Night Sweats

Q: I am 72 years old and reached menopause in my early 50s. However, I am still experiencing night sweats and want to know what could be causing them and how can they be stopped.

A: The cause of your night sweats is probably unrelated to menopause since you began that stage of life more than 15 years ago. However, there are other potential reasons for your symptoms. It might be as simple as the environment of your room (hot, too many blankets) or it could be related to a more concerning issue like an infection, malignancy, or hormonal imbalance. Needless to say, before we can stop the sweating, we need to know what is causing it to occur. Please make an appointment with your physician.

Profuse sweating

To evaluate your situation, we need to know the degree to which you sweat. For example, simple perspiration is your body's way of cooling itself to regulate its internal temperature. However, there are other triggers for perspiration that include stress, anxiety, certain medications or even illness. And, in some cases the stimulus for the body to perspire is so powerful as to cause "hot flushes." This in turn stimulates profuse "night sweats" that cause a drenching of the bedclothes and sheets.

Investigating the cause

Finding the source of night sweats requires a focused examination that is initially guided by the clues you provide. For example, consider the following items:

• When did the sweating begin (days, weeks, months, years ago)?
• At what time of the day does it occur (morning, afternoon, nighttime, anytime)?
• Is the sweating constant (throughout the day regardless of whether you are warm or not) or does it only occur once or several times per week?
• What makes the sweating worse (being nervous, hot, certain foods, medications)?
• What decreases the sweating (cool showers, avoidance of alcohol, certain spices, feeling calm and at ease)?
• Is the sweating mild or does it soak through your clothes?
• Is it limited to wet palms, soles of the feet and underarms or not?
• Does it affect normal activities such as not shaking someone's hand because yours are dripping wet?
• Do the episodes of sweating occur to such and extreme as to cause nervousness or anxiety about the condition? (If the answer to this last one is yes, it may be due to a medical condition of excess sweating known as hyperhidrosis).

Causes for increased perspiration

There are many of causes for increased perspiration, including potential triggers for the more severe form, known as  "night sweats." For example, if you have experienced unexplained weight loss or cough and fevers, your physician may look for health concerns such as tuberculosis or a potential malignancy. But there are other factors to consider, including the following issues, concerns and potential medical tests used in their evaluation:

• A medication checklist and review. Products such as aspirin and acetaminophen (which may trigger rebound sweating after their fever fighting effectiveness wears off), drugs for high blood pressure, antidepressants, anti-migraine medications, niacin, rituximab (used for certain cancers), tamoxifen, and even steroids (prednisone or prednisolone) may contribute to night sweats.
• Heat intolerance and/or tremors, and visual disturbances. Check for thyroid gland disorders such as hyperthyroidism.
• History of diabetes. If you are diabetic, you may need more frequent checks of your random blood sugar as episodes of hypoglycemia (low sugar levels) due to high sulfonylurea or insulin doses and/or change in diet or exercise patterns may contribute to your symptoms.
• Heartburn or acid reflux. Tests (endoscopy, others) and possible treatment with antacids or H2 blockers (ranitidine, famotidine, others).
• Overweight with excess body fat. This may cause the body to have difficulty regulating its temperature.
• Loud and intermittent snoring, trouble sleeping, or gasping for breath. A sleep study can rule out or diagnose obstructive sleep apnea.
• Presence of lymph nodes (tender or non-tender and in the absence of a current or recent infection) around your neck, armpits, groin, other regions. Possible biopsy to rule out a malignancy.
• Alternating bouts of fever throughout the day. Check for infectious diseases such as endocarditis, mononucleosis, human immunodeficiency, osteomyelitis (affecting the bones), autoimmune disorders, granulomatous disease such as sarcoid, or even a fungal infection such as histoplasmosis.
• Recent stroke and/or neurologic condition such as autonomic neuropathy (disrupts signals between the brain and other areas including the blood vessels, heart and sweat glands). May prompt further evaluation such as a thermoregulatory sweat test (check for causes of increased sweating).
• Tobacco smoking or alcohol abuse. May contribute to fluctuations in body systems leading to sweating.
• Flushing of the skin lasting minutes to days that may be accompanied by symptoms such as diarrhea, low blood pressure, wheezing and swelling of the extremities. May be suggestive of a medical concern known as carcinoid syndrome.
• Uncontrolled high blood pressure along with palpitations, headache and sweating. Concern for pheochromocytoma (rare and usually benign tumor that often starts in the adrenal gland).
• Anxiety, nervousness or depression. Sleeping alone when anxious or scared may trigger sweating.

Suggestions for better sleep   

While night sweats may be a symptom of a more serious condition (such as malignancy or infection), they may also be triggered by factors (environmental, sleep apnea, medications) that can be easily addressed by your physician. In the meantime, the following suggestions may be helpful:

• Avoid alcoholic drinks before bedtime.
• Keep your house cool and dry.
• Don't eat a large meal within four hours of bedtime.
• If you are sensitive to caffeine or certain spices, cut down or eliminate these ingredients from your dinnertime meal.
• Keep a cool glass of water by your bed in order to rehydrate your body if night sweats occur.
• Take a cool shower before going to sleep.
• Use a ceiling or room fan to increase air circulation.

For further information, please speak with your physician and check out the American Academy of Family Physicians and the Mayo Clinic.    

Find all articles by Dr. Rob.

Read More About Sleep Disorders on MSN Health & Fitness:

• Sleep and Seniors: Insomnia Isn't Inevitable
• Sleep: Your Body's Means of Rejuvenation
• Join the Discussion: Sleep Disorders Message Board

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)