Menopause can be a wild ride, I know this for myself! 

Night sweats were one of the most devastating symptoms, consistently robbing me of precious sleep. Night after night I was waking up drenched in sweat and throwing off my sheets in frustration…

If your nights are the same, and you're wondering how to manage night sweats during menopause for better sleep – you're not alone – in fact, 75% of women experience night sweats during menopause with above 40% rating them as “very intense”.

So where's the good news?

If you are interested in medications – read the latest issue of NAMS POSITION STATEMENT: The 2023 nonhormone therapy position statement of The North American Menopause Society.

In this article, we will look at the most effective and safe ways to combat night sweating that keeps us awake so that we are not limited to pharmacological drugs alone.

From changing your sleep patterns to understanding how your hormones work, now you can find a way to transform your nights. Read on to learn what triggers drenching sweats, dive into solutions and finally get a restful night's sleep. 

Let's get started!

Understanding Night Sweats During Menopause: Causes and Impact

What are night sweats?

What we understand as “Night Sweats” are characterized by intense, sometimes profuse sweating during sleep, which can cause us to wake up drenched and often in need of changing clothes or bedding.

Night sweats appear suddenly, even if your room is cool or the body is not under any stress, while normal sweating occurs when we overheat or after physical activity. 

The frequency and severity of menopausal night sweats can vary greatly from woman to woman.

Some of us may experience it only occasionally, while others suffer for years every single night, which greatly affects not only the quality of sleep but also health overall.

Why menopause triggers night sweats: hormonal fluctuations explained

Menopause provokes night sweats primarily because of significant hormonal fluctuations – and that is expected if you're going through menopause. We are talking about, particularly changes in estrogen and progesterone levels: a decrease in estrogen levels and a sharp increase in FSH or follicle-stimulating hormone.

“Menopause tests” check FSH at the beginning of the cycle – if it is elevated, it is a signal that estrogen is at zero and you are probably approaching menopause.  

To understand the night sweat triggers let's first talk about the Hypothalamus, a small but important part of the brain that acts as the body's control centre or thermostat. It monitors and controls body temperature, hunger, thirst, sleep, and even hormones.

The relationship between low estrogen, elevated FSH and the hypothalamus is a critical part of understanding the causes of night sweats and daytime hot flashes during menopause.

When estrogen levels drop, our bodies make numerous attempts to compensate by increasing FSH levels in an attempt to stimulate the ovaries. 

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However, this surge in FSH and drop in estrogen levels affects the hypothalamus, which is responsible for regulating FSH and estrogen production as well as body temperature. The hypothalamus becomes very sensitive to various factors (hormones, stress, daily rhythm, etc.), resulting in overexcitation of the thermoregulation centre. It is this overexcitation that leads to the sudden onset of night sweats and then a sudden cold snap as the body thinks it has overheated.

This explains why night sweats and especially daytime hot flashes often precede menopause and if you’re experiencing them but still have periods – you might also enjoy this article as you can start implementing lifestyle changes that can help you a big deal in the future.

This explains why night sweats and especially daytime hot flashes often appear before menopause. If you’re experiencing them but still have periods – you might also enjoy this article as you can start implementing lifestyle changes that can help you a big deal in the future.

How night sweats affect sleep quality and overall health

Night sweats are often accompanied by tachycardia or rapid heartbeat, which also appears as a result of overexcitation of the temperature centre. During these attacks, many of us may wake up with the sensation of palpitations, which makes these attacks of night sweats even more unpleasant and painful.

The rapid heartbeat is part of the body's response to the perceived temperature imbalance, which further increases feelings of anxiety and discomfort. The same thing happens to you during the daytime hot flashes. 

Over the years of living with symptoms, you become very sleep-deprived, and your nervous system and heart become unhinged, permanently ruining your entire health. That's why it's so important to address both hormonal and physiological factors that are causing your night sweats, as they work together to create these devastating symptoms during menopause and every part of your body.

Why Hormone Replacement Therapy May Not Be Enough?

Estrogen decrease is common during menopause, but the severity of night sweats varies from woman to woman.

Many of us resort to HRT or hormone replacement therapy to manage menopausal night sweats and hot flashes. Studies have shown that additional estrogen supplied with hormone therapy can significantly reduce the frequency and intensity of night sweats in many women (source). However, you are not guaranteed that HRT can eliminate hot flashes. 

First, estrogen alone from HRT may not be enough to handle all the physiological changes that occur during menopause. since it is FSH that is responsible for irritating the thermostatic centre in the brain.  

Second, different people's responses to HRT can vary greatly. Third, your hypothalamus may be more sensitive and react to the smallest changes in hormone levels, resulting in continued bouts of night sweats despite taking estrogen. Fourthly, it's lifestyle, because it's what creates a balanced hormonal environment.

