Why Are Hot Flashes Worse At Night? Our Experts Explain

By Tami Smith, CPT, Nutritionist

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Hot flashes that happen at night, also known as night sweats are the bane of so many menopausal women’s existence. I mean who doesn’t love waking up drenched in their own sweat, heart racing, feeling like they’ve been lit on fire from the inside? Just thinking about it can trigger waves of dread throughout our bodies.

This begs the question; why are hot flashes worse at night? They’re bad enough during the day. But at night? It’s a whole new level of discomfort.

In this article, we spoke with leading women’s health experts and menopause specialists for their thoughts on the matter and what we can do to reduce our symptoms and get some much-needed rest.

What Causes Hot Flashes?

woman experiencing hot flash

Researchers aren’t able to pinpoint exactly why hot flashes occur, however, it’s believed that they have a lot to do with spikes in hormones, particularly estrogen, that occur when a woman is entering menopause. These erratic hormonal fluctuations are believed to affect the hypothalamus in the brain, which is responsible for temperature regulation.

When your hypothalamus is triggered, your body mistakenly thinks it’s too hot so it gets to work to cool itself down by opening up blood vessels in the skin to allow the excess heat to release. The result is the all-too-familiar “red flush” and, of course, sweat.

Hot flashes are frustrating, uncomfortable, and embarrassing. But those that happen overnight often feel more intense during the night which can then trigger a whole slew of unwanted side effects like poor sleep and grogginess the next day.

Next, let’s talk about why your hot flashes are feeling worse at night.

Why Do Hot Flashes Feel Worse At Night?

The truth is that hot flashes can happen anytime day or night, but many women report their symptoms to be worse at night. There are a few reasons why this might be the case, including the following:

When you’re fast asleep, you might not feel an episode coming on in the same way that you’re able to during the day when you’re awake. By the time you wake, you’re already burning up, soaked in sweat, and undoubtedly uncomfortable. When these come on during the daytime, you’re much more likely to take the necessary actions to ensure the hot flash isn’t unbearable i.e. opening a window, stepping outside, removing a layer of clothing, etc.

According to Dr. Laura Purdy, MD, MBA, “Hot flashes may be worse at night, because of the hormone fluctuations in a woman’s body. There are certain times of the day or night, when hormone levels may cycle and surge, which can lead to the sensation of hot flashes, being more prevalent overnight. Also, it may be that nighttime is when we are still, not engaged in any other activities, and able to feel the feelings of hot flashes. It can be easy to overlook hot flashes during the day when we are doing other things, or even after exercising.”

Many women are more susceptible to hot flashes when their body temperature is warmer. Most of us sleep under blankets and sheets, increasing our body temperature and increasing the risk of a hot flash.

According to Leann Poston, M.D. from TeleMDNow, “When your brain senses a change in body temperature, even if it is due to an increase or decrease in blood flow, it responds by dilating blood vessels in the skin and increased sweating.”

Spicy foods, alcohol, and caffeine consumption have all been linked to nighttime hot flashes or night sweats. These factors have all been shown to intensify symptoms of night sweats.

Stress and anxiety at night can also lead to not only an increase in the number of hot flashes at night but also their intensity. If you’re having trouble sleeping and are worried about how you will deal with your hot flashes, you’re likely making them worse.

Elektra Health's Founding Physician, Dr. Anna Barbieri, says "our stressful lives can result in cortisol (stress hormone) elevations that persist into the night, they contribute to that 3-4 am wake up with a feeling of not just a night sweat, bit also worry and stress."

Are Hot Flashes the Same as Night Sweats?

In a general sense, yes, when most menopausal women refer to night sweats, they are speaking about the hot flashes that occur overnight when they’re sleeping. The term “night sweats” in relation to menopause comes from the fact that many women wake up sweating as a result of a hot flash that came on when they were asleep where they were likely under blankets, causing their body temperature to rise higher and their body to respond by perspiring. 

“In the medical sense, hot flashes are not the same as night sweats. The way that we talk about these two terms, hot flashes are specifically related to hormonal changes and fluctuations, usually, as they relate to the menopause transition. They are not a sign of anything, bad, or worse going on in your body, and they do not necessarily require treatment to make them go away”, says Dr. Purdy.

