When heat rushes to your face and keeps you from sleeping well

What follows combines several people's visits into one reconstructed account. It is not any one person's story, and anything that could identify someone has been removed.

How do people describe it when they come in?

Their face flushes hot, they sweat only around the head, they wake several times a night, and they feel even more tired after sleeping.

Many come in worried that menopause has started. Sometimes it has, and sometimes it hasn't. We sort that out first.

How do we tell?

We look at whether your menstrual cycle is changing, and whether the heat comes on suddenly, then cools and leaves you with chills.

If that pattern is clear, we see it as menopause and recommend a check with a gynecologist as well. If you're under 40 or have bleeding after menopause, that comes first.

Have your thyroid function checked too. It's a common cause of hot flushes, sleep problems and sweating happening together.

If it's not that pattern, what do we look at?

We look at whether heat is gathering only in the upper body while the lower body stays cold. We also check whether the middle of the abdomen has stiffened so that circulation can't flow downward.

In some people, when we press on the abdomen, the area from below the breastbone to the lower belly is unusually hard and tender. We also see cases where the sides are taut with gas.

People like this may also get dry skin and more flaking on the scalp. Because it looks like a skin problem, many come to us after trying ointments.

How do we treat it?

We loosen the stiff middle of the abdomen to make a path for what has risen to come back down, and work on replenishing what has dried out.

If we only cool the heat, the lower body gets even colder and people feel worse. So we warm the lower body at the same time.

We see sleep as something that follows once that flow is set right. We don't try to treat sleep separately.

How did people do?

Often, the heat rushing to the face comes less often first, and the number of times they wake at night drops next.

Dry skin and scalp are the last to follow. Sometimes you can only tell after a full season has passed.

What are the limits of this approach?

For people going through menopause, this period is itself something that passes, so it's hard to tell how much of the change is due to us.

One more thing: if you're receiving hormone therapy, keep it as it is. We don't interfere with that decision.

If you have the same symptoms

1. We first sort out whether it's menopause or not — both happen.
2. If you're under 40 or have bleeding after menopause, see a gynecologist first.
3. Have your thyroid function checked too.
4. We look at whether heat gathers only above while the lower body is cold.
5. Don't stop your hormone medication because of us.

We start by sorting out what kind of insomnia it is. Not being able to fall asleep and waking up during the night point to different places to look.

If poor sleep is wearing down your days, come and see us. We'll start by sorting out whether you can't fall asleep or keep waking up. Each points to a different place to look.

Because there are many possible causes, progress differs from person to person, even with the same care.