Night Sweats

Night sweats are not as disturbing for the patient as other forms but because undisturbed sleep is so important to our body, it can have a significant impact on our health – no on like to wake up to wet sheets, especially in the cold!

There are 2-4 million sweat glands that are used by our nervous system to cool off the body and keep it within a constant and acceptable temperature. When the sweating process exceeds its normal production, such as night sweats, we are dealing with the phenomenon called hyperhidrosis. The condition is acknowledged when the production of sweat by the axillary glands exceeds 100 mg in an interval of five minutes.

The hypothalamic preoptic sweat center is located in the brain and it sends commands through the brain stem and medulla to the innervations of the sweat glands. The nerves enter the spinal cord and synapse in the anterolateral cell column of the spinal cord. Neurons then exit the spinal cord and enter the sympathetic ganglia found in the chest and from there they supply the upper limbs. A hyperactive sympathetic nervous system is believed to be responsible for hyperhidrosis or excessive sweating. The deregulation of the sympathetic nervous system may occur when the individual is exposed to various distressful stimuli. Thermal stimuli may also trigger the negative effects of hyperhidrosis.

The most common areas of the body where emotionally triggered excessive sweating appears are the hands, the underarms and the feet. When, during sleep, emotional stimuli are reduced, hyperhidrosis may manifest itself through thermal sweating.

Symptoms of Night Sweats

• Damp and clammy bedding. You wake up to find your bedding soaked. You either feel too hot or clammily cold.

Night Sweats – Causes

• Menopause or Andropause. Menopause in women is the most common cause of night sweats. However, some men also suffer from night sweats during the male menopause, or andropause.
• HIV, tuberculosis. In fact, any infectious disease or condition that brings on a fever can cause night sweats.
• Diabetes. Diabetes can also cause night sweats.
• Sleep apnea. This is the one that most concerns us. Night sweats can also be a sign of sleep apnea. If you also suffer from severe snoring and excessive daytime sleepiness, it might be time for a study.
• Alcohol, some drugs, spicy foods. Consumption of any of these can cause night sweats. And by drugs, I’m not necessarily referring to street drugs. Some prescription drugs, like Zoloft, can also cause night sweats.

Treatment of Night Sweats

Various anticholinergic medications have success in treating excessive sweating. A treatment with Robinul starts at 1 or 2mg one to three times a day and has good effects on excessive manifestations of hyperhidrosis. Higher doses are usually needed to help sustain a favorable environment for a successful treatment.
Excessive Sweating Medications

The side effects that appear with an increase in dosage are to be considered. Hyperhidrosis medications, especially when used intensively, produce mouth dryness, also known as cotton mouth. Other patients suffer from side effects such as blurry vision, constipation or urinary retention. Reflex tachycardia and moderate memory impairment were also signaled with some patients undergoing medication treatment for hyperhidrosis.

Another medication used in the treatment of excessive sweating is Propranolol, a beta-blocker that has both sympathetic and generalized activity. It mostly targets stress induced hyperhidorsis and is successful in eliminating most of the negative effects of the condition. Side effects are considerable and include a slow heart rate and a low blood pressure. As a consequence of the two side effects mentioned before, the patients also accuse a continuous state of tiredness and apathy.

Anticholinergic medications such as Propentheline Bromide (Probanthine) and Oxybutynin (Ditropan) are also used in the treatment process. They are used orally and have been known to improve the excessive sweating process, reducing the sweat amount. Anticholinergic drugs are not suitable for targeted local use, as the skin does not absorb them properly.

Botox to Control Sweating

Botulinum toxin type A (BTX-A) is sometimes used to treat night sweating. It is injected into the skin and it acts as a temporary blockage for the sympathetic nerves that stimulate the excessive sweat production. This type of medication works well on local areas, where it is injected. When applied in 15 or 20 locations in the under arm area, Botox is usually effective; noticeable decreases in the sweat levels are observed after the injections. The downside of this treatment method is that it needs to be repeated every 3 or 4 months for facial treatment and up to 12 months for other areas.

The high cost of the Botox injections may prove to be a difficult obstacle to remove for a patient. The repeated usage of this treatment is expensive and the cure itself is temporary, not final. Another deterrent has been the pain that is associated to the Botox injections.

