What causes night sweats after a COVID-19 infection and how are they treated?

Managing Night Sweats After COVID-19 Infection

Night sweats following COVID-19 infection are a common post-acute sequela that may persist for months and should be managed with a combination of supportive measures, addressing underlying autonomic dysfunction, and gradual exercise rehabilitation.

Causes of Post-COVID Night Sweats

Night sweats after COVID-19 infection can be attributed to several mechanisms:

1. Autonomic Dysfunction: COVID-19 can affect the autonomic nervous system, leading to dysregulation of body temperature control 1

   • This is part of the post-acute sequelae of SARS-CoV-2 infection cardiovascular syndrome (PASC-CVS)
   • Often accompanied by other symptoms like tachycardia, palpitations, and orthostatic intolerance

2. Inflammatory Response: Persistent low-grade inflammation following infection can disrupt thermoregulation 1

3. Respiratory Muscle Dysfunction: COVID-19 can impair respiratory muscle performance, contributing to night sweats as the body works harder to maintain adequate oxygenation during sleep 1

4. Deconditioning: Physical deconditioning following illness can lead to autonomic imbalance 1

Management Approach

Non-Pharmacological Interventions

1. Fluid and Salt Loading:

   • Drink 3 liters of water or electrolyte-balanced fluid daily 1
   • Consider liberal sodium intake (5-10g daily) if blood pressure is controlled 1
   • Avoid alcohol, caffeine, large meals, and excessive heat exposure that can worsen dehydration 1

2. Sleep Environment Optimization:

   • Keep bedroom cool and well-ventilated
   • Use moisture-wicking bedding and sleepwear
   • Elevate the head of the bed with 4-6 inch (10-15cm) blocks 1

3. Graduated Exercise Program:

   • Begin with recumbent or semi-recumbent exercise (rowing, swimming, cycling) 1
   • Start with short duration (5-10 minutes daily) and gradually increase as tolerance improves 1
   • Transition to upright exercise as orthostatic intolerance improves 1

Pharmacological Interventions

For persistent and severe night sweats affecting quality of life, consider:

1. Beta-blockers:

   • Low-dose beta-blockers (bisoprolol, metoprolol, nebivolol, propranolol) may help control autonomic symptoms 1
   • Particularly useful if night sweats are accompanied by palpitations or tachycardia
   • Propranolol may be especially helpful if anxiety is a contributing factor 1

2. Other Medications:

   • Ivabradine may be considered for those with severe fatigue exacerbated by beta-blockers 1
   • Fludrocortisone (up to 0.2mg at night) in conjunction with salt loading may help with autonomic symptoms 1
   • Monitor for hypokalemia if using fludrocortisone 1

Monitoring and Follow-up

1. Return for Medical Evaluation if:

   • Fever >38°C persists for more than 48 hours 2
   • Breathing difficulties develop or worsen 2
   • Symptoms persist beyond 10 days without improvement 2

2. Consider Further Testing if Symptoms Persist:

   • Basic laboratory testing (complete blood count, basic metabolic panel, cardiac troponin, C-reactive protein) 1
   • ECG and ambulatory rhythm monitoring if palpitations accompany night sweats 1
   • Echocardiogram if cardiovascular symptoms are present 1

Special Considerations

• Persistence: Be aware that post-COVID symptoms can persist for months. Studies show that 92% of patients still had at least one symptom at 12 months post-hospitalization 3

• Symptom Clusters: Night sweats may be part of a broader symptom cluster. The fatigue and cognitive symptom clusters tend to persist longer than physical and respiratory symptoms 3

• Prevalence: Post-COVID sequelae affect approximately 10-30% of individuals following infection 1, with higher rates in those who were hospitalized

When to Consider Alternative Diagnoses

If night sweats are severe, persistent beyond 6 months, or accompanied by significant weight loss, consider referral to rule out other causes such as:

• Tuberculosis
• Lymphoma or other malignancies
• Endocrine disorders
• Medication side effects

Night sweats typically improve gradually over time as part of the natural recovery from post-COVID syndrome, but supportive management can significantly improve quality of life during this period.