She’s showing up.

She’s doing the work.

You’ve built trust, you’ve tackled the hard stuff, and yet… she’s still not getting better.

She’s exhausted. Foggy. Short-fused.

You’re wondering if it’s resistance. Or maybe trauma.

But what if it’s her thermostat?

Vasomotor symptoms (VMS), lovingly referred to as hot flashes and night sweats, can sneak in and quietly wreck therapy progress.

They interrupt sleep. Disrupt mood. Heighten anxiety. Muddle memory.

And the worst part, Reader?

Many women don’t always realize what’s happening in the beginning, especially when it shows up as 2am sweaty panic or an afternoon heat wave no one else seems to feel.

In this week’s video, I’m talking about a sneaky, often-missed reason therapy can stall: vasomotor symptoms.​

That includes hot flashes, but especially night sweats that wreck sleep and make everything else harder.

Even if a woman isn’t in full menopause yet, VMS can start years before her periods stop (and continue long after).

And they’re not just annoying, they’re linked to poor sleep, worsened mood, memory issues, and increased cardiovascular risk.

Here’s the punchline for therapists:

If your midlife clients aren’t improving, ask about sleep, and specifically about night sweats.

They may not realize it’s happening, but when you bring it up everything starts to make more sense.

A few signs to ask about:

• Is she waking up tired, even after “sleeping”?
• Does she wake up sweaty or cold (because her bedding and PJs are soaked)?
• Is her anxiety worse in the middle of the night or early morning?

Even if hormone therapy isn’t an option (or they're not interested), there are plenty of non-hormonal treatments that help.

SSRIs, SNRIs, gabapentin, lifestyle changes, CBT for menopause, and even tools like hypnosis can make a meaningful difference.

There is more support for some treatments (the best evidence is for hormone therapy) but it can also help to make small changes like wearing layers. It won't stop the hot flashes but can make them easier to manage!

You’re in a unique position to notice what others might miss. Sometimes all it takes is asking the right question to get things going again, Reader.

Curious how it all fits together? Watch the video for more insights!

Cheers to healthy brains,

Dr. B

Jessica Beachkofsky, MD

Your friendly, online psychiatrist!

P.S. Here's the video link for a discussion of vasomotor symptoms (VMS) aka hot flashes and night sweats

P.P.S. There's good evidence for estrogen therapy, some medications, and CBT but even if there's not a lot of evidence (not enough good or consistent data) it can still be helpful to make lifestyle changes!

P.P.P.S. Join me for a warm, breezy learning experience (not like my hot, sweaty Florida Gulf Coast) in October in Hawaii! You can earn 16 CEUs, do yoga, swim with manta rays, and hang with cool, like-minded therapists!​