Before your receive treatments, you should first ask your doctor exactly what steps they take during the process. Most experienced doctors will apply topical numbing creams before the treatment which greatly reduces any pain. You should also look for doctors who perform a starch-iodine test to map out the sweat glands prior to treatment.

Don’t ask these questions directly, but rather look for them in the response to your questions. If during the consultation you don’t hear these or similar answers, then ask them directly and make your evaluation. Many patients suffering from Night Sweats have been very happy with the results of this treatment.

Apart from axillary hyperhidrosis, Botox is also used to treat facial sweating and palmar excessive sweating. Many patients, who wish to avoid the pain of receiving the injection, do not accept treating the face and hands with Botox injections. Temporary paralysis of the hand muscles was observed in some cases, but this is not a frequent side effect.

Just a Bad Dream?

Just because you wake up with wet sheets does not mean you have a problem, it could be as simple as a dream, stress at work or similar factors. If however, you wake up at night with bedding and nightclothes damp with sweat at least 4 of 7 days, then you should seek medical attention.

Palmar Hyperhidrosis

Palmar hyperhidrosis, also known as excessive sweating of the palm, represents one of the most wide spread affections from all the forms of excessive sweating. (Possible solution for this is shown in the video below!) This condition manifests itself by exaggerating the amount of sweat ones hands produce leaving one with moist and cold hands. There are several factors that trigger the heavy hand sweat, like nervousness and anxiety. Even though emotional distress is a known to be a big factor, sweaty palms often occurs without any outside stimulus.

The effects of sweaty palms are both physical and psychological. People affected by excessive hand sweating become very aware of this issue and feel discouraged when interacting in society. They try to hide their problem form others, thus increasing the emotional pressure they put themselves to. This often leads to emotional distress, which, as we have shown, triggers the problem to begin with. What makes matters worse is that affected people may not have any control of their sweating.

People suffering from this condition have a constant need to wipe their hands and usually notice a tingling sensation in their hands. They also have difficulties maintaining and developing social encounters as they become apprehensive about shaking hands.

Sweaty palms also impact intimate relationships and makes the individuals withdrawn. Just the simple task of putting on making can prove difficult, as can typing or handling paper documents.

Our society is based on many rules of conduct – a firm handshake, for example, signifies determination and inspires trust. People who suffer from excessive hand sweat may miss opportunities on a social and professional level. Other people they come in contact with may interpret cold sweaty hands as signs of insecurity and lack of self-confidence. This can prove disastrous during a job interview!

Much of our success in life depends on how other people perceive us and patients suffering with excessive hand sweating are always struggling with their condition.

Treatment is available in many forms and positive effects have been obtained by the use of prescription strength oral medication and antiperspirants. Severe cases of sweating can also be cured surgically but should only be considered as a last resort.

Facial Sweating

Hyperhidrosis can manifest itself in many forms, and excessive facial sweating is on of them. When this condition occurs it extends to more than just the face, also affecting the scalp and even the neck. When the scalp is affected by excessive sweating, the hair may look oily and dirty. Even though this condition is known as facial sweating, the negative effects are serious as far as the hair is concerned. Blow drying the hair may prove to be a difficult task.

The social problems this condition raises are similar to the ones of hand and foot excessive sweating. Facial hyperhidrosis appears in unexpected moments and doesn’t need to be triggered by factors like stress or emotional uncertainty or pressure.

The condition may manifest itself in the most embarrassing situations, while talking to people, or having a business lunch. With female patients this poses an even bigger obstacle, as they have a hard time putting on make up and maintaining it in good shape. Excessive sweating will dilate the skin pores and the result is that the makeup will run over their face, creating an unpleasant situation. Facial blushing is another condition that may appear in combination with the excessive facial sweating.

Medications are used successfully to cure facial hyperhidrosis. Robinul and Sympathectomy are the most successful in dealing with this condition, either separate or in combination with facial blushing.

Underarm Sweating

Axillary hyperhidrosis represents the excessive sweating of the underarms (sweaty underarms). This condition is usually accompanied by palmar hyperhidrosis or excessive hand sweating. Axillary hyperhidrosis may occur in the presence of stimuli like emotional distress and anxiety, but often it doesn’t have to be triggered by them. The sympathetic nerves that control the activity of the sweat glands produce an excessive amount of sweat and this leads to sweaty underarms.

