Night Sweats

Night sweats, or excessive sweating during sleep, are a common symptom in women and men.

• 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.
• You may have other symptoms like chills, or shaking with a fever, vaginal dryness, or mood changes, depending upon the cause.
• Less common causes of night sweats include infections and cancers.

Doctors treat the problem by diagnosing the cause of your 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. In order 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.

Depending upon the underlying cause of the night sweats, other symptoms may occur in association with sweating. For example:

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

Depending upon the underlying cause of the night sweats, other symptoms may occur in association with the sweating. For example:

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

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.

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

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), and
• AIDS virus (HIV) infection.

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 an undiagnosed cancer frequently have other symptoms as well, such as unexplained weight loss and fever.

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.

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, and
• sildenafil (Viagra).

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

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

• autonomic dysreflexia,
• post-traumatic syringomyelia,
• stroke, and
• autonomic neuropathy.

The treatment for night sweats depends upon the underlying cause.

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 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.

 Medical Author: Dr. Jasmine Shaikh, MD

Medical Editor: Pallavi Suyog Uttekar, MD

Some symptoms of menopause such as hot flashes (a sudden feeling of warmth in the upper part of the body) usually last for one to two years. However, they can continue for 10 years or longer.

Menopause is the normal phase in a woman’s life that starts from her last menstrual period up to at least a year with no menstrual cycles. Menstrual periods stop permanently and she can no longer conceive. To say that a woman has reached her menopause, her periods should not have occurred for at least 12 months after her last period.

Menopause can happen anytime between 45 and 55 years of age. The average age for menopause in the United States is 52.

The transition (or time) from the beginning of irregular menstrual periods to the last menstrual period is known as perimenopause and the time after menopause is termed postmenopause. Perimenopause usually starts in a woman's mid the to late 40s and can last anywhere between one and four years before menopause strikes. Women who have undergone menopause are referred to as postmenopausal women.

Menopause that sometimes occurs early is known as premature menopause. This happens after the surgical removal of the ovaries (oophorectomy) or uterus (hysterectomy). It can also be due to an autoimmune disorder, in which the immune system of the body attacks the body’s own cells. 

What happens during menopause?

As a woman enters her 40s, her body starts producing low levels of the hormones estrogen and progesterone. Decreased levels of these hormones give rise to physiological and emotional changes in her body during menopause. A woman’s risk of some health conditions such as cardiac problems and diabetes also increases. 

In some women, the symptoms of menopause might either start at once or creep up slowly over time. Some of the symptoms that happen while transitioning to menopause include

• Irregular periods
• Breasts feel tender
• Periods that are shorter or longer than they were before
• Periods that are heavier or lighter than before
• Hot flashes/flushes 
• Vaginal itching and burning (due to vaginal dryness)
• Trouble sleeping
• Mood swings or irritability
• Forgetfulness
• Urinary incontinence (trouble holding the urine when the urge comes)
• Pain during sex
• Loss of interest in sex

How is menopause diagnosed?

The doctor usually diagnoses menopause after taking the menstrual history of the patient that includes gaps between two periods, the amount of blood flow during periods, and the time passed since the last period. 

A blood test that measures the levels of the follicular stimulating hormone (FSH) can also help the doctor ascertain the diagnosis of menopause. However, for many women, a blood test is not necessary. Most of the time, their menstrual history is enough to diagnose menopause. How to deal with menopause?

How to deal with menopause?

Meet the physician and discuss the symptoms that are occurring.

Healthy eating patterns and being physically active can help with many menopausal symptoms such as weight gain and mood swings.

Herbal supplements such as soy milk and red clover may help with some menopause symptoms. These contain an estrogen-like compound. However, one must discuss with their healthcare provider before starting any herbal supplements. These are to be avoided in women who take hormone replacement therapy.

Hormonal and nonhormonal treatments can help with some symptoms. Women need to discuss potential treatments with their doctors.

 Medical Author: Karthik Kumar, MBBS

Medical Editor: Pallavi Suyog Uttekar, MD

Night sweats are episodes of excessive perspiration that happen during sleep. They are often described as soaking or drenching and may require a change of sheets or even clothes. Night sweats can occur during sleep and without physical exertion. They aren’t caused by a heavy blanket or a warm bedroom. Instead, other underlying health issues may be responsible for these episodes of considerable sweating during sleep. Night sweats can reduce sleep quality, concern a bed partner, and provoke serious discomfort. 

What is the outcome of patients with night sweats?

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.

What are the eight causes of night sweats?

There are many different causes of night sweats. The most common include the following

• Hypoglycemia: Low blood sugar can cause sweating. People who take insulin or oral diabetes medications may have hypoglycemia at night that is accompanied by sweating.
• Hormone disorders: Sweating or flushing can be seen with several hormone disorders such as hyperthyroidism (hyperactive thyroid), carcinoid syndrome, and adrenal gland tumors.
• Neurologic conditions: Neurologic conditions including stroke and autonomic neuropathy may cause increased sweating and may lead to night sweats.
• Infections: Tuberculosis is an infection most commonly associated with night sweats. However, bacterial infections such as endocarditis (inflammation of the heart valves), osteomyelitis (inflammation of the bones), and abscesses can cause night sweats. Night sweats are also a symptom of human immunodeficiency virus (HIV) infection.
• Menopause: The hot flashes that accompany menopause can occur at night and cause sweating. This is a very common cause of night sweats in women.
• 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.
• Idiopathic hyperhidrosis: Idiopathic hyperhidrosis is a condition in which the body chronically produces too much sweat without any identifiable medical cause.
• Medications: Certain medications are known to be associated with night sweats. These include some antidepressants known as selective serotonin reuptake inhibitors (SSRIs), steroids, and medicines taken to reduce fever such as aspirin or acetaminophen that may paradoxically cause sweating.
• Lifestyle: Excessive intake of drugs, alcohol, and caffeine can also increase the risk of night sweats. Excess stress or workload may also increase night sweats. 

Other medical conditions such as gastroesophageal reflux disease (GERD), heart failure, anxiety, and panic attacks have been correlated with night sweats.

How can night sweats be treated?

The treatment for night sweats will 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.