Night sweats

Definition

Significant generalised night time sweating that soaks bedclothes or bedding.

Night sweats are a fairly common symptom and the majority of patients do not have an underlying haematological malignancy.

Medical causes are very varied and include:

infection
menopause
anxiety
endocrine causes:
- hyperthyroidism
- nocturnal hypoglycaemia in diabetics
- acromegaly
- phaeochromocytoma
obstructive sleep apnoea
connective tissue disorders
neurological:
- parkinsonism
- neuropathies
medications:
- antipsychotics
- SSRIs
- hormonal agents such as Tamoxifen and GnRH agonists
alcohol excess or withdrawal
drug abuse (including cannabis use / withdrawal)
gastritis
haematological malignancies.

Please see the Primary Care Management page for guidance on further investigation.

C.M & L.W 21-04-25

Who to refer:

Patients with night sweats and unexplained weight loss >10% can be imaged as per the GP access to CT for suspected cancer (no clinically obvious primary) to enable more rapid and appropriate specialist referral.

Only refer patients with genuinely drenching sweats and any of:

significant additional systemic symptoms: fever or alcohol induced pain
unexplained weight loss >10%, fever or alcohol induced pain
associated nodal enlargement and / or splenomegaly
abnormal FBC

Who not to refer:

Night sweats only; otherwise well with normal FBC – these patients should be investigated in primary care as are unlikely to have lymphoma
Patients with sweats which are not genuinely drenching
Patients with clinically significant isolated neck nodes should be referred directly to ENT neck lump clinic for consideration of biopsy.
Patients with clinically significant isolated axillary nodes should be referred directly to the Breast Clinic for further management.