The problems associated with excessive underarm sweating are more of a social connotation. This condition cannot be controlled by the patient. The involuntary occurrence of sweaty armpits poses a threat to the person’s social status and activity. Although the negative effects of excessive underarm sweating are not as important, they are still disturbing, and, in combination with other forms of hyperhidrosis, can destroy the balance of a person’s social life.

The treatment of excessive underarm sweating turns, at first, to medical deodorants, which can prove to be very effective. When the condition is more severe, the surgical resection of the sweat glands can be performed. Sympathectomy can also prove to be effective in treating axillary hyperhidrosis.

Foot Sweating

Excessive foot sweating, also known as pedal hyperhidrosis, usually appears in a combination with excessive hand sweat. Patients suffering from this condition may also experience problems with armpit and/or face. This condition (with the feet) is is not very common and although pedal hyperhidrosis is not as obvious and emotional upsetting as hand sweat, it can still be a problem.

Foot Sweating and Odor

The odor associated with heavy foot sweating represents one of the major issues of this condition. This can prove to be an obstacle in many social situations. The patients’ anxiety levels are high whenever they have to take of their shoes in a social environment, as they fear that the odor triggered by heavy sweating will become obvious to the others. People suffering from pedal hyperhidrosis also accuse feeling their feet wet and cold most of the time. This creates and uncomfortable feeling where they feel like they are slipping in their own shoes.

Other problems refer to the difficulties in getting pedicures. Foot infections are also more frequent, as the constant humidity favors the growth of germs and bacteria. Athletes foot is also observed with many patients of pedal hyperhidrosis.

The most commonly used medication for foot sweating includes antiperspirants and a variety of medications. These can produce good result when combined with iontophoresis. Even though it is rare, solitary pedal hyperhidrosis responds well to a treatment of sympathectomy.

Hot Flashes

Hot flashes are not only caused by low estrogens of menopause or perimenopause, they may also be caused by non disease or condition reasons such as anti-cancer drugs. Tamozifen and osteoporosis prevention drugs such as raloxifene which act as anti-estrogens can also promote hot flashes and night sweats. If you’re experiencing Hyperhidrosis (excessive sweating) or hot flashes more then a few times in a seven day period, it’s a good idea to take measures to lessen them.

Men undergoing prostate cancer treatment by way of anti-testosterone therapy, thermal blankets or other measures can experience menopause like symptoms, commonly referred to as male menopause (male hot flashes).

Estrogen and testosterone are believed to help protect the body against night sweats and hot flashes. When these hormones are no longer provided, the body may have a tendency to dilate blood vessels randomly which causes rapid increases in skin temperature -leading to excessive sweating.

Hot Flash – What is it?

Commonly referred to as blushing (facial blushing for example), a hot flash is the sudden feeling of warmth and a sudden increase in upper body excessive sweating. An intense feeling of heat, especially in the face and neck area, is experienced accompanied with redness.

These hot flashes are commonly mistaken for mild fevers such as those found with a urinary tract infection and sometimes with tuberculosis or cancer. The way you can tell a ‘hot flash’ or ‘night sweat’ is by the fact they come and go lasting only for a few minutes or even seconds.

There is not a definitive answer for the cause of ‘hot flashes’ which is often attributed to ‘male menopause’ or menopause in general, but it is known that our brain regulates our body temperature; if it senses the body temperature rising, the brain will release chemicals to help dilate the blood vessels to help remove the increased heat. The presence of estrogens estrogens and testosterone permit the body to tolerate greater changes in your core body temperature. For example, your body may normally tolerate a change in body temp of say 2 degrees before reacting. Without the estrogens, your body may start reacting at .5 degrees creating a hot flash, hyperhydrosis (excessive sweating), night sweats and more.

Woman who are menopausal, male menopause and others suffering from night sweats commonly forget one of the best kept secrets to reducing night sweating – Temperature! In fact, studies show that a woman in menopause can eliminate between 40 and 55 % of the night sweats by simply lowering the temperature by a few degrees. Other studies point out that because heat escapes from the head and foot region, simply wearing sandals may dramatically reduce the number of day sweats or hot flashes.

