Night sweats: 7 causes and strategies to try

Nobody wants to wake up sweating in the middle of the night, but unfortunately night sweats are really common. One study found that 41% of primary care patients had at least one episode in the prior month.

I hear from lots of women struggling with night sweats in particular because hot flashes and sweating are textbook menopause symptoms. During perimenopause (the transition time before menopause), about 80% of women get hot flashes. This figure drops again in the postmenopausal period, but that’s still not exactly low!

Even with the perfect strategy, we’ll never eliminate hot flashes, hormonal fluctuations, and other physiological causes of night sweats. But we can identify certain triggers, and then resolve them directly or mitigate them by hydrating wisely. That’s what this article is all about: managing night sweats.

What Are Night Sweats?

The purpose of sweating is to help cool your body when it exceeds the thermoneutral zone. As your body temperature rises, a region in the brain called the hypothalamus triggers sweating to cool you down. Accordingly, some cases of night sweats are a simple case of overheating, which can easily be resolved by a colder room, fewer blankets, and mattresses or pillows that promote cooling.

But assuming you’ve tried those things, night sweats can be a frustrating paradox. Our body temperature tends to drop at night to promote restful sleep, so we should expect less sweating during this time. Nonetheless, people with persistent night sweats often wake up with damp sheets, pajamas, and pillows.

That means there must be something else at play. Specifically, it may indicate your cooling system isn’t working properly. So what causes that? Read on.

7 Potential Causes of Night Sweats

Thermoregulation involves the brain, hormones, circulatory system, sweat glands, and the environment. With so many factors at play, maintaining your body temperature can actually be quite complicated, so night sweats aren’t always easy to decode. Let’s examine what’s linked to night sweats for clues.

#1: Menopause

Leading up to menopause, many women experience rapid, transitory elevations in core body temperature. These hot flashes oftentimes happen at night and leave a wake of perspiration. 

My heart goes out to all the women experiencing insomnia and other sleep disturbances during this frustrating time. It’s hard to sleep well when you keep waking up hot and sweaty, and it’s hard to feel your best when you aren’t sleeping well.

But the challenges women face aren’t just limited to perimenopause—the menstrual cycle affects thermoregulation in other ways as well. For instance, during the luteal phase (immediately following ovulation), women have higher skin temperatures and more significant sweat loss. I’ll talk more about that later.

#2: Hormonal issues

Menopause isn’t the only set of hormonal shifts that influence sweating. Hyperthyroidism, for instance, can elevate metabolic rate, raise body temperature, and cause night sweats.

The endocrine system is the network of glands, organs, and hormones regulating many bodily functions, and any disruption to the endocrine system could potentially disrupt thermoregulation. This includes but is not limited to: Diabetes, testosterone and estrogen imbalances, pheochromocytoma (adrenal gland cancer), carcinoid syndrome (slow-spreading tumors that make hormones), and hypothalamic dysfunction.

#3: Medications

Many people may be able to trace their night sweats back to drugs, supplements, or alcohol. Drugs that list sweating as a side effect include:

• SSRIs (a type of antidepressant)
• Blood sugar medications like insulin
• Proton pump inhibitors (for acid reflux)
• Antibiotics
• Pain pills
• And others

One quick aside: Outside of medications, alcohol also elevates core body temperature and can cause or exacerbate night sweats.

#4: Hyperhidrosis

People with hyperhidrosis sweat excessively even when their body doesn’t need cooling. The condition—which often begins in childhood—can be difficult to cope with socially as well as physically. Primary hyperhidrosis (the type defined by an unknown cause) doesn’t usually occur at night, but secondary hyperhidrosis (caused by medications, stress, illness, etc.) definitely can.

#5: Infections

When fighting a pathogen, your core temperature rises. This fever helps fight the infection by enhancing immune cell function, and making it more challenging for viruses and bacteria to replicate.

Feverish sweating, in turn, can cause fluid and electrolyte imbalances. Because of this, it’s crucial to rehydrate with water and electrolytes (like sodium and potassium) when you’re ill.

#6: Low blood sugar

Sweating is a textbook symptom of hypoglycemia (low blood sugar). To avoid hypoglycemia, people with diabetes must be careful with insulin, metformin, and other blood sugar medications, especially if fasting therapeutically. Work with your doctor on this one.

#7: Other causes of night sweats

Figuring out what’s causing your night sweats isn’t always easy. Here are some other potential causes:

• Anxiety, stress, or panic attacks that trigger the sympathetic nervous system
• Chemotherapy, radiation, and other forms of cancer treatment
• Gatroesopogheal reflux disease (GERD)
• Hot flashes during and after pregnancy
• Heart failure
• Migraines
• Nausea

Lots of possibilities, I know. Your doctor will probably want to run some tests to see what’s happening. Even if you can’t pinpoint the cause of your night sweats, you can still improve your sleep environment, reduce stress, and hydrate properly. Let’s talk about those strategies now.

Night Sweats: Treatment Strategies

How can you prevent and mitigate night sweats? Try these simple steps.

Optimize your sleep environment

Humans sleep best in a cool room. A cool room promotes lower core body temperature for better sleep and less nocturnal sweating. Optimal temperature ranges will vary (I prefer the mid-60s), but colder is better than warmer because you can always add more covers. The goal is to be cool yet comfortable.

If you continue to struggle with temperature, perhaps with a partner who runs hot, you might look into a cooling mattress or mattress topper. These devices (Ooler, Eight sleep, etc.) aren’t cheap, but they do seem to help many people.

Reduce stress

Stress stimulates the sympathetic nervous system and increases sweating. To activate the parasympathetic (calming) nervous system, do what you can to de-stress before bed. Meditation, light stretching, and avoiding the email inbox are good practice, for starters. Also, controlled breathing was shown to significantly reduce hot flashes in postmenopausal women.

Think about medications

First, consider if any medication or supplement you’re taking might be causing your night sweats. It’s a common side effect. And if you’ve exhausted all of your other options, you may chat with your doctor about medications (like hormone therapies) to reduce night sweats or address their root cause of them. These medications have downsides, so talk to your doctor to weigh the pros and cons.

Staying Hydrated After Sweating

Every time you sweat, you lose water and sodium. You lose a smidge of potassium, magnesium, and other molecules too, but mostly you’re losing salty fluid.

From a young age, many of us have been brought up to love water and avoid salt. As a result, most people rehydrate with water alone, neglecting to replace sodium. And if you don’t replace what you lose, you risk dehydration, low sodium, and the less-than-fun symptoms that come with them: fatigue, brain fog, muscle cramps, weakness, and a lack of energy.

At the least, it’s worth trying out a well-formulated electrolyte drink like LMNT and paying attention to how you feel. LMNT has a science-backed ratio of sodium and potassium for optimal fluid balance, and magnesium which can help promote restful sleep.

Nights Sweats Happen

Most of us will wake up sweaty at some point. If these sweats happen frequently, work with a medical professional to ascertain the cause, then take the appropriate steps to address it.

Even if you can’t figure out exactly what’s causing the night sweats, be sure to rehydrate with fluids and electrolytes. Your body will thank you for it.