3rd straight night of nocturnal sweats

Another night of awakening soaked in a cold sweat from head to toe. Grrr.

I would like to express my sincere appreciation for the numerous emails I have recently received from friends and strangers concerned for my wellbeing during this personally difficult time as I struggle with my health.

Literature on the subject of night sweats is scarce. Night sweats has been defined as drenching sweats that require the patient to change bedclothes. Tuberculosis and lymphoma are diseases in which night sweats are a dominant symptom, but these are infrequently found to be the cause of night sweats in modern practice. Any disease that results in autonomic overactivity (e.g., ankylosing spondylitis) may result in night sweats.

Mechanics of Temperature Regulation and Elevation
Normal human body temperature displays a circadian rhythm, and is generally lowest in the predawn hours at 36.1° C before rising to 37.4° C or higher in the afternoon (Young, 1988; Boulant, 1991, Dinarello and Bunn, 1997), so the fever/sweating events are probably linked with this daily cycle. There are three phases to fever. In the initiation phase, cutaneous vasoconstriction promotes heat retention and shivering generates additional heat. When the new (elevated) set point is reached, heat production balances heat loss and shivering stops. With lowering of the set point to normal, cutaneous vasodilatation promotes heat loss to the environment in the form of sweating (Young, 1988; Boulant, 1991, Dinarello and Bunn, 1997; Cleary, 1998).

Potential Causes of Night Sweats
When night sweats are due to an infection, the sweating usually occurs as the body temperature drops suddenly after running a fever. Non-infectious illnesses can cause night sweats as well. The first that comes to mind is a malignancy. The most common symptoms of lymphoma, a tumor of the lymphatic system, are swollen lymph nodes, often in the neck. In addition, some people also have fever, night sweats and weight loss. Several other malignancies and other diseases can lead to night sweats as well.

Tumour necrosis factor alpha (TNF-α)
Tumour necrosis factor alpha (TNF-α) is one of the peptide signalling molecules implicated in triggering night sweats in AS. Monocytes (a type of white blood cell) are a significant source of TNF-α. It is possible to reduce TNF-α levels. For example, thalidomide suppresses TNF-α production and helps to moderate the characteristic symptoms and signs of tuberculosis. However, care has to be taken when manipulating TNF-α levels to avoid reducing the person’s natural immunity. For example, it has been shown that when an antibody against TNF-α (Infliximab) is given in the treatment of rheumatoid arthritis, the patients have an increased risk of developing previously latent tuberculosis (Keane et al, 2001).