Night sweats and headaches

Night Sweats and Headaches: Possible Hypoglycemia?

Hypoglycemia, or extremely low blood glucose, is one of the primary dangers facing diabetics. The risks posed by hypoglycemia may be especially worrisome if the condition occurs during sleep, when the diabetic patient is incapable of monitoring and immediately responding to a significant drop in blood glucose levels. This is why it’s important not only to take steps to prevent nighttime hypoglycemia, but understand and recognize symptoms and warning signs of the condition.
One of the earliest indicators that a diabetic may be experiencing hypoglycemia in sleep is chronic night sweats, as well as waking up with painful headaches. For those whose night sweats and morning headaches do not self-resolve within a few days, it may be wise to try a quick test.
Set your alarm for the middle of the night – say 2 a.m. for a person who’s in bed by 11 p.m. Test your glucose levels and record the measurement, go back to sleep and test again immediately upon waking in the morning. If you begin to notice abnormal nighttime fluctuations during this exercise, it may be wise to consult your health care provider.
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Common Causes of Secondary Hyperhidrosis

Many medications can cause secondary hyperhidrosis, but so can a host of medical conditions, from anxiety to rheumatoid arthritis. So, it’s important to see a dermatologist who understands the problem and all its causes, says Kelley Redbord, MD, FAAD, associate clinical professor at George Washington University in Washington, D.C.

“We’ll ask patients questions about medical history, and a list of medications and supplements. These can be over the counter, prescription, and herbal,” Redbord says. Even simple substances such as iron supplements may cause secondary hyperhidrosis. If your primary care doctor isn’t familiar with hyperhidrosis, Redbord recommends seeing a medical professional who is knowledgeable about it. “You want to see someone knowledgeable about hyperhidrosis. If you go to primary care doctor, they might not be familiar with it,” she says.

  • Drugs more likely to cause excessive sweating include tricyclic antidepressants, desipramine, nortriptyline, protriptyline, and pilocarpine, a drug that increases the amount of saliva in the mouth, and zinc supplements. As many as 50% of people who take those medications may have some excessive sweating, according to the International Hyperhidrosis Society. But dozens of other medications can trigger heavy sweating in small groups of people who take them.
  • Medical conditions linked to secondary hyperhidrosis include anxiety, an infection such as tuberculosis, alcoholism, diabetes, gout, heart failure, hyperthyroidism, lymphoma, menopause, obesity, Parkinson’s disease, pregnancy, nerve injury, and rheumatoid arthritis.

Less-breathable fabrics (like your flannel pajamas) can also contribute to your sweaty sleep woes, which makes breathable cotton a better option for both your PJs and sheets.

Feeling hot can also impede your ability to actually fall asleep—in the process of drifting off, your body temperature should drop one to two degrees below normal, and it can’t do that in a warm room.

2. You have an excessive sweating disorder.

Yes, that’s a thing—it’s called hyperhidrosis—and, according to the American Academy of Dermatology (AAD), it essentially happens when a person sweats more than necessary (yes, even while they’re sleeping).

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One big difference between hyperhidrosis and run-of-the-mill sweating: Hyperhidrosis only affects specific body parts, per the AAD, specifically your palms, feet, underarms, and head. Keep in mind though, this is excessive sweating—the AAD says hyperhidrosis can interfere with daily activities (like opening doorknobs or using computers) in those who have it.

If you think you have hyperhidrosis, talk to your dermatologist—they can prescribe specific deodorants or other methods of treatment like Botox injections to block sweat glands, per the AAD.

3. You’re actually running from something in your nightmares.

This is probably the simplest explanation for those sweats: “If the sweating is chronic…sometimes it can be that the patient is totally healthy and is actually running in a dream, or frightful in a dream,” says Harry Banshick, M.D. “The sweat is the consequence of acting out the dream.”

Shah agrees, saying that anything that causes what’s called a sympathetic surge (also known as a fight-or-flight response) can lead to sweating. If you’re having ongoing, persistent nightmares, see your doctor to find out what might be causing it (stress is a big culprit).

4. Your body’s going through hormonal changes.

One of the most common causes of night sweats for women is fluctuating estrogen levels, Nandi says. “Menopause is associated with hot flashes, so it’s not uncommon for patients to report sweating even during their sleep,” Shah says.

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If you’re pregnant or on your period, those hormone fluctuations could lead to night sweats, too. However, menopause tends to cause to the most persistent sweats, and if it’s truly affecting your quality of life or sleep, Shah says it’s worth talking to your doctor about. “Sweating from menopause is unpredictable, but if you talk to your ob-gyn about hormone replacement therapy, it could help keep your temperatures under control.”

