By Nina Bahadur
Photography via SELF
Your bed shouldn’t double as a swimming pool.
Chances are you’ve woken up covered in a fine sheen of sweat at some point in your life, whether it’s because your air conditioner gave up the ghost or because of a particularly disturbing nightmare. You might call this kind of thing night sweats, which is technically correct: You’re sweating at night. But the phenomenon of night sweats as an actual medical diagnosis is another issue entirely.
“Night sweats are severe episodes of excessive sweating that can drench your pajamas and sheets,” internal medicine specialist Keri Peterson, M.D., tells SELF. The episodes are repeated and tied to an underlying medical issue, the Mayo Clinic says, not an outside factor like a sleeping environment that’s too warm.
The solution for your night sweats can be completely different depending on the cause, so that’s where you’ve got to start if you want to get to the bottom of your nighttime perspiration. Here are 11 possible causes of night sweats, including both the common and the pretty rare.
“If someone is having night sweats, my first thought is to ask them about their periods to see whether they are menopausal,” Barrie Weinstein, M.D., an assistant professor of endocrinology, diabetes, and bone disease at the Icahn School of Medicine, tells SELF.
Thanks to fluctuating hormones—specifically, reduced estrogen and progesterone—menopause can cause a slew of symptoms, including hot flashes that lead to night sweats, chills, irregular or absent periods, mood changes, vaginal dryness, a slower metabolism, and thinning hair, among others.
On average, people enter menopause at age 51, though it can happen at any point in a person’s 50s, 40s, or even earlier. Only around 1 percent of people who go through menopause experience it before 40, the Mayo Clinic notes, so if you’re younger than that, this probably isn’t your issue. But if you have a bunch of suspicious symptoms, you should still see your doctor just to be sure.
Menopause is a completely normal condition that doesn’t require treatment (unless it starts too early), but that doesn’t mean you don’t have options if the symptoms are interfering with your life. “If patients are having night sweats that are intolerable, they can discuss with their doctor whether hormone replacement would be a good option for them,” Dr. Weinstein says. Different kinds of hormone therapy can target various menopause symptoms, so you should ask your doctor which makes the most sense for you.
2. Anxiety disorders
People often think having anxiety is only about experiencing disproportionate worry and fear, but those emotions can trigger a whole host of physical symptoms, too. One of them is sweating way too much. (Others include fatigue, muscle tension, a rapid heartbeat, trouble breathing, stomach issues like nausea and diarrhea, and more.)
Generalized anxiety disorder, panic disorder, and social anxiety disorder—the three main ones under the anxiety disorder umbrella, though there are related issues like obsessive-compulsive disorder—can all cause excessive sweating, including at night.
Experiencing symptoms like a ton of nighttime sweating is a sign your anxiety might not be as under control as it could be. If you think your anxiety might be behind your night sweats, bring it up with your doctor—perhaps your primary care physician if you don’t have a therapist, or a mental health professional you see regularly. They can ask you some questions to figure out the best way to treat your anxiety, which might involve therapy, anti-anxiety medications, lifestyle changes, or some combination of these options.
Hyperhidrosis, which causes excessive sweating without the typical triggers like heat or exercise, comes in two forms: primary and secondary. Primary hyperhidrosis happens when doctors can’t pinpoint an underlying reason for your amped up sweating, like a health condition or medication. Secondary hyperhidrosis is when your excessive sweating happens because of a specific medical issue, whether that’s a health issue or a drug you’re taking to treat one.
Primary and secondary hyperhidrosis have a few differences. The former typically just shows up in a few key areas, for example, like your forehead, armpits, and the palms of your hand and soles of your feet, according to the American Academy of Dermatology. The latter usually involves sweating over much larger portions of your body, or even all of it. Another major difference is that, while primary hyperhidrosis usually only happens when you’re awake, secondary hyperhidrosis can flood your body with night sweats.
To treat the secondary hyperhidrosis that can cause night sweats, you’ll have to address the underlying medical issue at hand, the Mayo Clinic says. If you have no idea what it could be, have a conversation with your doctor to narrow it down.
“A number of medications can potentially cause night sweats as a side effect,” Adam Perlman, M.D. adjunct associate professor in the department of medicine at Duke University School of Medicine, tells SELF. That can include some antidepressants, drugs to treat diabetes, and cancer drugs, according to the Mayo Clinic.
