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How Hot Flashes in Women Protects Against Heart Disease

Hot flashes and night sweats are common symptoms of menopause. Interestingly, in a study of 60,000 post-menopausal women, those that suffered the worst night sweats and hot flashes at the start of menopause had a 17% lower chance of stroke and 11% lower chance of heart disease when followed for 10 years, compared with those who had no symptoms. Heart attack deaths were 24% lower. The authors could not give a clear explanation for their findings. Here’s my explanation:

I’ve written before that I often see hot flashes and night sweats in young men. They also have irritability, mood swings and insomnia. These symptoms are neurologic events that occur due to a relative change in the status of the involuntary nervous system. These young men are typically gaining weight quickly. This causes a rapid relative change in their sleep-breathing status, due to more frequent breathing pauses at night. Rapid weight gain is known to contribute to obstructive sleep apnea.

In menopausal women, not only do most gain some amount of weight, their progesterone levels begin to drop in their early 40s. Progesterone is a known upper airway muscle dilator, increasing muscle tone to the tongue. As progesterone slowly drops, the tongue relaxes more, especially when in deep sleep. This causes more frequent micro-obstructions and arousals, leading to the typical neurologic (vasomotor) symptoms commonly seen in perimenopausal women. It’s this relative change in the sleep-breathing status that irritates the involuntary nervous system (which regulates temperature, sweating, heart rate, blood pressure, digestion, and various other body functions).

Dr. Guilleminault of Stanford University states that people with obstructive sleep apnea have diminished nervous systems in the throat. Vibrations from snoring or reflux from obstructive events can damage the protective pressure and chemical sensors in the throat. If you already have some degree of obstructive sleep apnea as you approach menopause, it’s plausible that as progesterone levels drop, the additional breathing pauses don’t have as much of an effect on the involuntary nervous system, since it’s been happening already for years or decades. If your nervous system is intact, then the sudden increases in breathing pauses can lead to more severe vasomotor symptoms.

What this study suggests is that the more you’re susceptible to obstructive sleep apnea, the less likely you’ll suffer hot flashes and night sweats early in menopause. This can explain the higher rate of cardiovascular disease in post-menopausal women.

This is another example of interpreting scientific studies based on my sleep-breathing paradigm. If you’re not familiar with this concept, you can read my articles, or for a more in-depth explanation, take a look at my book, Sleep, Interrupted.

What do you think about my line of reasoning? Please enter your feedback below in the comments box.

Less Hot Flashes With An Antidepressant?

Can taking an antidepressant diminish menopause symptoms such as hot flashes and night sweats? A study just published in JAMA showed that menopausal women who were given Lexapro had small, but significantly less number of hot flashes per day compared to women given placebos.

Many antidepressants can diminish REM sleep, which is when you’re dreaming, and also when your muscles are most relaxed. Mirtazapine, another antidepressant, was shown to lower the AHI in sleep apnea patients by about 50%.

Women who are going through menopause are also going to have more frequent breathing pauses, due to a gradual lowering of progesterone levels. Progesterone is a powerful upper airway muscle dilator or stimulant. So if you lower this hormone, you’ll have more frequent breathing pauses, which will cause you to wake up all of a sudden, which can be a surprise to your nervous system.

It’s also been shown that many of the symptoms of menopause, including hot flashes and night sweats, are autonomic nervous system reactions (vasomotor symptoms) that can occur whenever your nervous system is shocked or in a state of major imbalance. I described young men having hot flashes and night sweats, mainly due to slowly progressing obstructive sleep apnea during rapid weight gain. These nervous system reactions can also occur during the daytime. Whenever your nervous system is en garde or edgy, it’s going to over-react to any form of stimulus. I vaguely remember reading another study what showed that women don’t wake up from hot flashes themsleves, but rather from breathing pauses. This is similar to why people get up to urinate at night (from breathing pauses).

Since even Lexapro can lower REM sleep qualtity, it’s not surprising that taking this drug can also lower the rate of hot flashes. If you have obstructive sleep apnea, do you suffer from hot flashes or night sweats?

Having Hot Flashes At Night? Here Are 10 Tips To Sleep Better

Weight Loss Helps With Hot Flushes In Menopause – Really?

 

Here's another menopause-related study that may have an alternative explanation. Researchers found that in overweight and obese menopausal women, weight loss significantly improved symptoms of hot flushes. They didn't give any conclusive or plausible explanation for the reason why. 

It's clear that if you're overweight or obese, a significantly higher number of women will have undiagnosed obstructive sleep apnea. Losing weight will improved symptoms of obstructive sleep apnea, which include hot flushes, night sweats, mood swings, insomnia, and irritability. We know that even young men can have these same symptoms. These symptoms are not directly caused by hormonal changes per sé—it's the relative change in the person's sleep-breathing status that can cause these vasomotor neurologic symptoms.

For the men out there with obstructive sleep apnea, do you suffer from hot flushes and night sweats?

The Male Menopause Myth

It’s commonly known that women going through menopause experience hot flashes, night sweats, moods swings, irritability, insomnia and weight gain, but these same symptoms are known to occur in men as well. They generally occur in men in their 40s to 50s, thought to be due to slowly decreasing testosterone levels, along with other symptoms such as loss of sexual desire or functioning, depression, memory loss, or chronic fatigue.

But what if I told you that I see young men in their 20s coming in to see me with the same exact problems? What I’ve discovered is that it’s really not mainly a hormonal issue, but a problem with their breathing. Let me explain.

What I’ve noticed in all these young men is that they all have in common a relatively narrow upper airway. When examined with a thin flexible camera, the space behind their tongues is very narrow, about 2-3 mm wide. This is mainly due to smaller jaw structures and dental crowding. Whenever someone with this anatomy starts to fall asleep, his tongue muscle starts to relax, and in deeper levels of sleep, it relaxes almost completely, leading to partial obstruction, and awakening. Once awakened, the man turns over. In most cases, they usually don’t like to sleep on their backs for this reason.

Most people compensate very well by sleeping only on their sides or stomachs. However, if there’s anything that narrows the upper airway, either due to inflammation (allergies or a cold), or structurally (fat), the tongue collapses much easier and the person gets less efficient sleep due to multiple arousals.

Inefficient sleep leads to an imbalance of the involuntary nervous system, leading to what are called "vasomotor" conditions, such as sweating, heart palpitations, and temperature fluctuations. So is a young man with a predisposed anatomy is slowly gaining weight, he may experience all the above "male menopause" symptoms.  If these obstructions last for more than 10 seconds, they are called apneas.

If you have more than 10 to 15 apneas every hour, then you may be diagnosed with obstructive sleep apnea. Untreated obstructive sleep apnea can lead to depression, anxiety, weight gain, erectile dysfunction, memory problems, hypertension, glucose intolerance, going to the bathroom often, heart disease, heart attack and stroke. The physiologic stress state that’s created also can lower one’s thyroid and testosterone levels, making it seem like he may have either hypothyroidism or low testosterone. 

So in a sense, the "male menopause" phenomenon does happen, but not for the reasons that you may think. The word menopause literally means cessation of menses. Since men don’t have periods, this is not an appropriate word. Instead, it should be renamed something alluding to the progression of a sleep-breathing disorder. Do you have any of these symptoms or know anyone who’s going through "male menopause"?

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