Eating the right types of food can also help reduce hot flashes. Most people are aware that hot peppers can contribute to excessive sweating, but did you know that many of the additives in food, not hot at all, can contribute to hot flashes? Health foods can not only help deal with the hot flash, but have profound impacts on all functions of the body.

Hot Flashes causes other than menopausal

Many systemic, but rare conditions can also produce flushing such as carcinoid syndrome, systemic mast cell disease, pheochromocytoma, medullary carcinoma of the thyroid, pancreatic islet-cell tumors, renal cell carcinoma and hyperthyroidism. These conditions are thought to inject chemicals into the blood stream that can agitate nerves and blood vessels within the brain. Make your doctor aware of any symptoms other than hot flashes including rapid or irregular heart rate and blood pressure.

Stress is by far the most common cause of hot flashes causing epinephrine and norepinephrine to be released into the blood stream. The body reacts by increasing blood flow and heat. The hot flash is the body’s way of expelling the excess heat.

Night sweats are commonly mistaken for male menopause when in fact it’s simply the days event triggering sweating at night. Female or male, stressful events that occurred during the day will be processed by the brain at night. Too much stress and the brain will actually start the process of hyperhydrosis during deep REM sleep

Stop Hot Flashes or Night Sweats without Hormonal treatment

If you experience a hot flash and it’s been less then a month, you may want to consider waiting to make sure it’s not a short term problem. They are necessary harmful and at that frequency, they do not usually represent a disease process. For the more frequent hot flash, you may want to try the following:

For daytime hot flashes:

* Try to avoid contributing factors such as strong emotions, caffeine, alcohol, cayenne, heavy clothing, etc.
* Use fans during the day.
* Wear natural material such as cotton.
* Practice deep, slow breathing techniques in the morning and evening, and use this technique when you feel a ‘hot flash’ about to happen.
* Exercise, walk, swim ride your bike every day for at least 30 minutes

If hot flashes and male menopause is still an issue after using these techniques, you should see your doctor for other treatments.

Erythrophobia

Erythrophobia is an unusual and persistent fear of facial blushing or blushing in general. Blushing displays a marked redness of one’s face; the term is seldom applied except when the redness is construed as a result of embarrassment, shame, or modesty. If redness persists for abnormal amounts of time after blushing then it is considered an early sign of rosacea.

Those suffering usually experience anxiety even though they realize that such a fear is irrational. The problem or anxiety stems from worrying about being the focus of attention which may lead to embarrassment. Many who try to hide blushing usually end up making the condition even worse.

People suffering from blushing usually try to avoid social gatherings, public speaking engagements, and other situations that may lead to a large gathering of people. Unfortunately, this can prevent the person from maximizing their full potential or possibly prevent them from moving up the ranks within their organization.

“Erythrophobia” also can refer to fear of the color red because of what it may symbolize, such as blood. The terms “redcoat” (British soldier in the American Revolution) and “red” (synonym for “communist”) gave Americans valid reasons to fear red. Other terms with “red” that have a negative connotation include “redeye” (an overnight air flight), “caught red-handed” (caught with evidence of guilt) “red-herring” (a deceptive tactic), “red ink” (a financial loss) and “seeing red” (angry).

“Erythrophobia” is derived from the Greek “erythros” (red) and “phobos” (fear). “Erythros” also gives us the English words “erythema” (inflammation of the skin that causes reddening) and “erythrocyte” (a red blood cell).

There is a cure for facial blushing, well, it may be a cure for many – Public Speaking. (What! You have to be kidding!) Actually, there is probably a ToastMasters organization close to you which acts as a support group for those that want to overcome this problem. They are a group of people just like you who want to improve their ability to speak in front of others and it’s a way for you to work on the issue on your own time!

Sympathetic Nervous System

The Autonomic nervous system is made up of the sympathetic system and the parasympathetic system. Think of these systems working together and maintaining a balance that impacts every part of your body! Heart frequency, heart capacity, lumbar function, kidneys, blood vessels, stomach and intestines are just a few examples.

