Overview

Night sweats refer to episodes of excessive sweating during sleep, which can result in drenched nightclothes and bed sheets. Unlike mild sweating caused by a warm room or heavy blankets, night sweats are often unrelated to external temperatures. They can occur in both men and women and may be occasional or chronic. While night sweats are sometimes harmless, they can also indicate underlying medical conditions that require attention.

Causes

Night sweats have a variety of causes, ranging from harmless to more serious medical conditions:

• Menopause: Hormonal changes during menopause can cause hot flashes and night sweats in women.
• Infections: Tuberculosis is a classic cause, but other infections like endocarditis, HIV, or abscesses can also lead to night sweats.
• Medications: Antidepressants, steroids, and fever-reducing medications can cause excessive nighttime sweating as a side effect.
• Hormonal imbalances: Conditions like hyperthyroidism or certain tumors can affect hormone levels and trigger sweating.
• Cancers: Some cancers, such as lymphoma or leukemia, are associated with persistent night sweats.
• Low blood sugar: Hypoglycemia can cause sweating during sleep, especially in people with diabetes.
• Sleep disorders: Disorders like obstructive sleep apnea may contribute to sweating episodes.
• Anxiety and stress: Psychological stress can lead to increased sweating, including during sleep.
• Idiopathic hyperhidrosis: A condition where the body produces excessive sweat without an identifiable cause.

Symptoms

Night sweats primarily involve episodes of heavy sweating during sleep, but additional symptoms may be present depending on the cause:

• Excessive sweating: Soaking through sleepwear and sheets despite a cool sleeping environment.
• Chills: Shivering after the sweating episode due to loss of body heat.
• Fever: Common in infectious causes, accompanied by sweating at night.
• Unintentional weight loss: Can accompany night sweats in serious conditions like cancer.
• Fatigue: Disrupted sleep due to sweating may lead to tiredness during the day.
• Other specific symptoms: Symptoms like cough, swollen lymph nodes, or palpitations may suggest an underlying disease.

Diagnosis

To determine the cause of night sweats, healthcare providers conduct a thorough evaluation, including:

• Medical history: Assessing frequency, duration, and associated symptoms like fever or weight loss.
• Physical examination: Looking for signs of infection, hormonal imbalance, or other systemic illness.
• Blood tests: Including complete blood count (CBC), thyroid function tests, and infection markers.
• Imaging tests: Chest X-rays or CT scans may be used to detect infections or tumors like lymphoma.
• Sleep studies: To diagnose sleep apnea if suspected.
• Hormonal studies: Evaluating estrogen, testosterone, or cortisol levels if hormonal causes are suspected.

Treatment

Treatment for night sweats focuses on addressing the underlying cause while also providing symptom relief:

• Hormone therapy: For menopausal women, hormone replacement therapy may reduce night sweats.
• Treatment of infections: Antibiotics or antivirals are used for underlying infectious causes.
• Adjusting medications: Modifying or changing medications if they are identified as the cause.
• Cancer treatment: Chemotherapy, radiation, or targeted therapies are used for cancers causing night sweats.
• Managing chronic conditions: Proper control of diabetes or thyroid disease can alleviate sweating.
• Sleep disorder management: Treatment of sleep apnea with CPAP therapy can reduce sweating episodes.
• Lifestyle adjustments: Sleeping in a cool environment, using moisture-wicking sheets, and avoiding spicy food, caffeine, or alcohol may help.
• Stress reduction: Mindfulness, therapy, or relaxation techniques can assist if anxiety is contributing to symptoms.

Prognosis

The prognosis for night sweats depends on the underlying cause:

• Benign causes: In cases like menopause or stress, night sweats often improve with appropriate treatment or lifestyle changes.
• Infectious causes: Generally resolve with proper treatment of the infection.
• Cancer-related night sweats: Prognosis depends on the stage and treatment response of the malignancy.
• Chronic conditions: Night sweats due to hormonal imbalances or chronic diseases may improve with medical management but can persist if the condition remains uncontrolled.

Early identification of the cause and targeted treatment greatly improve quality of life and reduce the frequency of night sweats.