If you think a drug you’ve recently introduced into your life might be behind your night sweats, see your doctor. “Ask your physician if other treatment options are available,” Dr. Peterson says. No matter how tempting it may be, don’t just quit the medication you suspect is causing your excessive P.M. sweating. Going cold turkey can bring on some serious ill effects. Stopping antidepressants suddenly, for example, can lead to antidepressant discontinuation syndrome, which happens when a sharp decrease in your levels of certain neurotransmitters causes symptoms like dizziness, insomnia, irritability, headaches, and, actually, excessive sweating. Talking to your doctor first is always the best option.
Hyperthyroidism is a condition where your thyroid—that’s a butterfly-shaped gland in your neck that essentially governs how your body uses energy—lets loose too much of the hormone thyroxine into your system, the Mayo Clinic says. That can put a bunch of your body’s processes on overdrive, leading to symptoms like night sweats, unintended weight loss, an increased appetite, a racing heart, anxiety, and more.
If your doctor thinks you might have hyperthyroidism, they can test your blood to see if you have too much thyroxine and too little thyroid-stimulating hormone, which is a signal your levels are out of whack, according to the Mayo Clinic. If you do, in fact, have this condition, there are a lot of treatment methods to choose from, including drugs that stop your thyroid gland from churning out too high a level of thyroxine, beta blockers that can slow a racing heartbeat, and more. A doctor can help you sort through the options at your disposal.
6. Obstructive sleep apnea
Obstructive sleep apnea, or OSA, is a sleep disorder that causes your breathing to stop and start while you—you guessed it—are asleep. If you have OSA, the Mayo Clinic explains, as you sleep, your throat muscles relax when they shouldn’t, which interferes with your airways’ ability to do their job of transporting air to and from your lungs.
Symptoms of OSA include night sweats, loud snoring, excessive fatigue during the day, abruptly waking up during the night while gasping or choking, other people noticing that you sometimes stop breathing while you sleep, and more. If that sounds pretty scary, well, you’re right on target—this condition can be serious and requires prompt treatment.
Treatment options include lifestyle changes like using a nasal decongestant before you sleep or avoiding sleeping on your back, sleeping with a continuous positive airway pressure (CPAP) machine to keep your airways open, using a mouthguard to do the same, and more intensive options, like surgery to remove the tissue that’s blocking your airways. The point is that you’re not just doomed to deal with OSA forever—you and your doctor can work together to treat it.
It might seem like tuberculosis (TB) isn’t around anymore, but it actually still is. This disease happens when bacteria called Mycobacterium tuberculosis attack your body (most often your lungs, but potentially parts like your kidney, spine, and brain), according to the Centers for Disease Control and Prevention (CDC). There, it causes an infection. Per the CDC, the symptoms of TB depend on where exactly the bacteria are attacking your body, but common ones include fever that can lead to night sweats and chills, weight loss, loss of appetite, and a cough that lasts three weeks or more.
You can get TB through contact with someone else who has it, since the bacteria passes from person to person through microscopic particles in the air. It’s not super common in the United States—a little over 9,000 new cases were reported in 2017, according to the CDC. Many of these cases were in people who immigrated from countries with high rates of the illness, like Mexico, India, the Philippines, Vietnam, and China. (One-fourth of the world’s population has tuberculosis.) Others were in people with weakened immune systems due to conditions like HIV.
Even though having tuberculosis frankly sounds pretty scary, the good news is that it’s curable as long as you stick to the treatment plan. To fully kick this illness, you typically need to take antibiotics for six to nine months, though that can vary based on your specific situation. (The good news is that you’d start to feel better and stop being contagious within a few weeks of treatment, but completing the full drug course is still essential in actually getting rid of the illness.)
Brucellosis is a bacterial infection that humans can pick up from animals, according to the CDC. “This typically happens through unpasteurized dairy products, but can occur through the air or direct contact with an infected animal,” Dr. Perlman says.
Brucellosis symptoms include fever, chills, sweating, weakness, fatigue, joint, muscle, and back pain, a loss of appetite, and headache, the Mayo Clinic says. So, being cooped up with brucellosis is essentially the opposite of how you want to spend your time.
The chances of you getting this in the United States are exceedingly rare (there were only 115 cases reported in the United States in 2010, according to the CDC’s most recent numbers). But if you’re a traveler, it’s worth knowing that high-risk areas include places like Eastern Europe, Asia, Africa, South and Central America, the Caribbean, the Middle East, and the Mediterranean Basin (Portugal, Spain, Southern France, Italy, Greece, Turkey, and North Africa). Huge swaths of the world, essentially.
