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In the Northeastern U.S., future heatwaves will increase in frequency, duration, and intensity due to climate change. A great deal of the research about the health impacts from extreme heat has used ambient meteorological measurements, which can result in exposure misclassification because buildings alter indoor temperatures and ambient temperatures are not uniform across cities. To characterize indoor temperature exposures during an extreme heat event in buildings with and without central air conditioning (AC), personal monitoring was conducted with 51 (central AC, n = 24; non-central AC, n = 27) low-income senior residents of public housing in Cambridge, Massachusetts in 2015, to comprehensively assess indoor temperatures, sleep, and physiological outcomes of galvanic skin response (GSR) and heart rate (HR), along with daily surveys of adaptive behaviors and health symptoms. As expected, non-central AC units (T-mean = 25.6 degrees C) were significantly warmer than those with central AC (T-mean = 23.2 degrees C, p < 0.001). With higher indoor temperatures, sleep was more disrupted and GSR and HR both increased (p < 0.001). However, there were no changes in hydration behaviors between residents of different buildings over time and few moderate/several health symptoms were reported. This suggests both a lack of behavioral adaptation and thermal decompensation beginning, highlighting the need to improve building cooling strategies and heat education to low-income senior residents, especially in historically cooler climates.