Night Sweats

Night sweats are episodes of excessive sweating during sleep that soak through nightclothes and bedding. Unlike normal sweating from a warm room or too many blankets, true night sweats occur regardless of environmental temperature and can be a sign of various medical conditions ranging from hormonal changes to serious infections or cancers.

Quick Facts

  • Common symptom
  • Many possible causes
  • Often hormonal
  • Can indicate infection
  • Requires evaluation

⚠️ Seek Emergency Care Immediately For:

  • Night sweats with chest pain or pressure
  • Difficulty breathing or shortness of breath
  • High fever (over 103°F/39.4°C) with confusion
  • Severe headache with neck stiffness
  • Rapid heartbeat with dizziness or fainting
  • Coughing up blood with night sweats
  • Sudden severe abdominal pain
  • Signs of severe infection or sepsis
  • Altered mental state or extreme confusion
  • Seizures with fever and sweating

These symptoms may indicate heart attack, severe infection, or other life-threatening conditions requiring immediate treatment.

Understanding Night Sweats

True night sweats, medically known as nocturnal hyperhidrosis, are characterized by drenching sweats that require changing nightclothes or bedding. They differ from normal perspiration or feeling warm at night. Night sweats can occur with or without fever and may be accompanied by other symptoms that provide clues to the underlying cause.

The body's temperature regulation involves complex interactions between the hypothalamus, autonomic nervous system, and sweat glands. Various conditions can disrupt this system, leading to inappropriate activation of sweating mechanisms during sleep. The pattern, frequency, and associated symptoms of night sweats help determine whether they represent a benign condition or require urgent investigation.

While many causes of night sweats are not serious, the symptom can indicate significant medical conditions. The presence of "B symptoms" - night sweats, fever, and unintentional weight loss - is particularly concerning as this triad often indicates malignancy or serious infection. Understanding when night sweats warrant medical evaluation is crucial for early detection and treatment of underlying conditions.

Common Causes

Hormonal Disorders

  • Menopause: Most common cause in women, due to estrogen fluctuations
  • Perimenopause: Hormonal changes before menopause
  • Pregnancy: Hormonal shifts, especially first and third trimesters
  • Hyperthyroidism: Overactive thyroid increases metabolism
  • Pheochromocytoma: Rare adrenal tumor causing hormone surges
  • Carcinoid syndrome: Tumors releasing hormones
  • Low testosterone: In men, can cause hot flashes

Infections

  • Tuberculosis: Classic cause of night sweats
  • HIV infection: Both acute and chronic stages
  • Endocarditis: Heart valve infection
  • Osteomyelitis: Bone infection
  • Abscess: Collections of pus anywhere in body
  • Brucellosis: Bacterial infection from animals
  • Fungal infections: Histoplasmosis, coccidioidomycosis
  • Malaria: Cyclic fevers and sweats

Cancers

  • Lymphoma: Both Hodgkin's and non-Hodgkin's
  • Leukemia: Blood cancers
  • Solid tumors: Various cancers can cause night sweats
  • Liver cancer: Primary or metastatic
  • Bone tumors: Primary or metastatic
  • Mesothelioma: Cancer of chest lining
  • Neuroendocrine tumors: Hormone-producing cancers

Other Causes

  • Anxiety disorders: Panic attacks, generalized anxiety
  • Sleep apnea: Disrupted breathing during sleep
  • Hypoglycemia: Low blood sugar, especially in diabetics
  • Medication side effects: Antidepressants, steroids, fever reducers
  • Alcohol or drug withdrawal: Especially alcohol and opioids
  • Autonomic neuropathy: Nerve damage affecting sweating
  • Idiopathic hyperhidrosis: Excessive sweating without clear cause
  • GERD: Gastroesophageal reflux disease

Night Sweat Patterns

Drenching Sweats

  • Soak through clothes
  • Wet bedding
  • Need to change clothes
  • Multiple times nightly
  • Suggest serious cause
  • Require evaluation

