Hot flashes, night sweats, and sleep disturbances,  are also  known as vasomotor symptoms are due to changes in female sex hormones. When this happens, a woman may experience difficulty sleeping, insomnia or waking in the night, as well as sweating and hot flashes.

Insomnia may increase during perimenopause, due to hormonal fluctuations altering circadian rhythms (10) and sleep patterns. While insomnia increases in both sexes with age, women are more likely to experience it, starting at the onset of pre-menopause. Women may in fact experience sleep disruptions five to seven years before the actual onset of pre-menopause (87). Hot flashes (night sweats) are often at the root of insomnia, but other problems like poor health and sleep apnea (especially experienced when overweight) may be the underlying cause. Anxiety and depression can also play a role in insomnia (80).

Regarding hormonal changes, both oestrogen and progesterone play a part in sleep. Oestrogen helps regulate magnesium levels. Magnesium is important to sleep as it is associated with muscle relaxation (81). As women lose the ability to produce oestrogen magnesium production may be compromised. This in turn impacts the ability to relax and fall asleep. Low oestrogen may be responsible for night sweats and has been associated with sleep apnoea (breathing problems) during sleep (81). Progesterone is associated with deep sleep, without it women find it hard to get a restful sleep (81).

Sleep hygiene in imperative to mental and physical wellbeing. Most adults need seven to nine hours of sleep per night. A lack of sleep is associated with a lack of concentration, anxiety, (81) depression, and irritability (all associated with menopause). It is also correlated with being overweight/obese and increased risk of heart disease, high blood pressure, diabetes and substance abuse (88).

How to improve sleep hygiene: Establishing a sleep routine; change your diet to avoid fatty or sugary foods and caffeine, all of which are associated with being stimulating and underlying night sweats (81); calcium and magnesium may be helpful (81). Magnesium, often lacking in processed foods. Magnesium has been shown to increase the ability to get to sleep and stay asleep, and to awaken. Magnesium has been shown to increase melatonin production and decrease stress hormone cortisol production (83) and to reduce the symptoms of treatment resistant depression (82). Calcium aids in making melatonin from tryptophan (an amino acid). Melatonin helps regulate sleep/wake cycles and the body’s internal clock (89). Potassium has been shown to improve the quality of sleep and lesson the likeliness of sleep disruption (90).

Hot flashes and night sweats may be due to rapid changes or fluctuations in ovarian hormones. Hot flashes usually occur early in perimenopause, and come and go depending on the severity of hormonal fluctuations (10). Some women continue experiencing hot flashes for years after menopause.

Disruptions in the body’s ability to regulate temperature may in part be due to a disruption in the production of certain neurotransmitters (serotonin and noradrenaline). These neurochemicals help to stabilize what is called the thermoneutral zone. Sex hormones play a role in the production of neurotransmitters, so when estrogen etc. starts to fluctuate so does the production of serotonin and noradrenaline. This in turn can disrupt the body’s ability to regulate heat and cold. So, if you can increase the production of these neurotransmitters, by natural or artificial means, it may help. There are activities and foods or supplements you can take to increase them naturally. Some anti-depressants/anti-anxiety medication can also help with this. These are SSRIs (selective serotonin re uptake inhibitors) and SNRIs (Serotonin nor-epinephrine re-uptake inhibitors). Keep in mind that this will help, but might not completely reverse the problem (294).

Natural ways to increase the production of serotonin include, but are not limited too, the following:

Light therapy (especially blue spectrum light) increases serotonin. When possible walk out doors in bright sunlight for 15 minutes a day (134;135). Otherwise, you can buy an inexpensive light box. Keep in mind that blue light can harm your eyes, so don’t look directly at it. Also, avoid blue light at night as it may affect the ability to go to sleep (including TV and tablet screens). If you purchase a blue light box place it on a high enough surface to allow the light to hit the lower part of the eye, as this is where blue spectrum light naturally is absorbed (178).

