Sleep hyperhidrosis

Sleep hyperhidrosis
ICD-10	R61.9
ICD-9	780.8, 327

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating (hyperhidrosis) during sleep. The sufferer may or may not also suffer from excessive perspiration while awake. A night sweat caused by a medical condition or infection can be described as ‘severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment’. [3] True night sweats with medical causes should be properly investigated by a medical physician.

Classification of Sweating

There are four types of sweats:

1. Diaphoresis: Diaphoresis is a cold sweat. Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions. It is distinguished from hyperhidrosis by the "clammy" or "cold state" state of the patient.
2. Primary Hyperhidrosis: Primary hyperhidrosis is a condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature. This is not a cold sweat.
3. Secondary Hyperhidrosis: Secondary hyperhidrosis is a condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature that is secondary to an underlying pathologic process such as infections, disorders of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning. This is not a cold sweat.
4. Night sweats: Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating (hyperhidrosis) during sleep. The sufferer may or may not also suffer from excessive perspiration while awake.

Epidemiology and Demographics

Sleep hyperhidrosis may occur at any age, but is most commonly seen in early adulthood.

Risk factors

• No differences in men or women.
• Night sweats may occur for genetic reasons and may be relatively harmless.

Natural History, Complications and Prognosis

• The natural history is unpredictable. Some patients may have a self-limited course, where as some may experience sleep hydrosis for life.
• They can be distressing and disrupt sleep patterns if severe; the patient may be frequently awakened due to the discomfort of damp sleepwear.
• While some causes of night sweats, such as menopause, may be relatively harmless, night sweats may also be a sign of a serious underlying disease.

Causes

Common Causes

One of the most common causes of night sweats in women over 40 is the hormonal changes related to menopause and perimenopause. This is a normal part of menopause and while annoying, it is not necessarily dangerous or a sign of underlying disease. Some women experience night sweats during pregnancy due to hormonal changes.

While there can be many causes of excessive sweating at night including the menopause and, for example, a bedroom that is unusually hot or too many bed clothes on the bed, it is important to distinguish night sweats that arise due to medical causes from those that occur because the sleep environment is too warm.

Causes by Organ System

Cardiovascular	Infective endocarditis, Prinzmetal's angina, Subacute endocarditis
Chemical/Poisoning	Camphoric acid, Organophosphate pesticides
Dental	No underlying causes
Dermatologic	Boil
Drug Side Effect	Abatacept Injection, Adalimumab Injection, Antidepressants, Antipyretics(salicylates, acetaminophen), Aspirin, Benzodiazepine withdrawal, Beta-blockers, Bethanechol, Bromocriptine, Bupropion, Calcium channel blockers, Cholinergic agonists, Cholinesterase inhibitors, Cyclosporine, Dinitrophenol, Estroven, Flutamide, GnRH agonist, Hydralazine, Oral hypoglycemic agents, Imatinib , Lamotrigine, Letrozole , Leuprolide, Levomepromazine, Natalizumab, Niacin, Nitroglycerin, NSAIDs, Omeprazole, Pegaspargase, Pentamidine inhalation, Phenothiazines, Pilocarpine, Raloxifene, Rituximab, Selective serotonin reuptake inhibitors, Sertraline, Sildenafil, Sympathomimetic agents, Tamoxifen, Theophylline, Tramadol, Trenbolone, Tricyclic antidepressants, Triptans, Venlafaxine
Ear Nose Throat	No underlying causes
Endocrine	Hyperthyroidism, Hypoglycaemia, Menopause, Pheochromocytoma, Thyrotoxicosis
Environmental	Systemic exertion intolerance disease
Gastroenterologic	Carcinoid syndrome, Gastroesophageal reflux disease
Genetic	Familial dysautonomia
Hematologic	Hodgkins disease, Leukemia, Lymphocytic leukocytosis, Lymphoma, Systemic mastocytosis syndrome, Waldenstrom's macroglobulinemia
Iatrogenic	No underlying causes
Infectious Disease	Blastomycosis, Brucellosis, Dental abscess, Fungal infections (Histoplasmosis, Coccidioidomycosis), HIV, Infectious mononucleosis, Lung abscess , Malaria, Mycobacterium avium complex infection, Nocardiosis, Osteomyelitis, Pneumocystis pneumonia, Pneumonia, Pyogenic abscess, Relapsing fever, Tuberculosis, Urinary tract infection
Musculoskeletal/Orthopedic	Fibromyalgia, Osteomyelitis
Neurologic	Autonomic dysreflexia, Cerebral palsy, Familial dysautonomia, Hypothalamic lesions, Post-traumatic syringomyelia, Stroke
Nutritional/Metabolic	Chronic pancreatitis, Hypercholesterolemia, Hyperlipidaemia, Hypertriglyceridemia, Obesity, Vitamin E deficiency,
Obstetric/Gynecologic	Menopause, Perimenopause, Pregnancy, Premature ovarian failure
Oncologic	Cancer, Carcinoid syndrome, Hodgkins disease, Leukemia, Lymphoma, Mesothelioma, Oat cell carcinoma of the lung, Solid tumors
Ophthalmologic	No underlying causes
Overdose/Toxicity	Alcohol withdrawal, Drug withdrawal (Ethanol, Benzodiazepines, cocaine, Heroin and other Opiates), Substance abuse
Psychiatric	Anxiety disorder
Pulmonary	Obstructive sleep apnea, Pneumonia
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Chronic eosinophilic pneumonia, Eosinophilic pneumonia, Granulomatous disease, Kikuchi disease, Sarcoidosis, Takayasu's arteritis, Temporal arteritis
Sexual	No underlying causes
Trauma	Post-traumatic syringomyelia
Urologic	Urinary tract infection
Miscellaneous	Chromium deficiency, Chronic fatigue syndrome, Idiopathic hyperhidrosis