If you were to get this illness, doctors would treat it with at least six weeks of antibiotics to clear the bacteria from your system, along with any necessary measures to target your symptoms in the meantime.
According to the CDC’s most recent figures, an estimated 1.1 million Americans are living with HIV, or human immunodeficiency virus. HIV is a virus spread through bodily fluids (blood, semen and pre-seminal fluid, vaginal and rectal fluids, and breast milk) that batters a person’s immune system by damaging their T cells (also called CD4) cells, which are integral in fighting infection, the CDC explains. When left untreated, it can develop into AIDS—acquired immunodeficiency syndrome—which makes you incredible vulnerable to what experts call “opportunistic infections” like tuberculosis and pneumonia that can lead to death.
A month or two after contracting the virus, people with HIV might experience flu-like symptoms for a few weeks, like a fever, rash, muscle and joint aches, headache, sore throat, and swollen lymph glands, the Mayo Clinic says. And, due to that fever, people with HIV “may routinely experience profuse night sweats,” internal medicine doctor Nesochi Okeke-Igbokwe, M.D., tells SELF. People with AIDS may experience a recurring fever along with night sweats, chronic diarrhea, persistent fatigue, unintended weight loss, and more.
The medical world has made some stunning advancements in reducing the power of these two illnesses, HIV especially. If a person with HIV starts treatment (antiretroviral therapy, or ART) before it’s advanced, they can live almost as long as a person without HIV, the CDC says. There are also preventive drugs, like PrEP, which is a mix of two HIV medications that you can take if you’re HIV-negative but at risk of HIV infection because of factors like having unprotected sex or having a partner with HIV. Here’s more information on how to decide if PrEP might be right for you.
10. Basically anything that can give you a fever, including autoimmune conditions like rheumatoid arthritis
Notice a pattern with tuberculosis, brucellosis, and HIV/AIDS? They’re all bacterial or viral infections that can lead to a fever, and thus, night sweats. It makes sense that anything that can make your temperature spike with a fever can also lead to night sweats. That includes causes beyond infections, like rheumatoid arthritis.
This condition happens when your body’s immune system mistakenly goes to battle with your synovium, the lining of the membranes that encase your joints, according to the Mayo Clinic. As such, you may be most familiar with the joint-related symptoms of rheumatoid arthritis, like having achy, swollen joints that are stiff, especially in the mornings or not moving in a while. But, thanks to that inflammation, the condition can also cause issues like fever that lead to night sweats.
If you have rheumatoid arthritis, your doctor can recommend the best medicine to help soothe pain and inflammation, along with slowing the progression of the illness, the Mayo Clinic says. They can also weigh in on whether or not physical therapy (to keep your joints as limber as possible) or surgery (to repair damaged joints and reduce pain) make sense for you.
This mouthful of a condition essentially means you have a super rare, usually benign tumor on one of your two adrenal glands (or, in some cases, both), the Mayo Clinic explains. Your adrenal glands release different hormones that keep your body functioning as it should, like cortisol and adrenaline, among others.
Even though the kind of tumor involved in this condition is typically non-cancerous, its mere presence is still a nuisance; a pheochromocytoma releases hormones that can cause episodic or persistent high blood pressure along with excessive sweating, headache, rapid heartbeat, tremors, paleness, and shortness of breath, the Mayo Clinic says.
The good news is that this kind of tumor is incredibly rare, developing in only two to eight people per million each year, according to the National Cancer Institute. Also, it’s treatable: The most common course of treatment for this is to take drugs that lower your blood pressure for around a week, then get minimally invasive surgery to remove the entire gland and tumor, the Mayo Clinic says. Your other adrenal gland should pick up the slack for its defunct partner after that, which will likely alleviate your symptoms. If both adrenal glands have sprouted these tumors, though, your doctor may decide to remove only the tumors and leave what they can of the glands behind.
If you have night sweats, there’s no need to toss and turn in bed like you’re on the heavy seas. Relief may be out there.
“Night sweats [are] a really common complaint,” Dr. Weinstein says. “If they are really bothersome and interfering with life, it’s time to see a doctor.”
Your doctor will review your symptoms, do a physical exam, and probably do some bloodwork or other lab exams as they see fit, Dr. Okeke-Igbokwe says. From there, you and your physician can work together to identify potential causes of your night sweats, talk about treatments, and get you closer to sweat-free sleep.
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