A woman adjusts her internal thermostat to reduce or avoid hot flashes and night sweats.
Adjust your internal thermostat to reduce or avoid hot flashes and night sweats. (For Spectrum Health Beat)

Hot flashes and night sweats are the most common symptoms of early hormone changes, happening even before menopause begins.

And they can sneak up on us and hit us when we aren’t expecting them. I can tell you from personal experience that the “surprise” hot flash has happened to me. It seemed to come out of nowhere.

It happened many years ago, but I remember it like it was just yesterday.

I was running up the stairs at the hospital, and by the time I got to the top step, I first felt warmth in my legs and then the hot rush spread upward to my face. Confused by this sensation, I wondered if I was starting to get sick. Or maybe I was just dehydrated.

Nope—I was having my first hot flash. It just took me some time to realize it was happening to me. During the next few days, I experienced more symptoms that confirmed my suspicion: I was in perimenopause.

I had a night sweat sneak up on me, too. This occurred several months after my first hot flash at the hospital.

I was at a meeting in Washington, D.C., and I ate a dinner that included just one simple carb (white rice). Everything else was a protein or vegetable, so I thought I was doing well. I also, however, had a glass of wine and a serving of chocolate mousse.

Later that night, I awoke with a terrible night sweat. Not putting two and two together, the next night I had a drink with dinner and another yummy dessert. You can probably imagine what happened again that night as I slept—another night sweat. It was then that I realized I needed to learn more about hormones and menopause, and that started my interest in helping others with the same issues.

When I can’t figure something out, I always go back to the physiology, or the basics of how our bodies work.

Hot flashes and night sweats actually make perfect sense if we look at how our bodies deal with temperature change. When I talk about hot flashes with my patients, I use the simple analogy of the thermostat in a home. When the thermostat is set to 70 degrees, it is programmed to turn on or off when the house gets above or below that temperature.

If the house heats up from sunshine streaming through the windows, the air conditioning kicks on. If the house gets too cold, the thermostat senses a temperature drop and turns the heat back on to heat up the room.

Our brain thermostat works the same: If our bodies get too hot, our air conditioning is sweating (think hot flash), and we can make our body warm up by shivering. For our bodies to function well, our temperature should remain around 98.6 degrees, and we typically tolerate a four-degree swing up to 100.6 or down to 96.6.

But, when our estrogen levels drop, our tolerance for high or low temperatures drop as well. The result is a narrowing of our comfort zone.

So many of my patients come to see me because they start experiencing hot flashes and night sweats, and they are worried about what these symptoms could mean to their health. Patients I’ll call Kim, Lisa, Martha and Linda all came to my office because of these symptoms.

Kim came to see me because she was worried something was really wrong. She had heard that night sweats meant she could have cancer. At age 46 she was having night sweats that occurred two nights before her period. Kim also noticed she was more irritable the two days that followed her night sweats, and she began feeling very tired and lazy as well. As soon as her period started, however, all of her symptoms would disappear.

Lisa came to my office because her periods became very sporadic and she started having night sweats almost every night. She woke up every morning feeling like she was having a wrestling match with her sheets and blanket, often having to change her T-shirt in the middle of the night. Lisa began sleeping with the windows open, freezing her poor husband out of the room from the cold pouring through the window. I pushed Lisa to think about what she might be doing differently that could be causing her night sweats to be worse. After some discussion, she admitted that she was often having a glass of wine or a dessert after dinner, and she wasn’t drinking enough water throughout the day.

Martha made an appointment with me because she started experiencing night sweats and hot flashes eight years after menopause. She thought she had made it through menopause easily because her menopause symptoms only lasted several months and then seemed to disappear. Now, at 62, she experienced the symptoms again. When we reviewed Martha’s history, I learned she had gained about 50 pounds during the past 15 months after a broken leg left her unable to exercise. As a result, she started gaining weight and couldn’t stop, even becoming pre-diabetic along the way.

Linda came to see me because her hot flashes lasted all day and proved to be unpredictable. She was very thin (too thin, in fact), and, as a high-strung executive, she didn’t eat much food, and lived on coffee and adrenalin. It didn’t take long to realize what changes Linda needed to make in her life.

All of these women had their own individual stories, but they all had one thing in common: low estrogen levels. This low level was making their thermostat very sensitive and their comfort zone small, meaning they used to be able to get under the covers and get cozy without overheating. However, now they could barely tolerate wearing lightweight pajamas and a sheet.

The good news is that none of these women (including you and me) have to live like this.

There are different options they should consider that can give them some relief. One option is to take estrogen if it’s safe and timely for them individually. Estrogen medication makes the thermostat less sensitive again, reducing hot flashes and night sweats.

Another option is to make some simple lifestyle changes.

Dehydration can trigger a night sweat, and drinking a glass (or two) of red wine or eating a dessert after dinner can have the same effect. So, drinking enough water throughout the day and avoiding the sugar at night are two easy changes.

Being overweight adds insulation, so losing even five pounds can remove enough of a layer to reduce night sweats. Even going to bed cold can help ward off a night sweat—starting the night a bit chilly and getting under the covers without flannels or socks can allow your body to warm up just enough. Reducing stress, avoiding rushes of activity (like running late for a business meeting or going to deliver a baby), or eating regularly throughout the day can also help with hot flashes and night sweats.

A simple habit of metered breathing every night before going to bed can also help lessen the frequency of night sweats. Metered breathing is a technique I discuss with my patients to help them fall asleep at night or get back to sleep if they wake in the middle of the night. Here’s how it works:

  • Find a quite place in your home and sit in a comfortable chair.
  • Begin staring at a spot somewhere in the room and focus on the sound of your breathing.
  • Continue breathing like this for five minutes, uninterrupted.

This technique is very effective in helping you relax each night before going to sleep. The next time you are having trouble falling asleep or you wake up during the middle of the night, try metered breathing. It really works, and you may soon find yourself using this technique every night.

Read all of Dr. Diana Bitner’s Midlife and Menopause Moments blogs at spectrumhealthbeat.org/womens-health/midlife-menopause-moments.