Hot and Bothered By Night Sweats

Q: I sweat a lot when I sleep. What can I do about it?

A: Many people experience night sweats from time to time. Most often it is due to a warm room or a brief illness. But if this is a constant problem—or if drenching night sweats are triggering the need to change your sheets and sleepwear and interrupting your sleep—a  full medical evaluation is needed.

Finding the source of night sweats requires some detective work. Sometimes the symptoms are a type of flush that causes a warmth and redness of the cheeks and upper body. In these cases a hormonal fluctuation may be the source of sweating. At other times a drenching type of night sweat may occur for a few days or many weeks. The trigger for these symptoms may be an infection, medication or other type of medical factor.

Needless to say, you as the patient can play a key role in narrowing down the diagnosis by providing key information to your physician. This would include:

• How long have your night sweats occurred (days, weeks, months)?
• Do they occur only at night or do you experience drenching sweats at other times of the day?
• Is your sleeping area too hot or crowded?
• Have you had any recent illnesses?
• Have you experienced any unexplained weight loss, fevers or shaking chills?
• Are you taking any medications, large doses of vitamins, dietary or herbal supplements?
• Do you have difficulty sleeping or been diagnosed with a sleep disorder?
• Do you eat within several hours of bedtime?
• Do you drink alcohol or use substances of abuse?
• Have you recently travelled to other areas?

In narrowing down the potential causes of night sweats, your physician may group the possible triggers into the following categories:

• Environmental (uncomfortable room temperature, poor air circulation, too many blankets, thick sheets, close proximity to a bed partner)
• Emotional (stress, anxiety, disturbing dreams)
• Hormonal (hyperthyroidism, pregnancy, perimenopause or early menopause, hypoglycemic episodes in those with or without diabetes, others)
• Medications including certain antidepressants, niacin (high doses), tamoxifen, leuprolide, prednisone, drugs for erectile dysfunction (flushing and warm sensation), and high blood pressure. Even medications used to fight fever (aspirin, acetaminophen) can lead to rebound sweating as their effectiveness wears off.
• Infections such as tuberculosis, mononucleosis, human immunodeficiency virus
• Medical conditions such as gastroesophageal reflux disease, obstructive sleep apnea and chronic fatigue syndrome
• Cancers such as lymphoma or leukemia
• Neurologic concerns such as autonomic neuropathy or a delayed complication from a spinal cord injury.

Depending upon the information you provided as well as the results from your physical examination, further diagnostic testing may be requested. This may include but is not limited to blood tests, a PPD skin test (checking for tuberculosis) and chest x-ray. Even after all testing is done, the cause of your extra sweating may not be found. This is referred to as idiopathic hyperhidrosis.

Fortunately, most cases of nighttime sweating are not serious. Taking a cool shower, drinking a cool glass of water, setting the bedroom thermostat to a more comfortable temperature, changing the sheets, and treating yourself to clean and dry nightwear before going to bed may provide some needed relief. However, the best way to solve your dilemma is to figure out the cause in order to receive the proper treatment. Please see your physician.

More From Dr. Rob:

• Why Can't I Stay Awake
• When Evening Workouts Leave You Wide Awake
• Sleep Paralysis: Wide Awake and Dreaming
• Silence a Snoring Spouse

Find all articles by Dr. Rob.

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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.)