a direct influence on maintaining this comfort zone broad and stable. The comfort zone becomes very small when the level of oestrogen drops or becomes unpredictable during the perimenopause. The thermostat is extremely sensitive. Any slight rise in core body temperature, such a rise that would have been completely overlooked by the body before, is now sufficient to cause the emergency cooling mechanism: flushing, sweating, and rapid heat release.
Night sweats are particularly worse than daytime flushes, and this is not merely because you are lying down and not distracted. The level of oestrogen normally decreases to the lowest level in the early morning hours, usually between 3am and 6am. It is at this point that the thermostat is the most sensitive and the comfort range is the most narrow. It is because of this reason that many women have their worst moments during the very early hours of the morning.
One mechanism has been more precisely discovered to be a brain chemical known as neurokinin B, which seems to directly stimulate the occurrence of hot flushes. The neurokinin B-producing cells in the brain of women with lower oestrogen over-activate and when they discharge, they overset the thermostat to the emergency heat-release program.
This finding has resulted in the creation of a more recent category of non-hormonal drug which acts specifically in blocking neurokinin B, and not simply in treating the symptoms. It is a significant step towards learning and curing the cause and not only the effects.
The sincere response is more than the majority of women anticipate. Hot flushes and night sweats were previously believed to take between two and five years towards the end period. Greater surveys, such as the long-running Study of Women’s Health Across the Nation have demonstrated the average to be around seven years, and in some cases much longer.
Also, there is actual variation in their starting time. There are those women who start feeling them long before their periods start to become irregular. Others do not show much until periods cease. The schedule is actually personal and there is no way to guess it.
The evidence does indicate that women who enter menopause at an earlier age, or whose symptoms develop earlier in the perimenopausal period, are more likely to experience an increased total period of vasomotor symptoms. The severity, the frequency, and the duration all differ to an enormous extent.
Learning your personal triggers is one of the most feasible measures you can undertake. Although there are many triggers that are specific to each individual, the most commonly reported ones include:
Being fat: fat in the body serves as insulation and thus it becomes difficult to get rid of heat in the body. Studies indicate that a 10-percent weight loss results in a significant change in the frequency and the severity of the flush.
Real environmental modifications are the beginning point that is free and frequently can be felt directly:
The best treatment of hot flushes and night sweats is menopausal hormone therapy (MHT), formerly referred to as HRT, in Australia. This is the long-standing and unequivocal stand of the Australasian Menopause Society and all the major international menopause organisations.
MHT treats the cause: it replenishes part of the oestrogen lost by the body and this reestablishes the temperature comfort zone once more and decreases the hypersensitivity of the thermostat. In the case of good candidate women, the night sweats can be graphical and comparatively fast.
MHT risks are actual, though perhaps exaggerated in the general knowledge, especially in the healthy females who initiate treatment during the first decade of menopause. The earlier blogs in this series deal with the safety evidence in a detailed manner. To those who feel unsure, the course of action is to talk to a GP who can then evaluate the situation on a case-by-case basis.
In women who are unable or unwilling to use hormone therapy, a number of non-hormonal drugs have a fair amount of justification:
Cognitive behavioural therapy or CBT does not decrease the number of hot flushes you experience. What it actually does, and with regular evidence in its support, is to mitigate the disturbance caused to you and your sleep by each flush. In women whose primary issue is the anxiety and hyperarousal that occurs after the episode and the resulting inability to resume sleep, CBT targets the responses.
And this is no prize of consolation. The evidence demonstrates that CBT has a significant positive effect on the quality and overall sleep during the menopause transition, even in the presence of the continuing flushes.
Personal triggers are not glamorous to identify and reduce, yet it is a practical, effective approach. A short journal of events before each bad night, what you ate and drank, the temperature in your room, your stress level, the amount of physical exercise you did will provide you with something to respond. To most women, simply reducing alcohol will make a difference in a few days.
After the heat is gone, this is one of the undervalued features of night sweats. The body that has lost heat quickly and sweated may then undershoot, and get too cold. Most women talk about how they have woken up and found themselves wet, and then tossed all the covers off only to shiver fifteen minutes after.
It is better to have a light blanket around like a thin blanket folded at the base of the bed so that you can easily add it back, that is without completely warming yourself up. This minor fact is not brought up much but makes the process of recovery after each episode significantly easier.
Occasional and mild night sweats are unlikely to require any medical intervention. However, when they are occurring on most nights, disturbing you, making you feel tired all day long, or dramatically influencing your work, mood or relationships, then it is time to have a good chat on the subject with your GP.
You need not take this as something to get through. Treatment can be found on a variety of intervention levels, starting with real environmental modifications, all the way to medication. A GP can assist you in identifying the method that is appropriate to your case, your preferences, and your medical history.
The commonality of night sweats does not imply that they are an unavoidable and incurable condition. They possess a particular, known cause, and there exist multiple, well-proven solutions to making them much, much easier to handle.