5. You’re taking antidepressants.

Patients taking antidepressants can definitely see an uptick in night sweats, Shah says, as certain classes of medications can cause an adrenergic reaction, which has to do with your adrenaline levels and leads to sweating. If you’re taking venlafaxine (or the brand-name Effexor) or bupropion (or its brand-named Wellbutrin, Zyban, or Aplenzin), you may experience more night sweats, Shah says.

But there’s good news if you don’t want to switch your antidepressant, as Shah says there are drugs docs can prescribe to calm down the adrenergic output, which won’t counteract your mental-health needs.

6. Your body’s fighting off an infection.

“Infections in general are related with changes in temperature because they come with fevers that will break, and that is obviously a common reason to sweat,” Shah says.

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One rare infection that’s commonly associated with night sweats: tuberculosis, which can infect any part of your body but is well-known for its effect on your lungs. People with an immunocompromised condition, like HIV, can develop tuberculosis more easily, Shah says. You might start sweating in your sleep before you even start coughing or realize something is wrong, Shah says, so see a doc stat if the symptoms persist.

7. You have undiagnosed lymphoma.

Lymphoma—a cancer of part of the immune system, according to the U.S. National Library of Medicine (NLM)—can cause multiple symptoms like fever, changes in weight loss, and, yes, night sweats, says Shah. Essentially, your body recognizes lymphoma as something it needs to fight off, and raises its temperature to try to do so, she adds.

While these “soaking sweats,” per the NLM, happen at night, heavy sweating might occur during the day for this, too, so get to your M.D. if you’re experiencing any other symptoms and they can test you for the condition, says Shah.

Emily Shiffer Emily Shiffer is a former digital web producer for Men’s Health and Prevention, and is currently a freelancer writer specializing in health, weight loss, and fitness.

Night Sweats: Should You Be Concerned?

Sometimes, night sweats may be a symptom of something a bit more serious.

Sleep apnea

Sleep apnea is a condition that causes you to stop breathing while asleep, usually multiple times in a night.

Obstructive sleep apnea generally occurs when something like throat tissue blocks your airway. You can also develop central sleep apnea when certain health conditions affect the function in your central nervous system.

It’s not unusual to have night sweats with sleep apnea. In fact, results of a 2013 study looking at 822 people with untreated obstructive sleep apnea suggest that excessive sweating at night happens three times as often in people with untreated sleep apnea.

If you have sleep apnea, you might also:

  • feel tired during the day
  • wake often in the night or sleep restlessly
  • wake up struggling to breathe
  • have difficulty focusing during the day
  • have headaches
  • wake up with a sore throat
  • have symptoms of anxiety or depression

Sleep apnea can have serious complications if it goes untreated, such as increased risk for asthma and cardiovascular issues.

It’s a good idea to see your healthcare provider for night sweats that happen with other symptoms of sleep apnea.

Cancer

It’s possible for unexplained night sweats to be a symptom of cancer, but this doesn’t happen often. If you do have cancer, you’ll most likely have other noticeable symptoms, too.

These symptoms may seem to resemble other, less-serious health issues, like the flu.

It’s a good idea to see your healthcare provider if you have night sweats and feel fatigued or generally unwell for more than 2 weeks.

It’s particularly recommended to see a doctor if you have a fever that doesn’t go away and you’ve recently lost weight without trying, as these can be early signs of cancer.

Types of cancer most often linked to night sweating include Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, and leukemia.

These cancers also usually involve the following symptoms:

  • persistent fatigue and body weakness
  • fever
  • chills
  • unintentional weight loss
  • swollen lymph nodes
  • chest and stomach pain
  • bone pain

Serious infections

Some serious infections can also cause night sweats, including:

  • tuberculosis, a highly contagious infection that usually affects your lungs
  • endocarditis, an infection in the valves of your heart
  • osteomyelitis, an infection in your bones
  • brucellosis, an infection you can get from animals with brucellosis or unpasteurized products from infected animals
  • HIV
  • certain tick-borne diseases

But as with cancer, infections also tend to cause other noticeable symptoms as well. These include:

  • chills and fever
  • aching muscles and joints
  • body pain
  • general weakness or fatigue
  • weight loss
  • lack of appetite

If the above symptoms last for more than a few days or suddenly get worse, call your healthcare provider right away. It’s also a good idea to seek medical care if your fever rises abruptly or won’t go down.

