When hot flashes steal sleep, therapy and education can help

Up to 70% of women experience sleep disruption around the menopause transition, often because of hot flashes that repeatedly wake them throughout the night. The resulting lack of restorative sleep can affect mood, energy levels, and overall health.

New research from The University of Texas Medical Branch (UTMB) suggests a whole-health approach may help. The study, published in the May issue of Menopause, the journal of The Menopause Society, found that combining cognitive behavioral therapy for insomnia (CBT-I) with additional education about managing hot flashes improved sleep among perimenopausal and postmenopausal women whose sleep was disrupted by nighttime hot flashes.

Emily Lantz, PhD, first author of the study and an assistant professor in the Department of Nutrition Sciences and Health Behavior at UTMB, said sleep is especially important during the menopause transition because insomnia can worsen other menopause-related symptoms and health concerns.

"Prior to this study, we interviewed women in perimenopause and menopause, and sleep disruption caused by nighttime hot flashes emerged as one of their most significant challenges," Lantz said. "Our research showed that incorporating education about hot flashes into CBT-I as part of a whole-health approach helped women sleep better and reduced disruptions caused by these symptoms."

A hot flash is a sudden, overwhelming sensation of intense heat that can spread through the body, particularly the face, head, and neck. It can cause heavy sweating, a rapid heartbeat, and, in some cases, chills afterward. Hot flashes are among the most common symptoms of perimenopause and menopause and are linked to hormonal changes that affect the body's ability to regulate temperature.

While hot flashes cannot always be prevented, Lantz said education helped study participants better understand what was happening and how to manage the symptoms when they occurred.

The study also demonstrated that the intervention could be delivered by a range of healthcare professionals.

"In our study, nurses and social workers were trained to deliver this information to patients under the supervision of a sleep psychologist," Lantz said. "The results showed it is feasible to train different healthcare professionals to provide this support in a clinical setting. The study also lays the groundwork for future research on how this approach can be scaled and incorporated into routine care for perimenopausal and menopausal women."

Women enrolled in the study had insomnia complaints and experienced at least one nighttime hot flash.

"While the women were awake during the hot flash, they said they tended to catastrophize how difficult the next day would be without enough sleep," Lantz said. "Part of CBT-I is teaching self-talk and coping strategies that help women mentally prepare for the hot flash, the sleep disruption, and the following day."

Although medications and hormone therapy can help manage hot flashes, they may not be the right choice for every woman. Lantz said CBT-I offers an effective, nonpharmacological alternative.

"There are medications available, but CBT-I is a frontline treatment and is as effective as medication," she said. "This is particularly important for women who are hesitant about taking medication. CBT-I focuses on healthy sleep behaviors and cognitive techniques to help reset sleep patterns."

Most adults need seven to nine hours of sleep each night, and improving sleep quality can also reduce depressive symptoms associated with chronic sleep disruption, Lantz said.

"When working with women who want a broader, whole-health approach as they enter perimenopause and menopause, combining hot flash education with CBT-I can be highly effective," she said. "Over the eight-week study period, we saw significant improvements in women's sleep and hot flashes. It's important for women to know that if they are struggling with nocturnal hot flashes and sleep disruption, they are not alone, and help is available."