You wake up drenched…pajamas sopping wet, sheets clammy beneath you…and it’s not the first time. But the bedroom is relatively cool, and you aren’t dressed too warmly—in other words, all that heat is coming from you.  

Contrary to popular opinion, menopause isn’t the only cause of night sweats. But if you’re a man or a woman not affected by menopause, you may be scratching your head at the same time you’re mopping your brow. Why are you getting these nightly soakings?

Little-known culprits

Menopause is the main cause of chronic night sweats, but other health conditions and factors can be to blame for excessive sweating that occurs at night (and sometimes during the day). These include…  

• Medications. Various drugs, used long term or even for just a few days, are a lesser recognized cause of night sweats. These include anti-depressants…pain relievers including aspirin, acetaminophen (Tylenol) or opioids…niacin/vitamin B-3, often taken to help lower cholesterol…tamoxifen (Nolvadex) to reduce breast cancer risk…steroids…hydralazine (Apresoline) to lower blood pressure…nitroglycerin for angina pain…and erectile dysfunction drugs such as sildenafil (Viagra). 

• Thyroid problems. An overactive thyroid, in which the gland produces too much thyroid hormone (hyperthyroidism), can rev up metabolism, triggering night sweating. But para­doxically, night sweats also can stem from an underactive thyroid (hypothyroidism) or cancer (see next ­column) of the thyroid gland.

• Low testosterone. This one is a men’s issue. Drops in testosterone, dubbed “manopause,” prompt hot flashes and night sweats that are similar to those that plague menopausal women. Hormone treatment for prostate cancer also can be to blame.

• Other hormone problems. In addition to thyroid and sex hormone fluctuations, various hormone disorders might be at play. These include carcinoid syndrome, which results in the overproduction of chemicals, including serotonin, in the presence of a rare, slow-growing cancer that may occur in the lung or digestive tract…or a type of adrenal gland tumor that ramps up hormones called catecholamines

• Infections. If you’ve had the flu, you may have felt the wrath of night sweats on top of classic symptoms such as fever, cough and achiness. But many infections can soak your sheets, including urinary tract infections (UTIs)…abscesses in the skin, tonsils, gut or appendix…and less commonly, tuberculosis…HIV…and heart valve inflammation known as endocarditis.

• Low blood sugar. Among people with diabetes, those taking insulin or pills to help control blood sugar sometimes experience drops in blood sugar during sleep that trigger sweating.

• GERD. Gastroesophageal reflux disease (GERD), a common cause of heartburn, can trigger night sweats.

• Neurologic disorders. While an unusual trigger for night sweats, brain conditions such as Parkinson’s disease, stroke or autonomic neuropathy (a condition that damages nerves controlling involuntary body functions such as digestion) may be the culprit.

• Cancer. Night sweats are an early symptom of certain cancers—particularly lymphoma and leukemia. But in this less common scenario, other symptoms are usually also present, including fever and unexplained weight loss. Chemotherapy to treat certain cancers can cause night sweats as well.

• Food. Certain foods may provoke sweating at night. Spicy foods, caffeine and alcohol are among the most common triggers. However, these foods are more likely to cause hot flashes right after eating them than night sweats.

• Stress or anxiety. These largely overlooked triggers can greatly contribute to night sweats by promoting the release of additional epinephrine, the body’s “fight-or-flight” hormone.

• Excess body weight. People who are overweight or obese are more likely to suffer night sweats than those of normal weight—due, in part, to body fat acting as insulation that traps heat and raises the body’s core temperature.

Pinpointing the cause

Unless it’s a clear case of menopause, night sweats should never be dismissed. That’s because they’re a symptom of something else, so it’s crucial to see a doctor to get to the bottom of it.­ Important: If you’re a menopausal woman suffering from night sweats, work with your primary care doctor and gynecologist to ensure that the symptom is due to menopause and not one of the conditions described earlier.

To find the cause, your doctor should… 

• Take a thorough medical history, including a travel history, to determine if you visited a region where tuberculosis is prevalent. Other questions may include: What medications, vitamins or supplements are you taking? Were you ill recently? Are any other unexplained symptoms occurring? This step is key because it tells the doctor how aggressively to pursue additional testing.

• Perform a complete physical exam, checking weight and for signs of disease such as nodules on the thyroid or loss of muscle mass in a male, which might indicate low testosterone.

• Order blood tests to check hormone levels or rule out various infections or certain types of cancer.

• Perform other tests, such as a Mantoux tuberculin skin test for tuberculosis and, when appropriate, evaluate for certain cancers, such as leukemia, through blood work.

• Order imaging tests, such as X-rays or a CT or MRI scan, to rule out malignancies such as thyroid cancer.

• Review your medications. Because certain drugs, including those described earlier, can trigger night sweats, it’s important for your doctor to review all medications and supplements you’re taking. In some cases, a different drug can be prescribed.

Caveat:After exhausting every possible avenue to figure out why the waterworks turn on while you sleep, it’s possible that your doctor may find…nothing. In this case, night sweats are deemed a case of idiopathic hyperhidrosis, which means your body sweats too much at night for no identifiable medical reason. Important: If a cause is not determined and night sweats continue, be sure to report any new symptoms, such as weight loss and/or fever. 

How to get relief

If there’s an underlying medical cause, treating that condition should eliminate night sweats. But if that’s not the case, you’ll want to take the obvious steps to get some relief, such as using fans, dressing in easy-to-peel-off layers and lowering the temperature in your bedroom. Beyond that, try these additional strategies…

• Invest in newer high-tech bedding or nightwear. These products include quick-­drying or moisture-wicking sheets or pajamas and are available online. Note: A device called BedJet includes a fan that is installed beneath the bed to blow cool (or warm) air into the bedding. 

• Freeze an icy gel pack during the day…and place it under your pillow at bedtime. You can flip the pillow periodically during the night to sleep on the chilled side.

• Try stress-busting techniques, such as acupuncture, meditation, deep breathing and/or yoga. Smart idea: Do these close to bedtime, when it’s helpful to quiet down the nervous system prior to going to bed.

• Consider taking vitamins and other supplements believed to combat night sweats. These include B-complex vitamins, vitamin E, black cohosh, red clover and evening primrose oil. Important: Get your doctor’s advice on which supplement(s) would be most appropriate for you—some may interfere with medications you’re taking. 

• Decrease sugar in your diet. This advice is ideal for overall health, of course, but is believed to also reduce inflammation in the body, which may contribute to hot flashes and night sweats.

• Ask your doctor about medications to battle night sweats if all else fails. This may include off-label use of a low-dose antidepressant, such as paroxetine (Paxil)…or the blood pressure drug clonidine (Catapres).