Why Are Hot Flashes Worse at Night?

Hot flushes affect more than 80% of women during menopause, with many experiencing a dramatic intensification of these symptoms at night. If you've ever woken up drenched in sweat, desperately kicking off the covers even though the room is cool, you're not alone.

So why do hot flushes become more severe at night, and more importantly, what can you do about them?

This article will examine the hormonal changes that trigger these vasomotor symptoms, why they're worse at night, and provide strategies to help you find relief and restore restful sleep during menopause.

If you also want more insights into your symptoms, Everlab’s detailed assessment includes a broad range of biomarkers that may identify specific imbalances causing more frequent and uncomfortable hot flushes.

The Science Behind Why Hot Flushes Happen at Night

Hot flashes are more likely to occur at night for most women because the body naturally regulates temperature during sleep. In healthy sleep physiology, core body temperature drops in the evening to help the body fall and stay asleep.

During the menopause transition, fluctuating and declining oestrogen levels make the hypothalamus (the brain’s temperature control centre) overly sensitive. As a result, even small, normal drops in temperature can be misinterpreted as overheating.

The hypothalamus responds by triggering blood vessel dilation and sweating, which produces the sudden feeling of heat, flushing, and perspiration commonly experienced as night sweats.

Hot Flushes and Night Sweats: What’s the Difference?

The terms hot flushes and night sweats are often used interchangeably, but they describe slightly different experiences of the same underlying process.

• Hot flushes, also called hot flashes, usually involve a rapid wave of heat, flushing, and sweating
• When these episodes occur during sleep and cause drenching perspiration, they’re often called night sweats

Together, these flushes and night sweats represent one of the most common menopausal symptoms.

Factors That Can Worsen Hot Flushes at Night

While almost all women experience hot flushes, some factors can worsen symptoms, such as:

Lifestyle Factors

Several lifestyle factors can increase the frequency or severity of menopause symptoms at night, causing sleep disturbance. These factors include:

• Alcohol and caffeine intake
• Smoking
• Stress and anxiety
• Poor sleep habits

Environmental Factors

Consider factors like:

• High bedroom temperature
• Heavy or insulating bedding that traps heat
• Synthetic sheets, blankets, or sleepwear that limit airflow
• Poor air circulation in the bedroom
• Warm or poorly ventilated mattresses that retain body heat
• Humid indoor environments that impair evaporative cooling
• Shared bedding that increases heat retention from another person

Dietary Triggers

Eating patterns, the foods you consume each day, and your overall nutrition can exacerbate symptoms, so consider:

• Alcohol consumption in the evening, which dilates blood vessels and raises core temperature
• Caffeine intake later in the day, including coffee, tea, energy drinks, and some soft drinks
• Spicy foods, which can stimulate thermoreceptors and increase heat production
• Hot drinks consumed close to bedtime, potentially elevating body temperature before sleep
• Large or heavy evening meals that increase metabolic heat during digestion
• High-sugar foods at night, which can trigger insulin spikes and thermoregulatory instability

Medical Treatment Options for Managing Hot Flashes

Key treatment options for reducing moderate to severe hot flashes and night sweats include:

Menopausal Hormone Therapy (MHT)

Formerly known as Hormone Replacement Therapy (HRT), MHT stabilises declining oestrogen levels to improve thermoregulation.

The North American Menopause Society states that when menopausal hormone therapy  is started at the appropriate time and prescribed correctly, it's one of the most effective treatments for vasomotor symptoms.

However, it  may not be appropriate for women with a history of breast cancer, uncontrolled high blood pressure, or certain cardiovascular conditions (read about how to reduce heart disease risks after menopause, too).

Non-Hormonal Drug Treatments

Certain prescription medications, such as certain antidepressants (particularly SSRIs and SNRIs), may improve menopausal symptoms for women with breast cancer who cannot use hormonal options.

These treatments can reduce the frequency and severity of nighttime hot flashes by influencing central thermoregulation pathways.