Neurological disorders

In rare cases, night sweats can occur as a symptom of certain neurological issues, including:

  • stroke
  • autonomic dysreflexia
  • autonomic neuropathy
  • syringomyelia

Neurological issues can involve many symptoms, but some common early indicators might include:

  • appetite loss or other GI or urinary symptoms
  • losing consciousness
  • feeling dizzy or lightheaded
  • trembling
  • muscular weakness
  • numbness and tingling in your arms, hands, legs, and feet

PMC

Discussion

Paragangliomas are rare neuroendocrine tumours, arising from the paraganglionic system composed of neural crest cells. Tumours that arise from the neuroendocrine cells of the adrenal medulla (80%) are referred to as pheochromocytomas, those that are found in an extra-adrenal location (20%) are called paragangliomas.1 Their prevalence has been estimated between 1:6500 and 1:2500.2

Paragangliomas mainly affect adults in their fourth or fifth decade of life. There is no sex predilection. They may occur isolated or as part of a hereditary syndrome. Up to 30% of patients with a paraganglioma have disease-causing genetic mutations, inherited in an autosomal dominant manner.3,4Up to now, 14 different genes have been reported, with different genotype- phenotype presentation and risk of malignancy and recurrence. These familial tumours can also be associated with multiple endocrine neoplasia syndrome and neuroectodermal syndromes; for example., tuberous sclerosis, Type 1 neurofibromatosis and von Hippel-Lindau disease.5

The majority of extra-adrenal tumours are seen in specific locations in the neck, chest and abdomen.5 A typical location is in the organs of Zuckerkandl, a collection of paraganglia located at the bifurcation of the aorta or at the origin of the inferior mesenteric artery. Forty percent produce high levels of catecholamines, which results in symptoms such as headache, palpitations, excessive sweating and hypertension.1 Approximately 10% of the paraganglioma are clinically silent, presenting as an incidental finding.5

When there is clinical suspicion for a catecholamine-secreting tumour by physical examination and clinical history, gathering biochemical evidence is recommended. Plasma free metanephrines or 24 hr urinary fractionated metanephrines and catecholamines are measured for the evaluation of catecholamine hypersecretion.

Either CT or MRI is recommended for initial tumour localization. Contrast CT is the primary imaging modality, given its excellent spatial resolution and good sensitivity (88–100%), but as with MRI, it lacks specificity (70–80%).3 MRI could be a better option in patients with metastatic disease, or when radiation exposure must be limited.

On contrast-enhanced CT scans, a paraganglioma appears as a large well-defined soft-tissue tumour with intense contrast enhancement due to their hypervascular nature. Areas of necrosis may be seen in the tumour, as well as punctate calcifications or focal areas of high attenuation caused by acute haemorrhage. The key to diagnosis is the location of the mass; when a hypervascular mass at the bifurcation of the aorta is found, the possibility of a paraganglioma should always be considered.5

On T1 weighted MR images, these tumours are usually hypointense or isointense compared to liver parenchyma. On spin-echo sequences, signal voids can be seen, resulting in the characteristic “salt and pepper” pattern. On T2 weighted images, a paraganglioma presents as a markedly hyperintense mass, but the tumour often displays complex and heterogeneous signal intensity due to haemorrhage.1

Only the presence of distant metastases allows differentiation of malignant from benign paragangliomas on imaging. Patients with large size of tumours, extra-adrenal or recurrent disease have an increased risk for distant metastasis. For detection and follow-up, nuclear medicine is indicated.

Progress in PET imaging allows for reliable early detection of metastatic disease, with a sensitivity of 74–100%.3,4 Most paragangliomas show uptake of 18F-FDG in PET imaging and even benign tumours can be highly 18F-FDG-avid.6 Aggressiveness and dedifferentiation alone do not explain the high 18F-FDG uptake, this in contrast to other neuroendocrine tumours, for example. thyroid cancers and endocrine pancreatic tumours. Specific genetic defects, tumour localization and malignant potential may all play a role in the degree of 18F-FDG uptake. However, the exact mechanism for the molecular changes is yet to be determined.

Paragangliomas express somatostatin receptors, enabling imaging with somatostatin receptor PET-tracers such as the 68Ga-DOTA-coupled peptides DOTATATE, DOTANOC and DOTATOC. Especially 68Ga DOTATATE PET-CT has been shown to have a higher sensitivity and uptake intensity compared to all other imaging modalities, and is a suitable first line investigation when a paraganglioma is suspected.7

Microscopically, all paragangliomas have a similar morphological appearance. They are highly vascularised and the cells that produce catecholamines are intimately related to the capillaries. In the presented case, the cells were highly immunoreactive for the neuroendocrine markers CD56, synaptophysis and neuro specific enolase (NSE).