Mild Sweating

  • Damp clothes
  • Face and chest
  • No bedding change
  • Often hormonal
  • May be normal
  • Monitor pattern

With Fever

  • Infection likely
  • Check temperature
  • Note fever pattern
  • Document symptoms
  • May need antibiotics
  • Urgent evaluation

Without Fever

  • Hormonal causes
  • Medications
  • Some cancers
  • Metabolic issues
  • Anxiety
  • Still needs workup

Associated Symptoms

Night sweats often occur with other symptoms that help identify the underlying cause:

Diagnosis and Evaluation

Medical History

  • Duration and frequency of night sweats
  • Severity (changing clothes/sheets)
  • Associated symptoms
  • Medication history
  • Travel history
  • Sexual history
  • Occupational exposures
  • Family history of cancer
  • Menstrual history in women

Physical Examination

  • Vital signs including temperature
  • Lymph node examination
  • Thyroid palpation
  • Heart and lung examination
  • Abdominal examination
  • Skin inspection
  • Neurological assessment

Diagnostic Tests

  • Complete blood count: Check for infection or blood cancers
  • Blood cultures: If infection suspected
  • Thyroid function tests: TSH, T3, T4
  • Chest X-ray: Screen for tuberculosis or tumors
  • HIV test: If risk factors present
  • Inflammatory markers: ESR, CRP
  • CT scan: If lymphoma suspected
  • Tuberculin skin test: For TB screening
  • Hormone levels: Estrogen, testosterone

Treatment Options

Lifestyle Changes

  • Keep bedroom cool
  • Use moisture-wicking sleepwear
  • Light bedding materials
  • Avoid spicy foods
  • Limit alcohol and caffeine
  • Stress management

Hormonal Treatments

  • Hormone replacement therapy
  • Birth control pills
  • Selective estrogen modulators
  • Testosterone replacement
  • Thyroid medications
  • Endocrine specialist referral

Medications

  • Anticholinergics for sweating
  • Antibiotics for infections
  • Antidepressants (some help)
  • Clonidine for hot flashes
  • Gabapentin
  • Cancer treatments if needed

Addressing Underlying Causes

  • Treat infections promptly
  • Cancer therapy if indicated
  • CPAP for sleep apnea
  • Adjust medications
  • Manage anxiety
  • Control blood sugar

When to See a Doctor

Schedule an Appointment For:

  • Night sweats lasting more than 2 weeks
  • Drenching sweats requiring clothing changes
  • Night sweats with unexplained weight loss
  • Fever accompanying night sweats
  • Enlarged lymph nodes
  • Persistent cough or breathing problems
  • Night sweats interfering with sleep quality
  • New medications causing sweating
  • Menopausal symptoms needing management
  • Concern about serious underlying cause

Living with Night Sweats

Practical Tips

  • Sleep environment: Cool room (60-67°F), fan, air circulation
  • Bedding: Moisture-wicking sheets, lightweight blankets
  • Clothing: Breathable fabrics, loose-fitting pajamas
  • Hydration: Keep water bedside, stay hydrated
  • Sleep hygiene: Regular schedule, avoid late meals
  • Track symptoms: Diary of triggers and patterns
  • Mattress protector: Waterproof but breathable
  • Extra bedding: Keep spare sheets nearby

Coping Strategies

  • Join support groups for underlying condition
  • Communicate with partner about sleep disruption
  • Practice relaxation techniques before bed
  • Consider separate bedding if needed
  • Maintain regular follow-up with healthcare provider
  • Address anxiety about night sweats

Related Conditions

Lymphoma

Cancer of lymph system often presents with night sweats.

Tuberculosis

Classic infectious cause of night sweats.

Hyperthyroidism

Overactive thyroid increases metabolism and sweating.

Menopause

Most common cause of night sweats in middle-aged women.