Symptom Guide: Night Sweats

What are night sweats?

Waking up in the middle of the night drenched in a sweaty tangle of sheets? Night sweats (also called “vasomotor symptoms”) are sudden waves of extreme heat in your body that cause you to sweat profusely. They’re hot flashes at night, and the reason you may be feeling like you ran a marathon (or two) in your bed.

What’s the cause?

Night sweats are caused by the fluctuation and decline of your hormones, mainly estrogen. You might have experienced them post-pregnancy or be experiencing them now in your 40’s and 50’s as you approach menopause.

Certain factors can make them worse, including stress, smoking, and being overweight. An individual night sweat episode can be triggered by factors like caffeine, alcohol, spicy foods, exercise before bedtime, stress, heavy blankets on your bed, tight clothing or a warm room temperature. Pretty much everything! Sheesh.

What’s happening inside your body?

Normally, when your body gets too warm, the hypothalamus (the part of the brain that modulates body temperature) signals your blood vessels to open up to release heat. This causes blood to flow more quickly to your face, neck and chest. It also makes your sweat glands open and your heart pump faster.

As you approach menopause, lower estrogen levels cause your hypothalamus to set off this sweat-fest at random, which is why you might wind up wide awake in the middle of the night with your clothes and sheets clinging to your body.

What does the research say?

• A recent analysis of the Study of Women’s Health Across the Nation (SWAN) found that vasomotor symptoms - like night sweats - typically last between 5 and 13 years. On a zero (meaning none) to three (meaning severe) scale, most women rated them moderate-to-severe.
• A 2006 analysis of SWAN looked at vasomotor symptoms by ethnicity and determined that African American women experience them the most often, while Asian women got them less frequently.
• Another 2006 study found a correlation among night sweats, depression, sleep disturbances and diminished libido in perimenopausal and early postmenopausal women.

How are night sweats diagnosed?

A doctor will diagnose you based on your description of symptoms.

What are effective treatments?

• Estradiol: The most effective and safe treatment available - estradiol is both natural and FDA-approved. It’s scientifically proven to eliminate night sweats in up to 75% of women and to reduce the frequency and severity in the remainder. Estradiol works by replenishing the exact form of estrogen that your ovaries are no longer producing.
• Paroxetine: An FDA-approved SSRI (selective serotonin reuptake inhibitor), Paroxetine may be prescribed for women who aren’t candidates for estrogen or choose not to take estrogen. It acts by inhibiting the reuptake of serotonin by your neurons, thus increasing the level of serotonin within your brain.
• Venlafaxine: An SNRI (serotonin norepinephrine reuptake inhibitor), Venlafaxine may be prescribed off-label to women who aren’t candidates for estrogen therapy or choose not to take estrogen. It acts by inhibiting the reuptake of serotonin and norepinephrine by your neurons, thus increasing their levels in your brain.
• Gabapentin: A prescription seizure medication, Gabapentin is also believed to act on a mechanism that helps control body temperature. It’s therefore used off-label for night sweats and has a calming effect, which can be good for sleep.
• Clonidine: Clonidine is a high blood pressure medication prescribed off-label to treat hot flashes by lowering blood pressure.

What are some non-medical treatments?

While less effective than the medical treatments, some women find that these help:

• Sleep environment: Setting your bedroom temperature somewhere between 60 and 68 F, investing in a cooling mattress and cooling pillow (pro tip: you can also place a cold pack under your pillow and flip it before sleeping!), using sheets with breathable material like cotton or linen and running a bedside fan can all help with body temperature. Keeping a glass of cold water nearby can help cool you down if you wake up during a night sweat.
• Nutrition: Phytoestrogens (like those found in soy) can mimic estrogen within your body. While soy is one of the most well-known phytoestrogens, other sources include yams, flax, and lentils.
• Supplements: Some women find that using black cohosh, vitamin E, and dong quai can help reduce their hot flashes and with them, night sweats. However, studies are inconclusive. Vitamins B6 and 12 are also occasionally used to help with anxiety related to hot flashes and the night sweats that follow.
• Breathing exercises: Deep breathing exercises and mindfulness meditation can help you manage the duration of your hot flashes and associated night sweats by calming your anxiety, thereby reducing heart rate and blood flow.
• Daily physical exercise: Sustained physical exercise can help your body to more effectively regulate temperature and release heat, which helps mitigate hot flashes throughout the day. That said, try not to exercise right before bed. This can raise your body temperature and increase the chance of night sweats.

What to do next:

• Connect with an OBGYN who treats menopause: Many doctors will list their specialties/areas-of-interest on their website, or you can ask when making your appointment.
• Determine your options: Collaborate with your doctor to identify and understand the treatment options available to you given your medical history.
• Decide what works for you: You know your body best. Select your treatment and keep working with your doctor to make sure it’s working optimally for you.

Hot flashes are the most common symptom of the menopausal transition. The average age of menopause is 51 and hot flashes often start for women in their 40s.

What are hot flashes?