Paragangliomas are more aggressive tumours compared to their adrenal counterparts, with 22–50% versus 2–10% developing metastases.1 In up to 10% of patients, metastases are already present at the time of diagnosis.4 Dissemination occurs via both the lymphatic and haematogenous routes, with the most common sites of metastasis being the regional lymph nodes, bone, liver and lung.8 The overall 5-year survival rate is 35–60% when metastases are present, with limited treatment options.4

Treatment involves surgical excision to reduce the symptoms of excess catecholamine. The decision for laparoscopic or open resection depends on the tumour size and location, as well as on the surgeon’s preference and expertise. Before surgery, patients with a hormonally functional tumour should undergo preoperative blockade to prevent perioperative cardiovascular complications, with α-adrenergic receptor blockers as the first choice.3 This emphasizes the role of the radiologist in the preoperative diagnosis, in order to notify the treating physician.

Molecular genetic testing should be considered in all patients with a paraganglioma. Based on the results, decisional algorithms are available for imaging follow-up.3 Patients require long-term periodic clinical and imaging follow-up, because metastatic disease or recurrence can appear even after decades free of disease.4

Symptoms and Signs of How to Stop Night Sweats in Men and Women

To determine what is causing night sweats in a particular individual, a doctor must obtain a detailed medical history and often order tests to decide if an underlying medical condition is responsible for the night sweats. Depending upon the cause of the night sweats and an individual’s medical history, tests may include blood tests, imaging studies (such as X-rays or CT scans), and further specialized tests.

Night sweating can arise from harmless situations or serious disease. If your bedroom is unusually hot or you are using too many bedclothes, you may begin to sweat during sleep – and this is normal. In order to distinguish night sweats that arise from medical causes from those that occur because one’s surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, and that are not related to an overheated environment. It is important to note that flushing (a warmth and redness of the face or trunk) may also be hard to distinguish from true night sweats.

There are many different causes of night sweats. Some of the known conditions that can cause night sweats include:

Cancer: Night sweats are an early symptom of some cancers. The most common type of cancer associated with night sweats is lymphoma. Leukemia also may cause night sweats. However, people who have an undiagnosed cancer frequently have other symptoms as well, such as unexplained weight loss and fevers.

Hypoglycemia: Sometimes low blood sugar can cause sweating. People who are taking insulin or oral anti-diabetic medications may experience hypoglycemia at night that is accompanied by sweating.

Hormone disorders: Sweating or flushing can be seen with several hormone disorders, including pheochromocytoma, carcinoid syndrome, and hyperthyroidism.

Neurologic conditions: Uncommonly, neurologic conditions including autonomic dysreflexia, post-traumatic syringomyelia, stroke, and autonomic neuropathy may cause increased sweating and possibly lead to night sweats.

Idiopathic hyperhidrosis: Idiopathic hyperhidrosis is a condition in which the body chronically produces too much sweat without any identifiable medical cause.

Infections: Classically, tuberculosis is the infection most notoriously associated with night sweats. However, bacterial infections, such as those that cause endocarditis (inflammation of the heart valves), osteomyelitis (inflammation within the bones), and abscesses all may result in night sweats. Night sweats are also a symptom of HIV/AIDS.

Night sweating can arise from harmless situations or serious disease. If your bedroom is unusually hot or you are using too many bedclothes, you may begin to sweat during sleep – and this is normal. In order to distinguish night sweats that arise from medical causes from those that occur because one’s surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, and that are not related to an overheated environment. It is important to note that flushing (a warmth and redness of the face or trunk) may also be hard to distinguish from true night sweats.

There are many different causes of night sweats. Some of the known conditions that can cause night sweats include:

Cancer: Night sweats are an early symptom of some cancers. The most common type of cancer associated with night sweats is lymphoma. Leukemia also may cause night sweats. However, people who have an undiagnosed cancer frequently have other symptoms as well, such as unexplained weight loss and fevers.

Hypoglycemia: Sometimes low blood sugar can cause sweating. People who are taking insulin or oral anti-diabetic medications may experience hypoglycemia at night that is accompanied by sweating.

Hormone disorders: Sweating or flushing can be seen with several hormone disorders, including pheochromocytoma, carcinoid syndrome, and hyperthyroidism.

Neurologic conditions: Uncommonly, neurologic conditions including autonomic dysreflexia, post-traumatic syringomyelia, stroke, and autonomic neuropathy may cause increased sweating and possibly lead to night sweats.

Idiopathic hyperhidrosis: Idiopathic hyperhidrosis is a condition in which the body chronically produces too much sweat without any identifiable medical cause.

Infections: Classically, tuberculosis is the infection most notoriously associated with night sweats. However, bacterial infections, such as those that cause endocarditis (inflammation of the heart valves), osteomyelitis (inflammation within the bones), and abscesses all may result in night sweats. Night sweats are also a symptom of HIV/AIDS.

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