Nutritional interventions to increase serotonin include the following: turmeric, dark chocolate, green tea, cold-water fatty fish, and fermented foods (yogurt, kefir, unpasteurized sauerkraut). The last helps balance gut bacteria as too much of a bacterium called lipopolysaccharides can lower serotonin levels (264;267;268). Eat tryptophan rich sweet or starchy (ideally complex) carbohydrates without protein (264; 273;274) as protein has nutrients that disrupt the uptake of tryptophan. Eat carbohydrates on an empty stomach (about three hours after a protein). The food source (like gram crackers, pretzels etc.,) should have at least 25 to 35 grams of carbohydrates and no more than 4 grams of protein. If you want a quick boost to your mood try a simple carbohydrate, but keep in mind that this will raise your blood sugar as well. You should feel an effect 20 to 40 minutes after eating (274). See appendix for books on the subject.

Reduce or eliminate caffeine as it may desensitize brain cells to serotonin (266), and avoid artificial sweeteners (aspartame) as it inhibits the uptake and conversion of tryptophan (264;265).

Exercise increases the production of neurotransmitters Dopamine, Norepinephrine and Serotonin (22).

Hot flashes may also be the result of blood vessels losing elasticity. This is called endothelial dysfunction. Here blood vessels stop functioning properly, by not constricting (narrowing) or dilating (widening) properly to accommodate proper blood circulation (187). Endothelial dysfunction may be the result of an inability to properly produce the neurotransmitter nitrogen monoxide.

Treatment for vasomotor problems like hot flashes or night sweats include the following. Taking the amino acid arginine may help as it is made into nitrogen monoxide by the body (188). If you choose to take arginine take amino acid lysine with it. Lysine will help keep arginine circulating in the blood to be transformed into nitrogen monoxide (189; 190).

Soy has been shown to improve hot flashes (19; 24; 54), for instance adding approximately 100 mg of soy isoflavone per day, in the form of a supplement, may decrease vasomotor symptoms (19). Those with thyroid problems should avoid soy as it is a phytoestrogen and may lead to estrogen dominance, which negatively effects thyroid functioning. Vitamin E (800-1200 IU), and Black Cohosh (dose of 40 mg/1 to 2 times a day) may also help (51;54). Saint John’s Wort, (Hypericum peroratum L or HPL) may relieve hot flashes (26). Keep in mind that Black Cohosh can cause rash, liver damage, and stomach upset (54).

Exercise should not be overlooked. Women hen exercising women report feeling more in control of their lives and bodies when they exercise. Women also report more positive feelings towards their overall situation, and say they are less distressed by these symptoms, regardless of their actual intensity (41).

Magnesium supplements have been shown to lessen the number of, and intensity of hot flashes, increase the ability to sleep and lessen night sweats (194) and reduce the severity of hormone related migraines (201). It can also help treat arrhythmia or disturbances to heart beat (201). Magnesium is also needed for Vitamin D to be properly absorbed (201).

Recommended oral intake of magnesium for adults (not breast feeding or pregnant) is 310 to 350 mg (194), and specifically 320 mg per day if female and over age 31 (198). Magnesium supplements come in different forms. These are the ones that absorb most easily: Magnesium citrate, magnesium lactate, and magnesium gluconate (198). Epson salts have magnesium in them and some of it is absorbed via the skin. This may explain why Epson salts relieve muscle pains, inflammation and swelling (198).

Keep in mind that magnesium supplements can interact with medications, so only take them under a health care provider’s supervision. If you have kidney disease you may not be able to take magnesium supplements. Too much magnesium can result in the following: lowered pulse rate and low blood pressure, problems breathing, nausea and vomiting and fatigue. Fee Infrequently it has caused coma and death (197). Hormone replacement therapy (HRT) may lessen the loss of magnesium (196; 198; 201).

Foods high in magnesium are: seaweed, green leafy vegetables (spinach & beat greens), bananas, chocolate & coco powder, legumes (including peanuts), seeds (poppy, fennel, cumin, celery, pumpkin & squash), nuts (Brazil, almonds, cashews, pine, black walnuts), and whole grains (whole wheat flour, wheat bran, oat flour, oatmeal, and bran cereals), and fish, diary, tofu and soybean flour (197;198).

Herbs and spices high in magnesium: marjoram, tarragon, savory, basil, sage, dill weed, coriander, and blackstrap molasses.

Magnesium is also in some medications (199) like laxatives, heart burn medicine (Rolaids Extra-strength) and diarrhea medications (Phillips’ Milk of Magnesia).

Hormone replacement therapy (HRT) is also a good treatment for vasomotor symptoms, but it is also potentially problematic as it may increase the likelihood of developing other health problems (294).

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