Differential Diagnosis for Profuse Sweating during REM Sleep
- Single most likely diagnosis
- Nightmare disorder: This condition is characterized by recurrent nightmares that can cause significant distress and lead to symptoms like profuse sweating during REM sleep due to the intense emotional and physiological responses associated with the nightmares.
- Other Likely diagnoses
- Sleep apnea: Although more commonly associated with pauses in breathing, sleep apnea can also lead to increased sympathetic activity, potentially causing sweating during sleep, including REM sleep.
- Sleep stage transition disorders: Disorders that affect the normal transition between different sleep stages can lead to abnormal physiological responses, including sweating.
- Medication side effects: Certain medications, especially those affecting the central nervous system, can disrupt normal sleep patterns and lead to sweating during sleep.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Neurodegenerative diseases (e.g., multiple system atrophy): These conditions can affect autonomic nervous system function, leading to abnormal sweating patterns, including during sleep.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause excessive production of catecholamines, leading to symptoms like profuse sweating, which might be more pronounced during the heightened sympathetic activity of REM sleep.
- Hypothyroidism: Although less directly linked, severe hypothyroidism can lead to autonomic dysfunction, potentially causing abnormal sweating.
- Rare diagnoses
- Fatal familial insomnia: A rare genetic degenerative brain disorder that leads to gradual degeneration of the brain's ability to sleep, with symptoms including excessive sweating.
- Autonomic nervous system disorders: Conditions like dysautonomia can lead to a wide range of autonomic symptoms, including abnormal sweating patterns during sleep.
- Certain infections (e.g., endocarditis, neurosyphilis): In rare cases, systemic infections can affect the central nervous system and lead to abnormal sweating, among other symptoms.