It’s 10 p.m., and the heat is on. Warmth radiates from my torso, up my spine, to my neck. It bubbles from within toward my skin. It’s my regular hot flash, and it’s the barometer of how the rest of my night will go. I can almost set my clock to it.
Nearly one year ago I had my last period. I’m in the throes of menopause, on the precipice of being post-menopausal, and this nightly bout of vasomotor symptoms (VMS), the medical terminology for hot flashes and night sweats, is the most predictable part of my experience. Aside from my 10 p.m. flare-up, I can never tell when a hot flash will strike. An indoor cycling class, a walk down the street, or lunch with my family can elicit an open-faucet-like sweat release from behind my left ear.
But it’s at night when VMS lets loose on my body.
Control to Chaos
In my life before menopause, I was a sound sleeper, and I like to think it’s because I have a bedtime routine. Each night around 11 p.m., I brush my teeth, wash my face, and then head to bed to read. After about 10 pages, I can barely keep my eyes open. Lights out. I go to sleep. For the past few years, that’s where my control ends and my menopausal body takes over. I always say it has a mind of its own…and, it turns out, this might truly be the case.
Researchers theorize that when estrogen decreases during the menopause transition, a neurotransmitter in our brain called neurokinin B starts to run amok and influence the hypothalamus, the brain center that is our body’s thermostat. The result is hot flashes, night sweats, and/or trouble sleeping. In fact, the odds of having these symptoms increase 66%, 50%, and 24%, respectively, in the season before your final menstrual period, according to a study of nearly 1,000 participants.
In my case, hot flashes don’t keep me from falling asleep. My 10 p.m. warmth isn’t a nightcap, but an appetizer that kicks off what’s to come in the hours to follow.
The heat rises again between the hours of two and four o’clock in the morning; I poke my leg outside of my light covers as I start to get warm. My coverlet and a sheet are too much. I try to fall back asleep, but it’s too late. My bladder and my cat have been alerted now, and they want me to act. I leave my bed and stumble through my apartment to the bathroom with my pet tailing me, meowing for food. The wave of hot flashes begins.
My body pulsates with heat as I move through the darkness feeding my furry friend and making my way back to my bed. I switch pillows looking for relief. I have a pillow that I save just for this moment, which lays untouched until the heat comes, so it’s optimally cool when I need it.
If I’m lucky, I’ll fall back asleep. The pillow’s coolness against my hot skin is just what I need to relax me and allow me to sleep until my alarm goes off — or for an hour before the next hot flash. My magical cooling pillow doesn’t always work, and I find myself tossing and turning in micromotions so I don’t wake my sleeping husband beside me. Normally, we fit fine on our queen sized bed, but on nights like this it might as well be my childhood doll’s bed. I need to find a space of my own so I don’t wake him.
Early Morning Ritual
I head to the couch as another round of hot flashes intensifies and the night sweats begin. I cover the couch with blankets to protect it from my soon-to-be wet skin. I need air; I turn on the ceiling fan and lie down on my side.
My cat sees an opportunity. Stomach full, it’s time to cuddle. He makes his way to my belly and curls up beside me. He doesn’t care that the waterworks have begun, that my wet nightgown is sticking to my skin, and that the fan that I so desperately needed because I was so hot is now causing me to freeze. Wet skin and clothes don’t pair well with the breeze. I try to reach up to the wall switch to turn the fan off, but my arms aren’t long enough to reach without disturbing the kitty who has fallen asleep.
Instead, I cover us with a blanket. The fan is whirling, the cat is snoring, and I’m shivering. Maybe if I lie here very still, I’ll fall back to sleep.
I feel my body and clothes dry. I check the clock. The alarm will go off in 90 minutes. I’m not willing to give up on sleep yet, so I make myself a deal. I’ll head to the gym if I’m still awake after five cycles of counting deep breaths from 10 to one. Inhale, 10, exhale. Inhale, nine, exhale. Inhale, eight, exhale, and so on. I lose count after three cycles, then I lose count all together. Next thing I know, my alarm goes off. I hope for a hot-flash-free day that will keep me cool and dry until 10 p.m. rolls around again.