Causes in Alphabetical Order

• Abatacept Injection
• Adalimumab Injection
• Antidepressants (Bupropion, Selective serotonin reuptake inhibitors, Tricyclic antidepressants, Venlafaxine)
• Antipsychotics (e.g. Clozapine, Fluvoxamine, Phenothiazines)
• Antipyretics (e.g. Acetaminophen, NSAIDs, Salicylates)
• Anxiety disorder
• Autonomic dysreflexia
• Beryllium
• Beta-blockers
• Boil
• Bromocriptine
• Brucellosis
• Calcium channel blockers
• Camphoric acid
• Cancer
• Carcinoid syndrome
• Cerebral palsy
• Cholinergic agonists (e.g. Bethanechol, Pilocarpine)
• Cholinesterase inhibitors (e.g. Organophosphate pesticides)
• Chronic eosinophilic pneumonia
• Chronic fatigue syndrome
• Cyclosporine
• Dental abscess
• Dinitrophenol
• Drug withdrawal: Benzodiazepines,Ethanol, Cocaine, Heroin and other opiates
• Eosinophilic pneumonia
• Estroven
• Familial dysautonomia
• Fibromyalgia
• Fungal infections (Blastomycosis, Coccidioidomycosis, Histoplasmosis)
• Gastroesophageal reflux disease
• Granulomatous disease
• HIV
• Hodgkins disease
• Hormonal agents (e.g. GnRH agonist, Tamoxifen, Raloxifene, Flutamide)
• Hydralazine
• Hyperthyroidism
• Hypoglycaemia
• Oral hypoglycemic agents
• Hypothalamic lesions
• Idiopathic hyperhidrosis
• Imatinib
• Infective endocarditis
• Infectious mononucleosis
• Kikuchi disease
• Lamotrigine
• Letrozole
• Leukemia
• Leuprolide
• Levomepromazine
• Lung abscess
• Lymphocytic leukocytosis
• Lymphoma
• Malaria
• Menopause
• Mycobacterium avium complex infection
• Natalizumab
• Niacin
• Nitroglycerin
• Nocardiosis
• Oat cell carcinoma of the lung
• Obstructive sleep apnea
• Omeprazole
• Osteomyelitis
• Pegaspargase
• Pentamidine inhalation
• Perimenopause
• Pheochromocytoma
• Pneumocystis pneumonia
• Pneumonia
• Post-traumatic syringomyelia
• Pregnancy
• Premature ovarian failure
• Prinzmetal's angina
• Pyogenic abscess
• Relapsing fever
• Rituximab
• Sarcoidosis
• Sertraline
• Sildenafil
• Solid tumors
• Stroke
• Subacute endocarditis
• Substance abuse
• Sympathomimetic agents
• Systemic exertion intolerance disease 
• Systemic mastocytosis syndrome
• Takayasu's arteritis
• Tamoxifen
• Temporal arteritis
• Theophylline
• Thyrotoxicosis
• Tramadol
• Trenbolone
• Tricyclic antidepressants
• Triptans
• Tuberculosis
• Urinary tract infection
• Waldenstrom's macroglobulinemia

Diagnosis

History and Symptoms

• History:

• Medical history should focus on potential infectious and oncologic causes
• Social history should focus on substance abuse and travel

Physical Examination

• Full exam with focus on endocrine, dermatologic and lymphatic systems

Polysomnography

No specific features have been reported.

Echocardiogram

An echocardiogram can be obtained if there is a high suspicion of endocarditis

Laboratory Findings

The folowing laboratory studies may be of use in determining the underlying cause of nightsweats.

• CBC w/ differential
• Eosinophil count
• Urinalysis
• ESR

More sophisticated laboratory studies would include the following:

• FSH
• PPD
• HIV w/ viral load
• Blood cultures
• Monospot
• Test for nocturnal hypoglycemia
• Free T4
• 5-hydroxyindoleacetic acid
• Quinizarin powder, turns purple on contact with sweat, can help in localizing the area of excessive sweating.

MRI and CT

• Suggest MRI/CT if necessary (chest/abdomen/pelvis)

Diagnostic Criteria

A. The patient has has a complaint of excessive sweating during sleep.

B. Polysomnography with quinizarin powder dusted on affected areas is expected to demonstrate excessive sweating during sleep.

C. The primary complaint can be due to other medical disorders, such as febrile illness or diabetes insipid us.

D. Other sleep disorders (e.g., obstructive sleep apnea syndrome) may be present and can precipitate the disorder.

Minimal Criterion: A.

Severity Criteria:

• Mild: No bathing or change of clothing is required; the patient may have to turn the pillow or remove blankets.
• Moderate: Sleep is disturbed by the need to arise and wash the face or other affected body areas, but no clothing change is necessary.
• Severe: A bath or change of clothing is required.

Duration Criteria:

• Acute: 1 month or less.
• Subacute: More than 1 month but less than 6 months.
• Chronic: 6 months or longer.

Treatment

Treat the underlying etiology with appropriate therapy

Acute Pharmacotherapies

• Ibuprofen or acetaminophen
• Antimicrobial if infection is the cause

References

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