Working up a sweat in your sleep

Excessive perspiration at night might be an indication of serious health issues

By RX FOR READERS/JUDY SIEGEL-ITZKOVICH
A man sleeping (illustrative) (photo credit: INGIMAGE)
A man sleeping (illustrative)
(photo credit: INGIMAGE)
I am an 86-year-old man. For several months, I have been waking up with my head and especially my neck full of sweat. My pajama tops are wet, and my wife has to change my pillowcase a few times a week. I dream a lot through the night, but the dreams are not scary. Could this be a cause? Is the sweating caused by some medical condition? What treatment is there?
S.B., Jerusalem
Dr. Karen Djemal, family medicine specialist and the director of the Terem Family Clinic in Jerusalem’s Hagdud Ha’ivri Street, replies:
There are many reasons for night sweats, so it’s important to check out the possibilities with your family doctor, who will be able to perform a physical examination and arrange appropriate lab tests.
Prof. Giora Pillar, a leading sleep medicine specialist at Rambam Medical Center and the Technion-Israel Institute of Technology Rappaport Faculty of Medicine, replies:
Night sweats such as what you describe have to be investigated, diagnosed and treated. Among the possible conditions connected to night sweats are sleep apnea (stopping breathing momentarily or periodically while sleeping); nightmares (post-traumatic stress disorder); endocrine problems, sarcoidosis (an autoimmune disease of unknown origin that leads to inflammation of the body’s organs) and others. Go to your family doctor for a consultation.
I am a woman in my 50s and have a hammertoe on my right foot. Until now I have wrapped the toe in lamb’s wool and wearing shoes was fine. Lately, it has been aching constantly. A doctor told me to have an operation. Is there an alternative to getting rid of the bump or at least easing the pain?
D.B.G., Tel Aviv
Judy Siegel-Itzkovich says:
The American Orthopedic Foot and Ankle Society explains that a hammertoe is a deformity of the second, third or fourth toe, which is bent at the middle joint, making it look like a hammer. At first, hammertoes are flexible and can be corrected with simple measures, but if nothing is done, they can become rigid and need surgery. Make sure your shoes fit properly. Wear sensible shoes, not high-heeled ones that put pressure on the ligaments or tendons in the foot.
Patients who have hammertoes try to manage them by treating the symptoms. This involves padding the toe and changing or stretching shoes for comfort. But if this doesn’t help, you may have to consider undergoing surgery
Patients with multiple problems in addition to the hammertoe should avoid surgery for just the hammertoe alone. Additional surgery may be needed to address the other deformities as well. Other reasons to avoid hammertoe surgery include active infections, poor circulation, and any serious illness that would make surgery unsafe. You should discuss your health history with your orthopedic surgeon prior to considering hammertoe surgery.
In joint resection, an incision is made over the top of the toe and the connective tissue may be cut to help straighten the toe. The end of the bone is removed to allow the toe to straighten completely, and pins are temporarily used to hold the toe straight. The pins are usually removed three to four weeks after the surgery.
Fusion can also be performed; the ends of the bone are cut and the toe is straightened. Pins, screws or other implants can be used to keep the toe straight while the bone ends heal together.
Complications specific to hammertoe surgery include a small chance that the hammertoe may come back after your surgery.
Dr. Shmuel Weiss, director of the foot and ankle clinic at Jerusalem’s Shaare Zedek Medical Center, replies:
If there is a bump that really bothers you due to rubbing against the shoe, the doctor is right that the recommended treatment is surgery. But before taking the plunge, you can try to straighten the toe with a foam “pillow” that puts pressure on the toe. You can use it in your shoes whenever you wear them. Sold in private and chain pharmacies, health fund pharmacies and shops for orthopedic products, it is made by Uriel Footcare for straightening hammertoes. Those with supplementary health insurance can get a discount.
I am a 51-year-old woman with type-2 diabetes controlled by medications and exercise. I am about five kilos overweight. I eat a regular balanced dinner at 7 p.m. but am hungry – real cravings for food – around 10.30 p.m. before going to bed at 11.30 p.m. Are there any snacks or drinks I can eat that would not cause me any harm but would handle my cravings?
V.C., Netanya
Veteran clinical dietitian Dr. Olga Raz comments:
I was surprised to read that you don’t mention proper nutrition among the things you do to stabilize our diabetes. Exercise and medications are very important, but so is what you eat.
An important principle is for diabetics to eat every three or four hours, including about an hour before you go to sleep. Preferably, what you eat then should include complex carbohydrates such as a slice of whole-wheat bread with a low-calorie spread, or oatmeal or natural yogurt with two or three tablespoons of Fiber 1 or another such dry whole-grain cereal without sugar. You can get guidance from a clinical dietitian who specializes in advising diabetics or go into my website at www.olgaraz.co.il.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527 or email it to jsiegel@jpost.com, giving your initials, age and place of residence.