Psychological impacts of sleep deprivation caused by night sweats

Night sweats can seriously disrupt sleep and overall health, creating a cascade of negative effects on how you will feel the next day and for the rest of your life.

During sleep, the body goes through various sleep stages, including non-REM sleep and the rapid eye movement (REM) phase or deep sleep phase during which the body rapidly restores both physical health and cognitive functions such as memory and emotional stability. 

Night sweats leading to wakefulness and tachycardia can prevent you from entering and maintaining the deep stage of REM sleep.  Frequent awakenings due to night sweats make sleep fragmented or interrupted, which is frustrating and exhausting because we lose the opportunity to regain our physical health and cognitive abilities. As a result, many of us consistently experience increased fatigue, irritability, and cognitive decline, which can't help but interfere with our ability to efficiently complete daily tasks and simply stay sane.

Insomnia during Menopause

Chronic night sweats can also lead to insomnia, compounding the difficulties associated with poor sleep quality. This happened to me when waking up in a sweat with a pounding heart, I just couldn't go back to sleep.

Over time, the effects of fragmented sleep can be reflected in more than just feeling tired all the time and walking around all day irritable with red eyes.  The worst part is that interrupted sleep weakens the immune system, increases the risk of cardiovascular disease and negatively affects metabolism. 

It is impossible to be both tired and alert at the same time, ready for sports or happy to take long walks. You simply cannot live without coffee and sweets! 

Our body's natural processes rely heavily on restorative sleep to maintain a healthy metabolism, and chronic sleep deprivation slowly leads to weight gain, hypertension, and severe inflammation. 

This link between poor sleep and menopause symptoms tends to create a vicious cycle: inadequate rest increases mood swings, anxiety, and hot flashes, leading to even more disrupted sleep. All of this only emphasizes the importance that this problem needs to be addressed even if the solution is complex, as better sleep will only make you kinder, healthier and happier. 

Step-by-Step Night Routine for Managing Night Sweats

Managing what is known as night sweats during menopause for better sleep requires some strategies to lifestyle changes that can help sleep peacefully and create a more comfortable sleeping environment.

2. Hydrate Properly:

• Drink a glass of water before bed to maintain hydration.
• Keep a water bottle nearby for easy access throughout the night.

3. Relax Before Bed:

• Take a warm bath an hour before bed to relax muscles and lower body temperature.
• Apply calming essential oils like lavender to reduce stress.

4. Practice Mindful Relaxation:

• Spend 10 minutes meditating before bed, using apps like Calm.
• Deep breathing exercises can ease anxiety and calm your body.

5. Adjust Evening Food Intake:

• Opt for lighter evening meals to avoid overheating during digestion.
• Avoid spicy foods, alcohol, and caffeine, especially before bedtime.

Lifestyle Changes to Reduce Night Sweats and Improve Sleep

1. Regular exercise

Regular exercise is known to be one of the most effective ways to achieve hormonal balance, as it helps regulate levels of cortisol. But how can it help to reduce night sweats?

Exercise promotes circulation and cardiovascular health, which is critical for effective thermoregulation. Physical activity increases blood flow, which allows the body to dissipate heat more efficiently. 

Regular aerobic exercise also increases the efficiency of sweating, which is vital for maintaining a stable internal temperature. In addition, exercise has been shown to have a positive effect on hormonal balance as it promotes a more balanced hormonal profile by increasing endorphins, stabilizing insulin, and increasing growth hormone production and testosterone, which makes us more active and motivated (source).

They also reduce weight, help relieve stress, and anxiety and improve mood, which can help reduce psychological stress, which also exacerbates hot flashes. 

It is important to choose the right time to exercise: exercising too close to bedtime can raise your body temperature, which can trigger night sweats and disrupt your sleep. 

2. Food and eating patterns

• Certain foods can increase the likelihood of night sweats and increase the number of hot flashes – spicy foods, hot drinks and foods high in sugar (source).  

• Heavy, spicy and full of simple carbohydrates (bread, rice, pasta) foods closer to bedtime can trigger night sweats.

• Interval fasting that takes place at night, on the contrary, reduces attacks.

• When estrogen levels drop, digestive processes slow down, so your body works harder to digest large amounts of protein. I've noticed that my night sweats are more common when I am eating heavy, protein-rich foods, especially close to bedtime, which raises my body temperature and metabolism, exacerbates night sweats or hot flashes and negatively affects my quality of sleep.

Large portions of protein require more energy to digest, causing an increase in internal body temperature, which can contribute to feeling overheated, especially if you are already sensitive to temperature fluctuations due to menopause.

