Sleep hyperhidrosis

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.

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.

Genetics
Night sweats may occur for genetic reasons and may be relatively harmless. However, they can be distressing and disrupt sleep patterns if severe; the patient may be frequently awakened due to the discomfort of damp sleepwear.

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.

It should be noted that while some causes of night sweats maybe relatively harmless, others may not and can be a sign of a serious underlying disease.

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.

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’. 

True night sweats with medical causes should be properly investigated by a medical physician.

Complete differential diagnosis of causes of in alphabetical order
The condition may be considered a sign of various disease states, including:


 * Anxiety disorder
 * Benzodiazepine withdrawal
 * Brucellosis
 * Cancer
 * Cerebral palsy
 * Cerebral and brain stem strokes
 * Diabetes
 * Drugs e.g. Sertraline
 * Eosinophilic pneumonia
 * Epilepsy
 * Familial dysautonomia
 * Fungal infection
 * Gastroesophageal reflux disease
 * Head injury
 * HIV
 * Hodgkin's disease
 * Hyperthyroidism
 * Hypoglycaemia (Chromium deficiency)
 * Hypothalamic lesions
 * Leukemia
 * Lung abscess
 * Lymphoma
 * Menopause
 * Mononucleosis
 * Obstructive Sleep Apnea
 * Opiate withdrawal
 * Orchiectomy
 * Osteomyelitis
 * Pneumonia
 * Pregnancy
 * Prinzmetal's angina
 * Pulmonary histoplasmosis
 * Subacute endocarditis
 * Substance abuse
 * Takayasu's arteritis
 * Temporal arteritis
 * Tuberculosis
 * Chronic Fatigue Syndrome
 * Chronic eosinophilic pneumonia
 * Chronic fatigue syndrome
 * Endocrine tumors
 * Infectious mononucleosis
 * Premature ovarian failure
 * Solid tumors

History and Symptoms
Note: facial redness, pain and tachycardia
 * History:
 * medical
 * social

Physical Examination

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

Electrocardiogram

 * Suggest echo if necessary

Laboratory Findings

 * CBC w/ differential
 * BUN/Creatnine
 * Eosinophil count
 * Electrolytes
 * Calcium
 * Magnesium
 * TSH
 * Urinalysis
 * ESR
 * FSH
 * PPD
 * HIV w/ viral load
 * Blood cultures
 * Monospot
 * Nocturnal hypoglycemia
 * free T4
 * 5-hydroxyindoleacetic acid

MRI and CT

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

Treatment

 * Treat determined etiology with appropriate therapy
 * Cease substance abuse

Acute Pharmacotherapies

 * Ibuprofen or acetaminophen
 * Antimicrobial if infection is the cause