Dr. Purdy goes on to explain that “night sweats, however, is a term that we use for a different type of sweating. It often is used to discuss undiagnosed cancers, and it is a much more serious symptom than a hot flash. In a night sweat, the person often finds themselves waking up with fully drenched sheets, to the point where they need to actually change their sheets. They also may need to change their clothes, and they might find that their mattress is even damp!”

Pay attention to your night sweats and, when in doubt, be sure to reach out to your doctor to check for any underlying issues or diseases that could be causing the intensity of your night sweats.

Tips For Dealing With Hot Flashes at Night

When it comes to handling those pesky overnight hot flashes, experts agree that the following should help to minimize your symptoms:

  • Wear lightweight pajamas to bed. Try finding a  silk material or a lightweight cotton pajama to help keep you feeling cool. Avoid heavy cotton, fleece, and flannel pajamas.
  • Use lightweight bedding. Waking up in a heap of sweat and blankets is not comfortable, to say the least. Keep your body temperature on the cooler side by avoiding heavy sheets and blankets.
  • Purchase pillows and/or a mattress cover that contains cooling gel technology to keep you comfortable.
  • Open up a window in your room to allow cool air to flow (if the weather is conducive to this, of course).
  • Get yourself a fan and point it directly at you while you sleep. Or, turn on your ceiling fan if you have one. "The fan as well as its whirr will contribute to better sleep," says Dr. Barbieri.
  • "Avoid triggers ie hot spicy foods, caffeine, alcohol. It is best to track your hot flashes and night sweats for a while and see if you can see any patterns especially with what you are eating - then avoid the things that seem to cause them. With alcohol - red wine and mixed drinks tend to be worse; dry white wine or clear alcohol with no additives (vodka and seltzer, tequila with lime) tend to be better, but best to avoid," according to Dr. Barbieri.
  • Keep a glass of cold water next to your bed and take small sips of water throughout the night when you wake. It will also come in handy when you wake up with a hot flash and need to cool off.

What About Medications for Hot Flashes and Night Sweats?

If you’ve tried seemingly everything and you are still experiencing sleepless nights due to your menopause symptoms, Dr. Purdy says “there are a few medications, such as estrogen, and supplementation to help with hot flashes and night sweats. Sometimes people use other medications such as Paxil, and there are a few supplements that have been recommended through the years, such as black cohosh, that have been reported to improve menopause symptoms somewhat.”

She goes on to say, “of course, it is always very important to discuss with your doctor before you start taking any medications, even over-the-counter supplements.”

Dr. Anna Barbieri goes on to explain that "There are a number of supplements that can be helpful. However, if we understand that the root cause of nightsweats is declining estrogen, the most effective strategy is estrogen replacement, ie hormone replacement therapy (HRT) also known as menopause hormone therapy (MHT). To be clear, not all women CAN use MHT and not all women WANT MHT. There are also non hormonal medications that can help. Some supplements that can help include non estrogenic agents like Swedish flower pollen (Relizen), and sleep promoting supplements like magnesium and melatonin. Plant derived estrogen like supplements soy isoflavones, pycnogenol, and rhapontic rhubarb. Red clover and black cohosh are often ingredients in night sweat supplements but have mixed reports as far as efficacy."

Final Thoughts

Experiencing hot flashes at night is largely unavoidable for many women during menopause. And while these flushes might feel more severe while you’re sleeping, the truth is that you’re likely just feeling more of the intensity of them because you’re asleep while the episode develops, leaving you little time to prepare.

Using our tips above, you can help to mitigate your experience of menopause night sweats and get some of the much-needed sleep you desire. Keep in mind that this too shall pass and so will your uncomfortable symptoms.

About the author 

Tami Smith, CPT, Nutritionist

Tami Smith is a certified Nutritionist and an ACE certified fitness trainer, specializing in pre and post-natal fitness. She studied business and earned her bachelor's degree in Business Economics. Tami is a mom of two and women's health advocate. Her passion is to help people live a fit, healthy life through proper nutrition and exercise!

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