• To avoid this, eat small, well-balanced portions of protein during the day but light meals in the evening. A balanced diet rich in fruits, vegetables, whole grains and lean proteins, helps to avoid triggers that can provoke night sweats.

• Include cooling foods in their diet. These foods help regulate body temperature and promote hydration.

• Leafy greens such as spinach, lettuce and arugula are also very beneficial as they provide the body with essential vitamins and minerals without burdening the digestion. 
• Yoghurt made with coconut milk, coconut water and chilled chamomile tea has a cooling and soothing effect.

• Caffeine and alcohol are two common culprits for increased night sweats, which is why it's so important to limit their consumption. Both substances systemically disrupt sleep patterns and raise body temperature, exacerbating the symptoms of night sweats. 

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3. Stay Cool and Stress-Free with Simple Lifestyle Changes to Beat Night Sweats

• Maintain a cool atmosphere in your room during the day to prevent nighttime overheating. Simple strategies such as dressing in lightweight layers and using breathable fabrics can help regulate body temperature. 
• Incorporated meditation and mindfulness practices into your routine: managing stress levels not only will help you reduce the frequency of night sweats but also promote relaxation, leading to better performance during the day and better sleep at night. 

Hormonal and Non-Hormonal Treatments for Managing Night Sweats

Let me say right away that studies and clinical trials of various treatments designed to reduce the frequency and severity of night sweats during perimenopause and menopause have come to the same conclusion year after year: The authors note that the placebo effect is higher in trials for hot flashes than for many other conditions.

NAMS (North American Menopausal Society) does not recommend starting treatment unless you see a doctor and complain that the symptoms of hot flashes and night sweats are bothering you a lot. For most women, hot flashes go away over time without intervention.

And if that's the case, your personal experience may not be the same as mine. However, that doesn't stop us at all from trying different therapies, dietary changes, and supplementation. The only thing I recommend is to keep a diary of observations to find what triggers night sweats and what stops them. Also, such notes will be very helpful in the dialogue with your doctor.

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Managing Night Sweats: Hormonal vs. Non-Hormonal Treatment Options

When it comes to dealing with night sweats during menopause to sleep better, you are offered both hormonal and non-hormonal treatments, each with its pros and cons. 

Hormone replacement therapy (HRT) is the most common method of dealing with severe menopausal symptoms, including night sweats. 

• It replenishes estrogen levels (as well as progesterone and even testosterone if it's a combination drug), which promises to alleviate hot flashes and improve sleep quality. However, as I mentioned above, HRT may not work if your hypothalamus is very sensitive. In addition, HRT comes with its risks such as blood clots and certain cancers, making it especially important to discuss your medical history with your doctor. 

• On the other hand, non-hormonal medications such as selective serotonin reuptake inhibitors (SSRIs), gabapentin and other medications (source) can also help manage hot flashes without the hormonal risks associated with HRT, offering another option for women who prefer or need a non-hormonal approach.

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Supplements and Therapy for Night Sweats

Many of you may turn to natural supplements that help you manage night sweats. Although numerous studies on the effects of supplements on the intensity and frequency of night sweats often conclude that placebos often have a stronger effect (source), I will still allow myself to flag some supplements here.

• Black cohosh (Cimicifuga racemosa or Actaea racemosa L.) is a popular herbal remedy that may reduce hot flashes according to some studies (source), although more research is needed to establish its effectiveness. There are concerns about side effects (dizziness, headaches etc). Black cohosh should not be thought of as an “herbal estrogen” or a substitute for estrogen (source). 

• Dose: Median daily dose of 40 mg (often found ineffective, source), however studies that reported Black cohosh as the effective remedy used higher doses of up to 128 mg/day (source1, source2) without toxic effects. If you want to try it, you may use a typical dosage of around 80 mg per day, but it's important to follow the specific product's instructions or consult with a healthcare provider.
• Duration: While individual responses can vary, research generally suggests that it may take about 4 to 12 weeks of consistent use to notice significant improvements in symptoms like night sweats (source).

• Vitex (Vitex agnus-castus) or Chasteberry acts primarily on the pituitary gland and stimulates the production of luteinizing hormone (LH) while suppressing the secretion of follicle-stimulating hormone (FSH) (source). 

Although some anecdotal evidence suggests that Vitex affects the thermoregulation centre in the hypothalamus, this area of research is not well understood. Still, by influencing hormones, Vitex may promote a more stable internal environment, potentially leading to fewer episodes of overheating and nighttime sweating. Some small trials showed reductions in night sweats, especially when combined with other supplements (source) but larger studies found no significant benefit.

