From the Guidelines
Severe nocturnal diaphoresis, or night sweats, are most commonly caused by hormonal changes, particularly in women who have undergone breast cancer treatment, as evidenced by studies such as 1 and 1.
Causes of Night Sweats
The causes of night sweats can be multifactorial, including:
- Hormonal changes, especially in women with a history of breast cancer treatment, as noted in 1 and 1
- Infections
- Medications
- Anxiety
- Underlying medical conditions
Management of Night Sweats
To manage severe night sweats, the following strategies can be employed:
- Keeping the bedroom cool (around 65-68°F) and using moisture-wicking bedding
- Avoiding triggers like alcohol, caffeine, and spicy foods, especially in the evening
- Staying hydrated throughout the day but reducing fluid intake before bedtime
- Using a cool pack or a fan in the bedroom for immediate relief during an episode
- Considering over-the-counter options like clinical-strength antiperspirants applied before bed or supplements such as black cohosh (40-80mg daily) if night sweats are related to menopause
Medical Treatments
Medical treatments for night sweats related to menopause may include:
- Low-dose hormone replacement therapy
- Certain antidepressants like venlafaxine (75mg daily) or paroxetine (7.5-20mg daily), as suggested by 1
- Gabapentin (300-900mg at bedtime), also mentioned in 1 for menopause-related sweats
It is essential to consult a healthcare provider for proper diagnosis and targeted treatment if night sweats persist despite these measures, as they can be a symptom of an underlying medical condition.
From the Research
Causes of Severe Nocturnal Diaphoresis (Night Sweats)
Severe nocturnal diaphoresis, also known as night sweats, can be caused by various factors. Some of the possible causes include:
- Menopausal symptoms, particularly hot flushes, which can be managed with hormone replacement therapy (HRT) 2
- Infections, such as tuberculosis and lymphoma, which can be diagnosed through a thorough history, physical examination, and directed laboratory and radiographic studies 3
- Malignancies, which can be detected through diagnostic tests such as PET-CT and bone marrow examination 4
- Sleeping disorders, such as obstructive sleep apnea, which can be evaluated through a screening test 4
- Medication-related causes, such as antihypertensives, antipyretics, and drugs of abuse, which can be identified through a medication review 4, 3
- Hormonal imbalances, such as hyperthyroidism and hypoglycemia, which can be diagnosed through laboratory tests 3
- Other medical conditions, such as gastroesophageal reflux disease and human immunodeficiency virus, which can be detected through diagnostic tests and laboratory studies 3
Diagnostic Approaches
To diagnose the cause of severe nocturnal diaphoresis, a structural analysis can be used, which involves:
- Distinguishing night sweats with or without fever 4
- Evaluating the patient's medical history and performing a physical examination 3
- Conducting laboratory tests, such as a complete blood count, human immunodeficiency virus test, and thyroid-stimulating hormone test 3
- Performing radiographic studies, such as a chest radiograph and computed tomographic scans 3
- Considering a bone marrow biopsy if necessary 3
Treatment Options
Treatment for severe nocturnal diaphoresis depends on the underlying cause. Some possible treatment options include:
- Hormone replacement therapy (HRT) for menopausal symptoms 2
- Medications, such as oxybutynin, which can be effective in treating primary sleep hyperhidrosis 5
- Alpha adrenergic blockers, which may reduce night sweats in patients taking serotonin reuptake inhibitors 6
- Thalidomide and thioridazine, which may benefit some terminal cancer patients with night sweats 6