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Is It Normal... to Wake Up in a Puddle of Sweat?

It’s 3 a.m., your hair is sweat soaked, you’re flushed, and you’ve got one leg over the bedside cooling off as you will yourself back to sleep. You’re hot and bothered — and not in a good way. 

If this sounds familiar, wipe your brow, grab a cool glass of water, and settle in. Let’s talk about hormones: the ones turning up the heat to get your attention.

First, what you eat can worsen night sweats, but this type of “nocturnal hyperhidrosis” is situational. A glass of wine before bed, sugar, caffeine, or even dairy late in the day can trigger your liver into breaking down toxins to be removed through sweating. But what about night sweats not related to what you eat? Those are rooted in hormonal imbalances. They can keep you up night after night, ruining your sleep and testing your patience. If left unaddressed, they can go on for years. The good news: In my clinical experience, if hot flashes are hormonal in nature, they can usually be helped. 

This was the case for Rose, a 52-year-old vice president at a large financial firm. She sought my help, but only after three years of progressively worse night sweats. 

When Rose called, she said she was at the end of her rope. In person, during our consultation, she elaborated: Her energy was low. She couldn’t catch up on sleep. She felt anxious, like her emotions were just under the surface, especially before her period, the timing of which was now rarely predictable. She had also gained more than 10 pounds through her hips and belly over the past year, and in her words, she felt like “a hot mess.”

When Rose and I met to go over her labs and physical, she wasn’t surprised to learn that she was deep in the hormonal upheaval of perimenopause, but she was taken aback that cortisol and estrogen were sabotaging her sleep and sanity.


Cortisol is a stress-busting hormone, and when it is low, we feel depleted and can have trouble getting started in the morning. We’re also more vulnerable to respiratory viruses, joint pain, and GI issues.


Cortisol is a stress-busting hormone, and when it is low, we feel depleted and can have trouble getting started in the morning. We’re also more vulnerable to respiratory viruses, joint pain, and GI issues. We gain belly fat, and are more prone to all other hormonal imbalances. Rose’s cortisol was likely suppressing both the estrogen and progesterone in her body, but the latter was taking the brunt, creating a condition called estrogen dominance. That was the likely reason for Rose’s feeling more emotional and the weight gain though her hips.

For a woman going through perimenopause, these imbalances can turn a natural shift into a worsening night sweats. Why? Your liver, which works hardest to detox from 2 a.m. to 4 a.m., goes into overdrive to deactivate cortisol from chronic stress. That looks — and feels — like waking up in a puddle of sweat at 3 a.m.

Within a month of my working with Rose, her night sweats were reduced by half; after three months they were only occasional. During our last visit, she shared that she feels much more like herself and no longer worries about feeling like a “zombie” at work from not sleeping. She’s clear-headed, calmer, and has lost the extra weight she was carrying. As for many women, Rose’s unrelenting night sweats were more than just an inconvenience. They were an indicator of hormonal imbalances. Once we got to the root of those imbalances and rebuilt her hormone health, she began sleeping well again.

Liver health clears the way for hormone health and reducing night sweats, and that’s often where I start with patients. Depending on lab and exam findings, an ordered approach beginning with nutritional support of liver detoxification may be necessary. Seeking qualified professional help is important.


How Estrogen and Progesterone Are Partners in Health 

Think of estrogen as that friend who’s kind of pushy; she’s well-meaning but can come across as a bit obnoxious to get what she wants — and she gets things done. Estrogen is our “focus” hormone. It preserves memory and skin elasticity; it gives us curvy hips and breasts. Too much gives you cramps and cravings, makes you bloated, and can give you menstrual headaches.

Progesterone is more like that steady, no-drama friend who calms everyone the heck down, lightens the mood, and works quietly behind the scenes to get things done. But she has trouble asking for help. Progesterone is a woman’s soothing, moisturizing, cycle-regulating hormone. It helps with fat loss and reduces blood pressure. Too little progesterone is related to gallbladder and thyroid problems, low libido, depression, and PMS.

The strengths of these two hormones complement each other. Progesterone helps estrogen calm down. Estrogen helps progesterone speak up. Together, in the right balance, they’re unstoppable. When they’re out of balance, however, we can feel exhausted and emotional. We might gain weight, have trouble sleeping, develop acne, and more.

Dr. Kimberly Higney assists patients in looking and feeling their best by helping them reset their hormone health and metabolism through lifestyle. She has a private practice on the Seacoast of New Hampshire. For more information visit cardeaseacoast.com.

Photo: Guille Faingold

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