Night Sweats and Sleep Disruption: Understanding the Science and Finding Relief
Feb 10, 2025
Night sweats are far more common that you may think… with around 60-80% of perimenopausal and menopausal women experiencing them (1). And they are far more than just an inconvenience—they can be a significant barrier to restorative sleep. The experience of waking up drenched in sweat is not only uncomfortable but can also lead to a spiral of unhelpful thoughts, feelings and behaviours that can keep you awake for hours.
As a psychologist, when I work with mid-life women, I often see the downstream effects of sleep deprivation caused by night sweats: daily exhaustion, increased stress, difficulty concentrating, higher anxiety and lower mood. Part of my work is to help women understand the biology behind night sweats which can help them manage these symptoms more effectively, a key benefit being the ability to fall back to sleep more easily. I hope today’s newsletter might give you insights and tips to help you reclaim sleep, in the face of this common symptom of peri/menopause.
The Biology Behind Night Sweats
Ok, ready for some science? … I hope I don’t put you to sleep here đ
Night sweats and hot flushes (medically known as ‘vasomotor’ symptoms) occur when the body's thermoregulation—the process of maintaining an optimal internal body temperature—becomes dysregulated. This can happen for several reasons, but for many people, the primary reason is a hormonal imbalance caused by rapid fluctuations in hormone levels in the brain and body. For example, during perimenopause and menopause, declining estrogen levels also affect other hormones that regulate sleep, while simultaneously affecting the hypothalamus, the part of the brain responsible for regulating body temperature. These hormonal changes can create a narrowing of the “thermoneutral zone”, which is the temperature range in which the body feels comfortable. Think of it like a thermostat for aircon and heating at home, with a narrower temperature range to set off either the cooling or heating systems.
When the body/brain perceives that core body temperature increases above this thermoneutral zone, it starts to activate cooling mechanisms, like sweating. Similarly, if the core body temperature is perceived to drop below the neutral zone, warming mechanisms begin, like shivering. This narrowing of the thermoneutral zone can seem similar to a hypersensitive response to body temperature, where even small variations in core body temperature trigger exaggerated cooling mechanisms like sweating.
This process is closely linked to the autonomic nervous system. When the hypothalamus perceives that the body is overheating, it activates the sympathetic nervous system to cool the body down. The result? A surge of sweat, rapid heart rate, and a sudden feeling of heat. Unfortunately, this physiological reaction at night time causes sweating and often wakes people up, fragmenting their sleep and making it difficult to feel rested.
An interesting discovery about oestrogen is that in addition to the affects of narrowing the body’s thermostat, it’s also the immediate shifts in oestrogen (ie. a sudden oestrogen withdrawal) in the body, that can trigger a hot flush. In other words, the rate of change in oestrogen, and a woman’s perception of this, also causes hot flushes.
How Night Sweats Disrupt Sleep
Sleep is divided into four stages of light sleep, medium sleep, deep sleep, and REM sleep. Each stage plays a critical role in physical restoration, memory consolidation, and emotional regulation. Unfortunately, night sweats can abruptly pull you out of deeper sleep stages, leading to fragmented and less restorative sleep. Over time, this can contribute to chronic sleep deprivation, which has been linked to mood disorders, cognitive difficulties (e.g. a feeling of brain fog), health problems, and even immune system dysfunction.
Beyond the physical disruptions, night sweats can create a sense of dread around bedtime, as you may anticipate another restless night. This anticipatory anxiety can further exacerbate sleep difficulties, creating a vicious cycle that becomes challenging to break.
Strategies to Regulate Body Temperature and Reduce Night Sweats
While the biology of night sweats can feel outside our control, there are practical steps you can take to manage symptoms and improve sleep quality:
1) Optimise Your Sleep Environment
- Keep your bedroom cool. We all have different home environments, so only if it’s available and appropriate, use the breeze from an open window, a fan or air conditioning for good airflow.
- Try moisture-wicking sheets and pyjamas made from breathable fabrics like cotton or bamboo. These materials can help you stay dry and comfortable through the night.
- Try using a cold pack under your pillow, or a specialised cooling pillow might be helpful.
- Wear layered clothing that you can easily remove if you get too warm.
- Keep a cool drink by your bed to sip if you wake up.
- Use layers of bedding, such as a sheet, blanket and doona in winter to allow you to throw one layer off when needed.
- If you share a bed with someone, having two separate blankets or doonas can also help with the different needs of warmth over night.
2) Identify and Manage Triggers
- Common triggers for night sweats include alcohol, caffeine, spicy foods, and stress. Keeping a symptom diary can help you identify patterns and make informed adjustments to your lifestyle and what foods to avoid.
- Avoid heavy meals or hot beverages or hot showers close to bedtime, as they can elevate your core body temperature.
3) Adopt Relaxation Techniques
- Stress activates the sympathetic nervous system, which can exacerbate night sweats. Incorporating relaxation techniques such as progressive muscle relaxation, deep breathing, or mindfulness meditation into your evening routine can help calm your nervous system and reduce the likelihood of night sweats.
- We have a free Body Scan Mindfulness Meditation for peri/menopause on our website you can use each night.
4) Practice Good Sleep Hygiene
- Establish a consistent sleep schedule by going to bed and waking up at the same time every day.
- Limit screen time in the hour before bed, as the blue light from devices can disrupt melatonin production and make it harder to fall asleep.
- As mentioned earlier, reduce caffeine and alcohol and limit sugar intake that all interfere with sleep.
5) Explore Medical and Psychological Interventions
- If your night sweats are severe or unresponsive to lifestyle changes, it may be worth consulting a healthcare provider. Menopause Hormone Therapy (MHT) can be an effective treatment for menopausal symptoms, including night sweats. Non-hormonal options, such as cognitive-behavioral therapy for insomnia (CBT-I) and mindfulness training can also provide tools to improve sleep quality and reduce the effects that hot flushes and night sweats can have on your sleep.
- Medications may also be prescribed to help regulate body temperature and reduce symptoms.
- It is also important to make an appointment with a doctor who specialises in menopause to discuss treatment options for hot flushes and night sweats.
Final Thoughts
Night sweats can feel overwhelming, but they don’t have to define your nights—or your days. By understanding the physiological mechanisms behind night sweats and adopting strategies to manage them, you can take meaningful steps toward more restful and restorative sleep. If symptoms persist or significantly impact your quality of life, don’t hesitate to seek professional support. Sleep is a cornerstone of mental and physical health, and addressing night sweats is a critical step in protecting it.
(1) Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am. 2011 Sep;38(3):489-501. doi: 10.1016/j.ogc.2011.05.006. PMID: 21961716; PMCID: PMC3185243.
