During menopause, women may experience sleep issues like insomnia, night sweats, frequent waking, and morning grogginess. If these disturbances become chronic, they aren’t just annoying — they may impact health in significant ways. For example, a recent study noted that night sweats and hot flashes could increase the incidence of sleep apnea in menopausal women, which can raise cardiovascular risks.
Fortunately, there are some treatment options and lifestyle changes that can help, according to Lila Nachtigall, M.D., professor of obstetrics and gynecology at NYU Langone Health. Here she talks to HealthCentral about how to handle these all-too-common problems in menopause.
HealthCentral (HC): What seems to be the biggest struggle for women who are dealing with hot flashes and night sweats?
Dr. Nachtigall: They’re often told to just “get through it,” and that it’s normal, so there’s nothing they can do. I’ve seen patients who’ve been to multiple doctors and are told that hot flashes are a minor inconvenience. But in fact, they can significantly affect quality of life, including sleep.
Without solid sleep, you may set yourself up for a cascade of other health issues, so this is a problem that should be addressed, not ignored.
HC: What’s happening in the body during episodes of hot flashes and night sweats?
Dr. Nachtigall: We don’t yet know the exact mechanisms at play, but we have some good leads. There was a study done by Yale where participants had PET scans during their hot flashes, and what that showed was a marked decrease in blood flow to the brain while it was occurring.
That gives us a strong hint about what’s going on with the system, and particularly the brain. There are estrogen receptors in the brain, and when they don’t receive as much estrogen as they expect, they give off a substance we call “brain epinephrine.” That has an adrenaline-like effect. So, your brain is expecting estrogen, doesn’t get it, so it decreases blood flow and instead floods your body with a substance that raises your temperature and, if you’re sleeping, may wake you up as a result.
HC: What are the negative effects when this kind of cycle is chronic, meaning you wake up often?
Dr. Nachtigall: One of the most common symptoms of menopause is insomnia, and that might involve trouble falling asleep, staying asleep, or both. Because it’s common, many women go back to that assumption that they just have to get through it, that they have to tolerate what can sometimes be intense discomfort.
However, that kind of consistent sleep deprivation increases stress and can affect the heart. This might happen because hot flashes compromise blood flow, and so you’re dealing with constriction of arteries, and that can be difficult for the heart.
HC: When should a woman seek professional care for hot flashes or night sweats?
Dr. Nachtigall: If you experience this every once and a while and it doesn’t seem to be making a huge difference in your life, then you’re probably fine to ride it out. Some women might experience this only a few times during their entire menopause experience, and some women never have it happen, while others might get these night sweats every night. What’s important to keep in mind is that they’re not good for your health, so the more often it happens, the more likely it is that you should see your doctor.
There are some over-the-counter remedies that people try, but in my opinion, FDA-approved estrogen supplements tend to work best. There’s also a non-hormonal drug that is a low-dose antidepressant. It’s not a high enough dose to do anything psychologically, but it’s been found to stop hot flashes for many patients. But I’m not against remedies that involve herbs or soy, as long as those are sourced from reputable companies.
HC: Beyond medication, are there other strategies for dealing with the issue?
Dr. Nachtigall: Whether dealing with night sweats or not, it’s always a good idea to implement better sleep hygiene strategies because sleep is crucial at any age. That might mean lowering the temperature of your bedroom, having a night-time ritual that sets you up for falling asleep faster, avoiding screens for an hour before bed so you limit exposure to blue light, and other tactics.
Most importantly, don’t just assume that you have to suffer through it. Just because a symptom is common doesn’t mean you should be lying there, wide awake, drenched in sweat, saying, “This is no big deal, everybody goes through this.” If it’s bothering you, and impacting your life, then talk to your doctor about it. And if your doctor isn’t willing to help solve the problem, then find another doctor.
Interview has been condensed and edited.