Hot flashes (also called “hot flushes” or “vasomotor symptoms”) are sudden feelings of extreme heat in the body that are most intense over the face, neck and chest. They can cause your skin to look like you’re blushing—and can make you want to take that ice bucket challenge ASAP.

Hot flashes can also make you sweat (“night sweats” are actually hot flashes that happen during sleep) and can lead to a rapid heartbeat and feelings of anxiety or dread. If you lose enough heat, you may feel chilled when they’re over.

Up to 75% of women experience hot flashes, making them the most common symptom of perimenopause and menopause. That’s right, you can have hot flashes and still be getting your period. Each episode can last anywhere from thirty seconds to ten minutes, and recent research has suggested that most women get them over the course of about 7.5 years, often starting in their 40s during perimenopause. Good times, right?

What causes them?

Hot flashes are caused by the fluctuation and decline of your hormones, mainly estrogen. Certain factors are thought to make them worse, including stress, smoking, and being overweight. Some people find that hot flash episodes can be triggered by a long list of factors, among them caffeine, alcohol, spicy foods, processed foods, food sensitivities, and warm weather.

What’s happening inside your body?

Normally, when your body gets too warm, the hypothalamus (the part of the brain that modulates body temperature) signals your blood vessels to dilate in order to release heat. This causes blood to flow more quickly to your face, neck and chest, your sweat glands to open, and your heart to pump faster.

During menopause, lower estrogen levels cause your hypothalamus to set off this reaction at random, making you feel like you just ran a four minute mile when really you did nothing of the sort.

What does the research say?

• A recent analysis of the Study of Women’s Health Across the Nation (SWAN) found that hot flash symptoms typically last between 5 and 13 years and were rated moderate-to-severe by most women.
• A 2006 analysis of SWAN looked at hot flashes symptoms by ethnicity and determined that African American women experience them more frequently than other groups, while Asian women experience them less frequently.
• Research on 430,000 Swedish women discovered that 11% of 38-year-old women were already experiencing hot flashes, and 30% of 60-year-old women were still getting them.

How are hot flashes diagnosed?

A doctor can diagnose you based on your description of your symptoms.

What are effective treatments?

• Estradiol: This is the most effective treatment available. Replenishing the exact form of estrogen that your ovaries are no longer producing, estradiol is scientifically proven to eliminate hot flashes completely in up to 75% of women and to reduce the frequency and severity in the remainder.
• Gabapentin: A non-hormonal off-label prescription medication, Gabapentin is believed to act on a mechanism that helps control body temperature. It is particularly effective for night sweats.
• Paroxetine (aka “Paxil” or “Brisdelle”): An FDA approved, low-dose SSRI (selective serotonin reuptake inhibitor) that may be prescribed for women who aren’t candidates for estrogen therapy due to breast cancer or who want non-hormonal treatment. It acts by inhibiting serotonin within your brain.
• Venlafaxine (aka “Effexor”): An SNRI (serotonin norepinephrine reuptake inhibitor) that may be prescribed off-label to women who aren’t candidates for estrogen therapy due to breast cancer or who want a non-hormonal treatment. It acts by inhibiting serotonin and norepinephrine within your brain.
• Clonidine: Clonidine is a high blood pressure medication prescribed off-label to treat hot flashes by lowering blood pressure.

What are some non-medical treatments?

While less effective than the medical treatments, some women find that these help:

• Nutrition: Phytoestrogens (like those found in soy) can mimic estrogen within your body. While soy is one of the most well-known phytoestrogens, other sources include yams, flax, and lentils.
• Supplements: Some women have found that using black cohosh, vitamin E, and dong quai can reduce their hot flashes. Studies suggest they work by regulating hormone levels, though exactly how is still being researched. Vitamins B6 and 12 have are also occasionally used to help with anxiety related to hot flashes.
• Breathing exercises: Deep breathing exercises can help you manage the duration of hot flashes by calming your anxiety, thereby reducing heart rate and blood flow.
• Physical exercise: Sustained physical exercise can help your body more effectively regulate temperature and release heat.
• Layers: Wearing loose clothing and dressing in layers (think a t-shirt and light sweater versus a cable knit) allows you to control your temperature by removing items to cool off.
• Cannabis: While cannabidiol (CBD) seems to be everywhere these days, at present, there is very little evidence to suggest that CBD can treat the symptoms of menopause.

What to do next:

• Connect with an OBGYN who treats menopause: Many doctors will list their specialties/areas-of-interest on their website, or you can ask when making your appointment.
• Determine your options: Collaborate with your doctor to identify and understand the treatment options available to you given your medical history.
• Decide what works for you: You know your body best. Select your treatment and keep working with your doctor to make sure it’s working optimally for you.

Learn More:

Are you experiencing other symptoms that you want to better understand and learn how to treat and manage them? Check out our following guides:

• Symptom Guide: Hot Flashes
• Symptom Guide: Brain Fog

This article was reviewed by Emily Hu, MD

Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.