It's 11:00pm on a hot July night. Your day has been a particularly busy one including activities like working all day, walking the dog and an hour step-aerobics class. You watch exactly one episode of Sex in the City and read the latest issue of Vanity Fair. Now, you’re totally fatigued. Your bed looks cozy with light, sweat-proof sheets. With all the things that have happened throughout the day, getting a good night's sleep doesn't seem a lot to ask for, but sometimes sleep can be a problem during the menopause transition.

The a/c is cranked to 10+; the fan oscillates on high in the corner of the room. You wear your special hot flash-free pajamas and are ready to hit the sack. Only ten minutes of “lights out” time passes when you suddenly experience a crawly sensation throughout your body. The temperature of the room seems to raise ten degrees and your sweat-proof sheets start working over time to absorb the moisture that exudes from your body. The fiery glow of hot flash hell begins to illuminate your bedroom and insomnia takes over.

The hot flash phenomenon
So, what exactly happens to your body during a “hot flash” or power surge? When a hot flash comes on, it usually starts with a sudden, overpowering feeling of being flushed (especially in the upper body and face). It feels like a warm sensation and it is normal to perspire. It is also common for dizziness and palpitations to accompany the sweltering feeling of a hot flash.

Scientists have not exactly figured out the biology behind the symptoms of a hot flash yet. But many people think hot flashes are caused by a lack of or drop in circulating estrogen in the body. A sudden drop in estrogen sends a message to your brain to take care of it. Your brain senses something is wrong so it sends out a surge of adrenaline (norepinephrine). Norephinephrine triggers the fight or flight response in humans and your body responds accordingly. You begin to swelter and your private summers begin (hot flashes) ... day or night.

The sudden lowering of estrogen levels in the body also affects serotonin levels. Serotonin helps control many behavioral and physiological functions like mood, emotions sleep and appetite. When estrogen levels are lowered in the body, it affects your serotonin levels which could also be causing you to lose your snoozing time.

Hot flashes and insomnia are linked
This scenario is common among menopausal women. The link between hot flashes and sleep problems now has scientific merit. The latest research shows a definitive link between severe hot flashes in menopausal women and chronic insomnia. Researchers at Stanford University interviewed 982 women to find out more about women's experiences with hot flashes and sleep problems. The results were published in the June 26, 2006 Archives of Internal Medicine.

Out of the total 982 women interviewed, about 57% of them were premenopausal, 21% postmenopausal and 22% perimenopausal. When questioned about their hot flashes, thirty three percent of all the women experienced one at some point in their lives. Perimenopausal women reported the symptom most (seventy-nine percent). Women also rated their hot flashes on a scale of mild to severe.

- Mild- hot flashes usually don’t cause sweating (50% of the women who experienced hot flashes classified them as mild)

- Moderate- hot flashes usually include sweating that doesn’t limit activities (1/3 of the hot flash population reported them as moderate)

- Severe- hot flashes usually cause sweating that prompts a woman to stop her activity (15% of the women who experienced hot flashes classified them as severe)

The women interviewed were also required to report any sleep problems they experienced. The term 'chronic insomnia' included at least six months of poor quality sleep (including trouble falling asleep or staying asleep). More than half (57%) of the perimenopausal women and 51% of the postmenopausal women experienced chronic insomnia.

Of the women who experienced 'severe' hot flashes, 81% also reported symptoms of insomnia. Interestingly enough, as the severity of hot flashes increased, so too did the symptoms of insomnia. The researchers released a statement concluding, "Severe hot flashes are associated with chronic insomnia in women aged 35 to 65 years. The dramatic increase in insomnia in women with severe hot flashes indicates that severity of hot flashes should be routinely assessed in all studies of menopause."

Don't ignore your sleep
Hot flashes should be more than assessed. Losing your snoozing time can cause sleep deprivation which may lead to mood swings, anxiety and irritability. Many women seem to get hot flashes in the middle of the night often resulting in interrupted sleep. They awaken, perspiring and have a difficult time going back to sleep.

As more scientific studies are released linking insomnia and hot flashes, we should not hesitate to mention our sleep problems to our healthcare provider when they are assessing our menopausal symptoms. Treating your hot flashes may help you get a better night's sleep.

Read the full version of this edition of The Menopause Minute.

Read more about hot flashes.

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