Night Sweats

Doctors in primary care fields of medicine often hear their patients complain of night sweats because they are common. Night sweats refer to any excess sweating occurring during the night. However, if you keep your bedroom temperature unusually hot or you are sleeping in too many clothes, you may sweat during your sleep, which is normal.

To distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.

In one study of 2267 patients visiting a primary care doctor, 41% reported experiencing night sweats during the previous month, so the perception of excessive sweating at night is common. It is important to note that flushing (a warmth and redness of the face or trunk) also may be hard to distinguish from true night sweats.

Many medical conditions and diseases can cause night sweats. Examples include women in perimenopause or menopause; medications, hormone problems (Low-T), low blood sugar, and neurological problems.

Perimenopause and Menopause

The hot flashes that accompany the menopausal transition can occur at night and cause sweating. This is a very common cause of night sweats in perimenopausal women. It is important to remember that hot flashes and other symptoms of perimenopause can precede the actual menopause (the cessation of menstrual periods) by several years.

Hormone disorders

Sweating or flushing can be seen with several hormone disorders, including pheochromocytoma (a type of adrenal gland tumor that overproduces hormones known as catecholamines), carcinoid syndrome (overproduction of certain hormones by tumors of the lung or gastrointestinal system), and hyperthyroidism (excessive levels of thyroid hormones).

Idiopathic hyperhidrosis

Idiopathic hyperhidrosis is a condition in which the body chronically produces too much sweat without any identifiable medical cause.

Infections

Classically, tuberculosis is the infection most commonly associated with night sweats. However, bacterial infections, such as the following conditions can also be associated with night sweats:

• Endocarditis (inflammation of the heart valves)
• Osteomyelitis (inflammation within the bones due to infection)
• Abscesses (for example, boils, appendix, tonsils, perianal, peritonsillar, diverticulitis)
• AIDS virus (HIV) infection

Cancers

Night sweats are an early symptom of some cancers. The most common type of cancer associated with night sweats is lymphoma. However, people who have undiagnosed cancer frequently have other symptoms as well, such as unexplained weight loss and fever.

Antidepressants

Taking certain medications can lead to night sweats. In cases without other physical symptoms or signs of tumor or infection, medications are often determined to be the cause of night sweats.

Antidepressant medications are a common type of medication that can lead to night sweats. All types of antidepressants including tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and the newer agents, venlafaxine (Effexor) and bupropion (Wellbutrin) can cause night sweats as a side effect, with a range in incidence from 8% to 22% of persons taking antidepressant drugs. Other psychiatric drugs have also been associated with night sweats.

Other medications

Medicine taken to lower fever (antipyretics) such as aspirin and acetaminophen (Tylenol and others) can sometimes lead to sweating.

Other types of drugs can cause flushing (redness of the skin, typically over the cheeks and neck), which, as mentioned above, may be confused with night sweats. Some of the many drugs that can cause flushing include:

• niacin (Niacor, Niaspan, Slo-Niacin - taken in the higher doses used for lipid disorders)
• tamoxifen (Nolvadex)
• hydralazine
• nitroglycerine
• sildenafil (Viagra)

Many other drugs not mentioned above, including cortisone, prednisone, and prednisolone, may also be associated with flushing or night sweats.

Neurologic conditions

Uncommonly, neurologic conditions may cause increased sweating and possibly lead to night sweats including:

• Autonomic dysreflexia
• Post-traumatic syringomyelia
• Stroke
• Autonomic neuropathy

Depending upon the underlying cause of the night sweats, other symptoms may occur in association with sweating, such as:

• Certain infections and cancers
• Shaking and chills can sometimes occur if you have a fever
• Unexplained weight loss due to lymphoma

Additionally, symptoms of night sweats may appear as the following:

• Night sweats due to the menopausal transition are typically accompanied by other symptoms of menopause such as vaginal dryness, daytime hot flashes, and mood changes.
• Night sweats that occur as a side effect of medications can be accompanied by other medication side effects, depending upon the specific drug.

Conditions that result in increased sweating in general (as opposed to only night sweats) will result in increased sweating at other hours of the day.

Night sweats are commonly treated by internists, family practice specialists, or gynecologists. If they are related to specific medical conditions, other specialists, including endocrinologists, neurologists, infectious disease specialists, or oncologists, may be involved in the care of patients with night sweats.

The treatment for night sweats depends upon the underlying cause. Treatments also vary for any individual patient and should always be overseen by a health professional. Some potential treatment methods include modifications to environment and behavior, cognitive behavioral therapy (CBT), and medications.

• Lifestyle modifications: Avoiding caffeine, alcohol, and spicy foods; drinking sufficient water; maintaining a healthy weight; utilizing relaxation techniques, and wearing breathable clothing before sleeping are a few modifications that may relieve night sweats.
• CBT: This is a type of talk therapy that is commonly used for health problems such as depression, anxiety, and insomnia. It is normally conducted in person by a psychiatrist or counselor, but numerous self-directed programs have been developed. Studies have found that CBT for hot flashes and night sweats can reduce their frequency and improve mood and quality of life in menopausal women. CBT is compatible with other approaches, such as behavior modifications, and likely has the greatest effect on night sweats when combined with other approaches.
• Medications: Sometimes existing medications may cause night sweats.
  • Switching to different diabetes or thyroid medications may help deal with night sweats. Changing the drug dose and timing may also help manage night sweats.
  • If night sweats are caused by an underlying infection or hormone problem, medication to treat the underlying condition may help relieve symptoms. For example, starting hormone replacement therapy for menopause or taking medicines if tuberculosis is present may help.
  • A doctor may be in the best position to discuss the potential benefits and downsides of any specific medication.

In summary, night sweats are usually a harmless annoyance; however, they are sometimes a sign of an underlying medical condition. Persons with unexplained night sweats should seek medical care.

Night sweats affect many people. They are sometimes no cause for concern, but they can interrupt sleep and reduce the quality of life. In some cases, night sweats are a sign of a health issue that requires attention. Sleeping in a cool room with bedding and pajamas made from light, natural fabrics may help. If not, a doctor can recommend other approaches, which may include medications and therapies.