Night sweats

Night Sweats (Excessive Sweating During Sleep)

Night sweats refer to episodes of excessive sweating during sleep that can soak sleepwear and bedding, even in a cool environment. They are distinct from simply feeling warm or overheating due to heavy blankets or room temperature. While occasional night sweats may not indicate a serious problem, persistent or severe episodes can be a symptom of an underlying medical condition requiring evaluation.

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Causes of Night Sweats

1. Physiological/Benign Causes

• Menopause or perimenopause: Hormonal fluctuations, especially declining estrogen, often cause hot flashes and night sweats.

• Idiopathic hyperhidrosis: A benign condition where the body chronically produces excessive sweat without an identifiable cause.

• Environmental factors: Sleeping in a hot room, heavy bedding, or tight sleepwear.

2. Infectious Causes

• Tuberculosis (TB): A classic cause of persistent night sweats.

• HIV infection: May be accompanied by weight loss, fever, and fatigue.

• Endocarditis: Bacterial infection of the heart lining.

• Other infections: Osteomyelitis, abscesses, or chronic bacterial/viral infections.

3. Malignancy

• Lymphoma: Especially Hodgkin’s lymphoma, often associated with fever and weight loss (“B symptoms”).

• Leukemia: Can also present with fevers, sweats, and fatigue.

4. Endocrine & Metabolic Disorders

• Hyperthyroidism: Overactive thyroid leading to heat intolerance and sweating.

• Diabetes (hypoglycemia at night): Especially in patients using insulin or sulfonylureas.

• Carcinoid syndrome: Rare tumor that releases serotonin and other chemicals.

5. Medications & Substances

• Antidepressants: SSRIs (e.g., fluoxetine, sertraline) and tricyclic antidepressants.

• Antipyretics: Aspirin, acetaminophen can alter thermoregulation.

• Steroids: Corticosteroids may trigger sweating.

• Alcohol, caffeine, or drug withdrawal (e.g., opioids, benzodiazepines).

6. Other Causes

• Gastroesophageal reflux disease (GERD): Can trigger nocturnal sweating.

• Chronic anxiety or stress: Heightened sympathetic activity.

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Associated Symptoms Warranting Urgent Evaluation

• Unexplained weight loss

• Fever and prolonged fatigue

• Persistent cough or shortness of breath

• Swollen lymph nodes

• Bone pain or bruising

• Severe drenching sweats disrupting sleep regularly

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Diagnosis

A doctor may:

• Take a detailed history (frequency, severity, triggers, family history).

• Conduct a physical exam (lymph nodes, thyroid, abdomen).

• Order blood tests (CBC, thyroid function, blood sugar, inflammatory markers).

• Request imaging (chest X-ray, CT scan if TB, lymphoma, or other causes suspected).

• Additional tests like HIV testing, blood cultures, or hormone tests if clinically indicated.

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Management & Treatment

1. Treat Underlying Cause

• Infection: Antibiotics (e.g., TB treatment with isoniazid, rifampicin, ethambutol, pyrazinamide for 6 months).

• Hyperthyroidism: Antithyroid drugs (carbimazole, methimazole, or propylthiouracil), beta-blockers for symptoms.

• Hypoglycemia: Adjust insulin dose or change diabetes medications.

• Lymphoma/leukemia: Chemotherapy, radiotherapy, or immunotherapy depending on stage.

2. Symptomatic Relief

• Keep bedroom cool and well-ventilated.

• Wear lightweight, breathable clothing.

• Use moisture-wicking bedding.

• Reduce alcohol, caffeine, spicy foods.

• Manage stress and anxiety with relaxation techniques or counseling.

3. Medication-Related Adjustments

• If antidepressants or other drugs are suspected, a doctor may switch to alternatives.

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Medications Commonly Used (Depending on Cause)

• Paracetamol or NSAIDs (e.g., ibuprofen 400 mg every 8 hours PRN) for fever-related sweating.

• Clonidine (0.1–0.2 mg daily) may help menopausal night sweats.

• Hormone replacement therapy (HRT) for menopausal women (estradiol patches or tablets).

• Anticholinergics (oxybutynin 2.5–5 mg up to 3 times daily) may help in idiopathic hyperhidrosis.

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Precautions

• Avoid self-medicating with hormones or strong medications without medical supervision.

• Night sweats persisting more than 2–3 weeks require medical evaluation.

• Individuals with a history of cancer, TB, or immunosuppression should seek urgent review.