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Night Sweats and Hot Flashes in Older People

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Night sweats and hot flashes are symptoms that can cause immense discomfort. The article below briefs their management in elderly individuals.

Medically reviewed by

Dr. Rajesh Gulati

Published At March 27, 2023
Reviewed AtMarch 27, 2023

Introduction

Aging is associated with changes in the dynamics of physiological, environmental, psychological, biological, social, and behavioral processes. Many age-related changes occur that are usually benign, resulting from decline in the function of senses and activities of day-to-day life and increased susceptibility to frailty, frequency of a condition, or disability.

Advancing age is considered a major risk factor for many chronic diseases in humans. Menopause is also a condition faced by women as they age. And this accompanies its many symptoms. One of them is hot flashes and night sweats. Around 75 % of perimenopause and menopausal women experience this. Few men are also affected by these symptoms in old age.

What Are Hot Flashes and Night Sweats?

A sudden feeling of warmth in the body, typically more intense on the face, neck, and chest is called hot flashes. In many individuals, the skin becomes red or pink. It is almost akin to blushing. This intense warmth may cause sweating. And sweating a lot can cause an individual to lose body heat but, in turn, may experience chills after the hot flash is over.

Menopause is the main cause of hot flashes and night sweats. Night sweats are drenching sweats that are so intense that they are enough to soak an individual's clothes and bedding and can disturb their sleep. Sweating is healthy and it is a cool-down response that keeps body temperature at a comfortable and safe level. But on the other hand, night sweats are not comfortable. This can also accompany reddening of the skin and rapid heartbeats. Both these symptoms may signal underlying conditions that require medical attention.

What Are the Possible Causes of Hot Flashes and Night Sweats in the Elderly?

Menopause in women is considered a major cause of hot flashes and night sweats during advancing age. But both are symptoms of multiple conditions and side effects of many medications. They can occur for many reasons, regardless of sex. The causes include:

  • Bacterial Infections: These include conditions like a pyogenic abscess (pus in the liver), osteomyelitis (inflammation of bone marrow and bone), and endocarditis (inflammation of the inner heart lining).

  • Viral Infections: This includes flu, cold, and COVID-19.

  • Infectious Disease: This includes conditions like human immunodeficiency virus and tuberculosis.

  • Substance Abuse: This includes consumption of cocaine, heroin, and alcohol.

  • Hormonal Disease: This includes endocrine tumors, diabetes, and overactive thyroid.

  • Cancer: Conditions like lymphoma (blood cell cancer) and leukemia (bone marrow and blood cancer).

  • Neurologic Disorders: This includes syringomyelia (cyst of the spinal cord), autonomic dysreflexia, autonomic neuropathy (damage to autonomic nerves), and stroke.

  • Digestive Disease: Includes conditions like gastroesophageal reflux disease.

  • Behavioral Health Conditions: This includes anxiety and panic disorders.

  • Side Effects of Cancer Treatment: This includes Tamoxifen, opioids, steroids, and aromatase inhibitors.

  • Side Effects of Other Medications: These medications include diabetes medications, antidepressants, steroids, acetaminophen, high blood pressure drugs, and Aspirin.

  • Sleep Disorders: Conditions like obstructive sleep apnea.

  • Night Sweats: Other than the above conditions, night sweats can also be related to hyperhidrosis, a condition that involves excessive sweating without any apparent cause or reason.

How Are Night Sweats and Hot Flashes Managed in the Elderly?

The effective way to relieve hot flashes is to take estrogen, but it carries risk. Other medications like antiseizure and antidepressant drugs can also help, though they are less effective than hormones. Hot flashes and night sweats subside gradually for most women without treatment but can take a prolonged time. The other ways to manage are:

  • Hormonal Therapy: Estrogen is the basic hormonal therapy used to reduce hot flashes and night sweats. The duration of how long the treatment continues depends on the balance of benefits and risks of hormonal therapy. Doctor's advice is required in cases of endometrial cancer, heart disease, stroke, breast cancer, and blood clots.

  • Antidepressants: Antidepressants include Venlafaxine, Citalopram, Escitalopram, and Paroxetine. A low dose of paroxetine is the only non-hormone treatment for hot flashes.

  • Prescription Medications: Medications like Pregabalin (antiseizure medication that helps in reducing hot flashes), Oxybutynin (a pill or patch mostly used in urinary conditions like overactive bladder, Clonidine (a pill or patch used in treating high blood pressure), Gabapentin (antiseizure medication moderately effective on hot flashes).

  • Nerve Block Procedure: This procedure is known as the stellate ganglion block, which is used to treat hot flashes. It involves injecting anesthesia into a nerve cluster in the neck and is mostly used for pain management. This has side effects like bruising at the site of injection and pain.

What Lifestyle Changes Prevent Hot Flashes and Night Sweats in the Elderly?

Before considering the medical approach to managing night sweats and hot flashes, some lifestyle changes can help to cope with them. If hot flashes and night sweats keep an individual up at night, then lowering the room temperature may help by drinking small amounts of cold water before bed. Other lifestyle changes are:

  • Dressing in layers that can be removed at the start of a hot flash. Wear loose-fitting, cotton or linen, lightweight dresses on the bed.

  • Using a portable fan when a hot flash strikes.

  • Avoiding spicy foods, alcohol, and caffeine. This may spike other symptoms that can worsen hot flashes and night sweats.

  • Quit smoking and it is good not only for hot flashes but for overall health.

  • Maintain a healthy weight. Women with more weight or obesity experience more frequent and severe hot flashes.

  • Do body-mind practices, meditation, yoga, and hypnotherapy can help with the management of hot flashes and night sweats.

  • Sip cool water frequently at night.

  • Maintaining and following a routine before bedtime using relaxation, breathing, and meditation techniques.

  • Exercises like dancing, walking, swimming, and cycling can be included to stay active.

  • Use mattresses and pillows that contain cooling gels.

  • Acupuncture can reduce the frequency and severity of night sweats and hot flashes, but the results are conflicting.

  • Dietary supplements like black cohosh, ginseng, plant estrogens, Dong Quai, and vitamin E can relieve mild to severe hot flashes.

Conclusion:

Hot flashes and night sweats are commonly faced issues by the elderly. A proper treatment plan, management of symptoms, and lifestyle changes can help deal with them. It is always important to consult healthcare professionals before taking any hormonal therapy on their own by discussing the family, medical history, and concerns about the therapy. Choosing the right dose and duration is more important for safe, effective results.

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Dr. Rajesh Gulati
Dr. Rajesh Gulati

Family Physician

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