The sympathetic nervous system pushes where the parasympathetic function is more relaxed. The sympathetic chain nervous connects to skin, blood vessels and organs in the body cavity and is located on both sides of the spine which consists of ganglias.
Autonomic Nervous System

The autonomic nervous system most notably kicks in gear during emergency situations that cause stress and requires us to “fight” or take “flight”, as well as non-emergency situations that allow us to “rest” and “digest”. The autonomic nervous system also provides maintenance of normal internal functions and works with the somatic nervous system. When the body reacts to signals such as danger, it is the sympathetic ganglia that performs functions such as widening the lungs for more oxygen, reduces desire to consume food, sends blood to the brain and increases heart rate.
Nervous System

Above is a common picture of the sympathetic nervous system and inner connections. You can see that how complicated the sympathetic chain is and how difficult Endoscopic Thoracic Sympathicothomy is! This is not a matter to be taken lightly!

Hyperhydrosis Treatment

Hyperhydrosis is something better known as excessive sweating and is a common problem. Sweating is controlled by a portion of our nervous system in the pores of our skin and in approximately 1% of the population there is an excessive control and excessive sweating, Hyperhydrosis, occurs. The locations of Hyperhydrosis include the feet, hands, armpits, main body trunk and the face.

The primary occurrence of Hyperhydrosis starts in childhood or adolescence and continues throughout life. There has been discussion that psychiatric conditions can promote the occurrence of Hyperhydrosis but this is very rare and it is more probable that it is the condition that causes the conditions to be induced in the person. Causes of Hyperhydrosis can include Hyperthyroidism or as part of similar endocrine diseases, Endocrine treatment for prostatic cancer or other types of malignant disease, severe psychiatric disorders, Obesity and Menopause. This is known as secondary Hyperhydrosis.

Many individuals suffer from Hyperhydrosis in many areas of the body. Sweating can appear suddenly or manifest itself more continuously and can be elicited by high outside temperatures or emotional stress, or appears without any obvious reason. Generally, it worsens during the warm season and gets better during winter similar to common sweating amongst people. Arguably the most embarrassing location for Hyperhydrosis is in the palms of the hands which are also very socially disturbing. However problems such has halos of salt in the cloth recently in the armpit region is also extremely embarrassing. Hyperhydrosis in the face can be the most aggravating of the areas subject to Hyperhydrosis as citizens may judge the person to be of a nervous or unstable condition.

Treatment of Hyperhydrosis is varied. The most obvious is the use of antiperspirants which are a common solution to excessive sweat amongst people without the condition of Hyperhydrosis. Iontophoresis can be tried if antiperspirants have not lead to the desired result. This method consists in applying an electric current to the palms or soles immersed in an electrolyte solution. The procedure has to be repeated regularly with several sessions a week then decreasing as treatment continues to one session every 1 or 2 weeks. There are no specific drugs that could be used for the condition of Hyperhydrosis but psychotropic drugs have showed to decrease the effects of Hyperhydrosis. However, this usually takes a long time to occur and the side affects are extensive and occur far before any results can be seen.

Psychological help can only help the person to the live with the condition and merely to aid those who are troubled by the condition. Alternative medicine has almost no effect from experiences such as acupuncture or massages. The use of botulinum however has shown some significant progression in combating the condition of Hyperhydrosis. Initial reports have been published regarding the use of botulinum toxin in Hyperhydrosis. Some drawbacks are the costs of this treatment which has to be repeated at regular intervals and the side-effects but these appear to be negligible.

Hyperhydrosis is a common misspelling for hyperhidrosis

ETS – Endoscopic Thoracic Sympathectomy

Excessive sweating occurs when the sympathetic nerves become over active. These nerves can be interrupted in several ways by surgery and the procedure bears the name of endoscopic thoracic sympathectomy or ETS. The 12 segments of the sympathetic nerves that are found in the thoracic cavity play a key role in the operation and their name indicatives range from T1 to T12. Different forms of hyperhidrosis are assigned specific T indicators (facial sweating may be a T2 or T3, for example).