Blood Pressure Medications

Some prescription medications, such as clonidine, may help reduce hot flashes by affecting vascular responses, although they are typically prescribed at lower doses than those used to treat hypertension.

Cognitive Behavioural Therapy and Mental Health Support

Cognitive Behavioural Therapy (CBT) is an evidence-based approach that focuses on changing thought patterns and behavioural responses to symptoms. It can help you develop coping strategies that improve sleep quality.

Research shows that there is a huge connection between mental health and hot flushes. For instance, anxiety about experiencing night sweats can trigger more episodes, thus creating a frustrating cycle. So, CBT aims to break this cycle by teaching techniques to manage anxiety and develop practical strategies for when hot flushes occur.

Supporting your emotional health during this transition is also crucial. Chronic sleep disruption caused by night sweats often affects mood, concentration, and overall quality of life.

Herbal Medicines and Complementary Approaches

Many women continue to explore herbal medicines and complementary approaches to help reduce menopausal symptoms. While scientific evidence varies in quality, some herbs contain biologically active compounds that may influence symptom severity.

• Black cohosh: Some research suggests it may help ease symptoms through actions on neurotransmitter pathways, though evidence is inconsistent.
• Red clover: contains phytoestrogens that may act weakly like oestrogen in the body. Some studies indicate it may reduce the frequency of hot flushes in certain women, though results are variable.
• Soy isoflavones: Found in soy foods and extracts, these have shown modest benefit in some trials, but findings depend heavily on formulation and dose.
• Evening primrose oil: Although popular, scientific trials generally do not support evening primrose oil as an effective treatment for reducing hot flushes compared with a placebo.

Caution: These herbs are not considered replacements for established medical treatments. It's best to consult your healthcare team before starting any herbal or complementary therapy.

Optimising Sleep Habits and Bedroom Environment

Improving sleep hygiene is among ob gyn's top tips for managing menopause symptoms. Key lifestyle changes include:

• Maintaining a consistent sleep and wake schedule
• Keeping the bedroom temperature cool (around 18°C)
• Ensuring adequate ventilation or airflow, even when using air conditioning
• Using blockout curtains and minimising electronic disturbances
• Using a fact sheet to track when hot flushes happen to identify potential triggers
• Keeping a cold pack or cool water by the bedside
• Considering separate bed covers if sharing a bed to manage heat retention
• Using relaxation techniques like slow, deep breathing and yoga to help the nervous system settle

Managing Other Menopausal Symptoms

While hot flushes often receive the most attention, menopause is associated with a wide range of interconnected symptoms. Other symptoms of menopause include:

• Fatigue and sleep disturbance
• Vaginal dryness
• Joint aches
• Brain fog
• Mood changes and anxiety
• Low libido
• Weight gain

In most cases, these symptoms don't occur in isolation. For instance, poor sleep from night sweats can worsen mood, while unmanaged stress can intensify physical symptoms.

Also, addressing sleep quality and supporting metabolic and hormonal health could help reduce hot flushes and other symptoms.

How to Seek Professional Help

Persistent or severe hot flashes that disrupt sleep, mood, or daily functioning may require further evaluation.

At Everlab, we take a functional medicine approach and analyse hundreds of biomarkers to assess hormone patterns, metabolic health, nutrient status, and interconnected symptoms.

We look at contributing factors, including thyroid dysfunction, nutrient deficiencies, and metabolic changes, then create a personalised plan that addresses root causes holistically.

Conclusion

Nighttime hot flushes and night sweats are common during menopause, but their intensity often reflects broader hormonal and metabolic shifts.

If you are looking for a deeper understanding of your symptoms, a comprehensive assessment with Everlab can help uncover the factors affecting your sleep and overall well-being during this transition.

Sources:

1. My Menopause Centre: Understanding Why Hot Flushes Occur Predominantly at Night
2. Cleveland Clinic: How To Find Relief for Hot Flashes at Night
3. John Hopkins Medicine: Managing Hot Flashes: Tips from a Menopause Expert‍