Surprising Signs of Hypothermia That Are Too Easy to Miss

On average, 1,300 people die every year in the United States from excessive cold. Know how to spot signs of hypothermia so you can get the help you (or a loved one) needs quickly.

Man driving car on to the mountains. Traveler with backpack. Hiking in cold weather.
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What is hypothermia?

Hypothermia is an abnormally low body temperature after your body loses heat from exposure to the cold. The tricky part is that it comes on so gradually that many people have no idea that they’re experiencing signs of hypothermia, according to the U.S. National Library of Medicine. Once your body temp falls below 95 degrees Fahrenheit, you need emergency help; otherwise, hypothermia can be fatal. It’s just one of the 10 ways winter can kill you.

Sharp icicles and melted snow hanging from eaves of roof, Beautiful icicles slowly gliding of a roof.

Skipped-Over Sign: Drowsiness

Some of the common signs of hypothermia include shivering, a weak pulse, or shallow breathing. But once mild hypothermia begins to take hold, you may also appear sleepy. If you—or someone you’re with—becomes sluggish in the bitter cold and you just want to lie down, you’re in serious danger. By the way, there’s a group at risk of hypothermia even indoors: babies and toddlers sleeping in rooms that are too cold (in which case, you won’t even see this warning sign). Keep them adequately warm while following the safe sleeping guidelines set by the American Academy of Pediatrics, including putting them in a sleep sack or wearable blanket.

Uphill road landscape in winter at Iceland. Asphalt road with sideways full of snow
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Skipped-Over Sign: Confusion

Something that makes the signs of hypothermia even tougher to spot is the fact that you can be in denial that there’s even a problem. “One of the paradoxes with hypothermia is that the symptoms can lead to cognitive impairment, which can affect your insight and ability to be self-aware,” says Brad Uren, MD, assistant professor of emergency medicine at the University of Michigan Medical School. That’s where the buddy system comes in. Being with a group means you can all keep an eye out for each other, he says.

footprints in the snow
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Skipped-Over Sign: Appearing a bit… drunk

This is related to confusion, as someone may begin to slur their speech or not be as vocal as hypothermia sets in, says Dr. Uren. “If it looks like someone has been drinking, think cold—not alcohol,” he adds. (In general, it’s a good idea to refrain from drinking during cold weather activities, as alcohol can lead to more rapid heat loss, putting you at an increased risk for a problem.) Check out 15 other weird things that happen to your body in winter.

seat of rope way at winter

Skipped-Over Sign: Clumsiness

You went skiing with friends—one of your favorite activities. When you started, you were fine zipping along; now you’re finding it really tough going and you’re falling more than normal. Given that confusion is one of the common signs of hypothermia, you may not realize you’re impaired in this way, says Dr. Uren. That’s where it’s smart to check in with your pals. Here’s how to safely exercise outdoors this winter.

Frozen winter forest in the fog. Carpathian, Ukraine.

How to treat hypothermia

If your friend is showing signs that they may have hypothermia, your first goal is to warm them up. If they’re in the water, get them out, dry them off, and shuttle them into a warm place. (A building, car, around a fire). “Your first step is to remove them from the situation,” says Dr. Uren. Then, call for medical help.


Think about what you’re wearing

If a friend is wearing wet clothes, they need to change, stat. “Wet clothing drains heat from the body at a much faster rate,” says Dr. Uren. You never know what you may be up against when out in the cold—even if you’re driving: Here’s how to survive if your car breaks down in a winter storm.

Vintage pair of yellow working and trekking boots, stepping on snow-covered surface.
Ksenia Faleva/Shutterstock

Be prepared

One thing that commonly pops up among patients who’ve had hypothermia, says Uren, is that people didn’t think they’d actually have to face the cold. “People say I thought I was only going to be out for a minute,” says Dr. Uren. But a quick drive in your car wearing a spring jacket won’t bode well if you get stuck in the snow. Prepare: toss your heavy coat in the trunk, bring your boots, and keep a shovel and snow scraper in your car just in case. Your car should be prepped, too: here are 8 cold-weather fixes it may need.

A temperature gauge in the snow reading around 0 fahrenheit.

Watch the weather

The National Weather Service offers a handy Wind Chill Chart that gives you an idea of just how cold the outdoor temp can be when the wind hits, says Dr. Uren. For instance, being outside in a light 15 mph wind when it’s zero degrees out does sound cold, certainly, but what you might not expect is that you’re at risk for frostbite within 30 minutes. Then, you have a whole new problem.

Jessica Migala
Jessica Migala is a freelance health and fitness writer with more than a decade experience reporting on wellness trends and research. She's contributed to Health, Men's Health, Family Circle, Woman's Day, and O, The Oprah Magazine, among other publications. Jessica lives with her husband and two young sons in the Chicago suburbs.