Night sweats in women: common causes, night time hot flashes and when to get checked

You kick the covers off. Five minutes later you pull them back on. Your pillow feels damp, your pajamas are stuck to you, and it's 2:47am again.

If that sounds familiar, you've probably typed something like "night sweating causes women" into a search bar at least once. This post walks through what night sweats are, the common causes doctors consider, what night time hot flashes have to do with perimenopause, and when it's worth getting checked.

First: what counts as "night sweats"?

Almost everyone sweats a bit at night, especially under a heavy duvet or in a warm room. That's not what doctors mean by night sweats.

The NHS describes night sweats as sweating so much that your night clothes and bedding are soaking wet, even though the place you're sleeping is cool (NHS). Mayo Clinic describes them as repeated episodes of very heavy sweating during sleep, heavy enough to soak your nightclothes or bedding. It adds that waking up sweaty because you're under too many blankets or the room is too warm usually isn't considered night sweats (Mayo Clinic).

So one useful first question is: is it the room, or is it me?

Night time hot flashes and perimenopause

A hot flash is a sudden feeling of heat, usually in the face, neck and chest. ACOG describes it as a sudden feeling of heat that rushes to the upper body and face, lasting from a few seconds to several minutes or longer. When hot flashes happen at night, they're often called night sweats, and they can wake you up and leave you feeling tired and sluggish the next day (ACOG).

The National Institute on Aging calls hot flashes and night sweats among the most common symptoms of the menopause transition, and notes that heavy sweating and cold shivering can follow a hot flash (NIA). Cleveland Clinic adds that a hot flash can come with flushed skin, clammy skin, chills and a faster heartbeat (Cleveland Clinic).

Why does this happen? Experts aren't completely sure. Cleveland Clinic explains that hormonal changes are the most likely cause, and that when estrogen levels drop, the body's temperature control can be thrown off (Cleveland Clinic).

The NHS also notes that women from a Black ethnic background are more likely to have hot flushes that are severe and last longer (NHS).

Night sweating causes in women: it's not always hormones

This is the part that matters most. Perimenopause is a common reason for night sweats, but it's far from the only one.

The NHS lists the most common reasons for night sweats as:

• menopause symptoms (hot flushes)
• anxiety
• medicines, such as some antidepressants, steroids and painkillers
• low blood sugar
• alcohol or drug use
• hyperhidrosis, a harmless condition that makes you sweat too much all the time

It also says that sometimes the cause is never found (NHS).

Mayo Clinic's list is longer. It includes medicines, anxiety disorders, thyroid problems, sleep disorders such as sleep apnea, infections, and some less common but more serious conditions (Mayo Clinic). Cleveland Clinic notes that thyroid disorders are a common cause of hot flashes outside of menopause, along with viral infections and certain medications (Cleveland Clinic).

That's exactly why this blog won't tell you what's causing your night sweats. A doctor can look at the whole picture.

When to see a doctor about night sweats

The NHS suggests seeing a GP if:

• you have night sweats regularly that wake you up or worry you
• you also have a very high temperature (or feel hot, cold or shivery), a cough or diarrhea
• you have night sweats and you're losing weight for no reason

(NHS)

Mayo Clinic adds a few more reasons to book a visit: night sweats that happen regularly, interrupt your sleep, come with fever, weight loss, pain in a specific area, cough or diarrhea, or start months or years after menopause symptoms ended (Mayo Clinic).

If your night sweats come with other perimenopause-type changes, like shifting periods, sleep trouble or mood changes, it's still worth mentioning them all together. That helps your doctor see the pattern.

Night sweat tips: comfort ideas from reputable sources

These aren't a cure and they won't stop night sweats. They're simple comfort ideas that health organizations mention, and they're worth running past your doctor, especially if you're already being treated for something.

Keep the bedroom cool. ACOG suggests keeping your bedroom quiet, cool and dark, and using a fan if that makes you more comfortable (ACOG).

Lighter bedding and layers. Cleveland Clinic's list of everyday hot flash tips includes using light sheets instead of heavier blankets, dressing in layers, and keeping your home cool with fans or air conditioning (Cleveland Clinic).

Notice your triggers. Cleveland Clinic lists common hot flash triggers, including warm rooms, alcohol, caffeine, spicy food, hot drinks, hot showers or baths, stress and smoking. Everyone's triggers are different (Cleveland Clinic).

Keep a short night log. For a couple of weeks, jot down:

• what time you woke up, and whether you were soaked or just warm
• how warm the room was and what bedding you used
• anything you had in the evening (alcohol, a late meal, a hot bath)
• any new medicines
• where you are in your cycle, if you still have periods

This isn't for diagnosing yourself. It just makes the conversation with your doctor much more specific than "I've been sweating at night."

The bottom line

Waking up hot and damp is miserable, and it chips away at your sleep, mood and patience. Night time hot flashes are a common part of perimenopause, but night sweats have plenty of other possible causes, some simple and some that need attention. If they're regular, waking you up, or coming with other symptoms, talk to your doctor. You deserve to sleep.