The ETS operation itself is performed through some small incisions located in the underarm area while the patient is under general anesthesia. The risks involved by this procedure are low and the beneficial results are usually satisfactory. There are three main methods of performing ETS sympathectomy, each with its own advantages and disadvantages:
Sympathectomy by clamping or clipping ETS (ETS -C / ESB)

This method does not involve the cutting of the sympathetic nerves. Instead, the surgeon interrupts their activity by applying a titanium clamp to the nerve, thus stopping their activity. The clamp exerts pressure on the nerve and the signals the nerve produces don’t reach the sympathetic nerve endings. This is method that has a positive effect in the sense that the sympathetic ganglia are not destroyed. This leaves the patient with the possibility of having the nerves reconstructed in the future by simply removing the titanium clamp.

Various forms of excessive sweating can be removed with this method. Selected segments of the sympathetic nerves are cut during this procedure. This leaves very little chances of a successful reconstruction of the nerves in the future.

The sympathetic nerves are surgically cut with electrocautery or surgical scissors. The difficult reconstruction of the nerves represents this method’s negative effect. ETS Insurance facts.

The variation of the levels of classification for ETS depends on the type of hyperhidrosis that the patient presents:
Facial Blushing is T2
Facial Sweating is T2 or T3
Hand Sweating is T3 or T4
Underarm Sweating is T4 or T5

Side Effects of Sympathectomy Surgery

Compensatory sweating is unpredictable and cannot be precisely identified before surgery. The intensity of this side effect varies from patient to patient. Many sympathectomy patients only experience very little moisture and sweating and hot weather seems to favor this phenomenon.

In spite of sympathectomy surgery side effects, most patients agree that they would rather experience compensatory sweating than the condition they had before surgery. Patients are willing to trade a more severe hyperhidrosis or extensive facial blushing for the effects of compensatory sweating. The number of patients experiencing aggravated forms of this side effect is low. In the cases where compensatory sweating is exceeding the expected levels, the titanium clamp may be removed. This reverses the surgery and the side effect diminishes in time. However, this operation must take place soon after the surgery, as after a few months the chances of reversing the operation are very low.

When the denervation area affected by the surgical procedure of sympathectomy is extended, the side effect of compensatory sweating also increase in intensity. The initial methods of performing sympathectomy implied that a large segment of the sympathetic nerves was cut. The side effects were also high, in accordance with the extent of the surgery. Modern methods greatly reduce the levels of compensatory sweating. The identification of specific hyperhidrosis conditions is now more accurate. By targeting the exact section of the sympathetic nerves, the surgeon doesn’t allow compensatory sweating to aggravate.

Successful treatment of compensatory sweating can also be achieved by the use of medication. Robinul and Ditropan are used to treat the side effect with good results. Several other side effects related to the sympathectomy surgery were observed with patients. Nerve damage is a possible risk, while bleeding and infection may also occur. Patients have also experienced post surgery rib pain and dryness of the hands or face. A decrease in the heart rate was also signaled by some patients. Other rare complications of sympathectomy include damage to the lungs and Horner’s syndrome. These are very rare complications as the new surgery methods have greatly improved over the years.

ETS Insurance Coverage

Some insurance companies consider treatment of intractable, disabling primary hyperhidrosis (excessive sweating) with Botox (botulinum toxin type A) or iontophoresis (electrophoresis, Drionic device) medically necessary when all of the following criteria are met:

* Topical aluminum chloride or other extra-strength antiperspirants are ineffective or result in a severe rash; and
* Member is unresponsive or unable to tolerate pharmacotherapy prescribed for excessive sweating (e.g., anti-cholinergics, beta-blockers, or benzodiazapines); and
* Significant disruption of professional and/or social life has occurred because of excessive sweating.

Insurance Coverage Beyond Botox and Iontophoresis

Insurance companies may consider the following surgical treatments for hyperhidrosis medically necessary for members who meet the above-listed criteria and have failed to adequately respond to treatment with Botox and Iontophoresis:

* Open thoracic sympathectomy
* Video-assisted endoscopic thoracic ganglionectomy (ETG)
* Endoscopic sympathetic ablation by electrocautery
* Chemical thoracic sympathectomy
* Thoracoscopic sympathectomy
* Endoscopic thoracic sympathectomy (ETS)
* Video-assisted thoracic sympathectomy (VATS)
* Excision of axillary sweat glands.
* Lumbar sympathectomy
* Tumenescent liposuction for axillary hyperhidrosis

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