• Dose: 1,000 mg dried fruit or 50-125 mg fruit extract.
• Duration: 8-16 weeks. 

• Siberian rhubarb or Rheum rhaponticum (extract known as ERr 731™) has been clinically trialled to relieve common menopause symptoms, including significant reductions in hot flushes from just 4 weeks, in women taking 4mg per day (source). 

The North American Menopause Society says that trials had low retention rates and limited safety data. However, women find it very effective in reducing symptoms like hot flashes by taking a supplement with Siberian rhubarb called Estrovera (source).

• Dose: 4mg per day
• Duration: 12 weeks. 

• Magnesium supplements, especially magnesium citrate. Magnesium supplementation is not associated with hot flashes,  but it plays a critical role in regulating the body's response to stress, helps relax muscles and promotes calmness, making it easier to fall asleep (source). Magnesium intake helps alleviate night sweats, supporting overall sleep quality. 

• Dose: 200 to 400 mg per day for relaxation and sleep improvement.
• Best forms: Magnesium Citrate.

• Melatonin, a hormone produced in darkness, helps regulate the sleep-wake cycle and is a great antioxidant. If you suffer from insomnia or irregular sleep patterns during menopause, melatonin may help you fall asleep faster and increase sleep duration (source). 

• Dose: up to 1 mg per night for sleep improvement.
• Duration: up to 4 to 6 weeks without significant issues.

Want to find out more about useful supplements for menopausal symptoms? Click here to read the full article about the Top 19 Hormone-Balancing Supplements and Essential Nutrients for Menopause.

• Cognitive behavioural therapy (CBT) has emerged as an unexpected but effective solution to combat night sweats (source). This psychological approach can help you develop coping strategies and stress reduction techniques that can minimize the frequency and intensity of night sweats. 

This type of therapy can help you identify and overcome negative thought patterns and beliefs associated with menopause. Cognitive therapy can reduce stress and anxiety, which are known to trigger or exacerbate night sweats. Improving your overall emotional well-being can improve sleep quality and help you feel more in control of your menopausal symptoms. 

• A sleep diary can help you identify patterns (food, stress etc) associated with night sweats and sleep disturbances. By tracking the timing of night sweats, as well as lifestyle factors such as diet, exercise, and stress levels, you can gain insight into what may be triggering your symptoms. 

Regardless of the treatment method chosen, it is important to consult a physician if you have severe night sweats. He or she can advise on the most appropriate treatment options based on individual health and needs, providing a comprehensive approach to combating night sweats during menopause to improve sleep.

Building a Sleep-Friendly Routine to Combat Night Sweats

I'll go back to the most obvious factor, without which all those supplements and hormones will only provide temporary relief.

To combat night sweats and improve the overall quality of sleep during menopause, it's important to establish a sleep routine.

One of the most effective strategies is to have a consistent bedtime and wake-up time, which helps regulate the body's internal clock, making it easier to fall asleep and wake up. 

This consistency will give your body the ability to sleep through more restorative sleep cycles and better nights during menopause. 

To relax before bed, develop a soothing ritual before bedtime. Activities such as taking a warm bath, using essential oils such as lavender or chamomile, gentle stretching or meditation, and reading will help reduce stress and signal to your body that it's time to relax. 

I find relaxing meditations before bedtime, such as those from the Calm app, very helpful.

Not only do these practices create a calming environment, but they also help lower my heart rate and prepare my body for sleep, which reduces the likelihood of nighttime sweating and improves hot flashes throughout the day.

What to Do When Night Sweats Wake You Up

1. Go to the bathroom and drink a few sips of water.
2. Try the square breathing technique: inhale for four counts, hold for four, exhale for four, and hold again.
3. Change positions or move to a cooler part of the bed.
4. Engage in a brief meditation to calm your mind and body.

I also take a few little balls of the homoeopathic remedy Coffee arabica – despite its controversial name, it helps me to fall asleep quickly.

All of these techniques contribute to a faster return to sleep. By consistently applying these strategies, you can create a more restful and restorative sleep pattern, leading to better overall health.

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Conclusion:

Night sweats are common in menopause but they don’t have to ruin your nights! With the right combination of quick fixes, lifestyle adjustments, and treatments, you can finally cool down and get the sleep you deserve.

Remember to take small steps—adjusting your bedroom environment, incorporating soothing nighttime rituals, and even speaking with your doctor about the right treatments for you. Over time, these strategies can make a significant difference. In addition to night sweats, there are other less familiar symptoms of menopause – learn about them here.

Ready to reclaim your restful nights?

Start today by trying one of the quick fixes, and don’t hesitate to reach out to a healthcare professional if needed. Sweet dreams are on the horizon!

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