Sweat Culture: A Case for Inclusion by Bryon MacWilliams

Bryon MacWilliams is an American writer who was a foreign correspondent based in Moscow for nearly twelve years. He is author of the books, With Light Steam, and The Girl in the Haystack. His journalism, essays, poetry, and literary translations have appeared in publications big and small.

Sweat culture can get tribal. 

The Finnish sauna. The Russian banya. The Turkish hammam. The Japanese sento. The Korean jimjilbang. The Native American sweat lodge.

The architecture — the rituals — reflect the culture and personality of a people. 

The farther a bath culture spreads from its origins, though, the more it changes. And the more it changes, the more some try to preserve what was. The words “authentic” and “traditional” become code for what's better and worse, what’s right and wrong — not that, but this

But why take sides when so much unites us? 

All great baths make us healthier. All baths make us equal, humble, before the elements — air, fire, water. All baths make us feel not merely clean, but euphoric.

To me, each of the world’s great baths is a path to the same destination.

Besides, in sweat culture (like every culture), things aren't always what they seem. What we think is unique to one culture, sometimes, is not. 

Take the Finnish smoke sauna, or savusauna, the very root of sauna culture. As it happens the legendary bath is long rooted, too, in Russia, even carries a similar name — the black (chyornaya) or smoke (kurnaya) banya. 

Both baths are primitive steam rooms with primitive stoves, without chimneys.

Finns aren’t sure where the savusauna originated. Russians aren’t all that sure where the black banya originated, either. (The Russian Academy of Sciences traces the banya to the Baltic Sea region, to the northwestern territories between Lake Ilmen and the Western Dvina, or Daugava, River. Nearby, sauna cultures evolved — and endure — in Estonia, Finland and Lithuania.) 

Most Finns don't know this. Most Russians don't know this, either. 

Many are stout guardians of their respective sweat cultures — even though the baths at the core of each culture are, in fact, the same.

I love when history, and identity, are unclean — when fictions move narratives closer to true. 

I love, too, when connections drift, steam-like, across cultures.

Tribalism is antithetical to such connection; it's a different energy.

I'm grateful that the North American Sauna Society favors connection over separation, and has given me the opportunity to share with readers of its blog an excerpt from my book, With Light Steam, a memoir about Russia through the lens of its banya culture.

What follows is the beginning of the chapter during which I travel to Chuvashiya, an agrarian republic along the Volga River, to steam in the near-mythical granddaddy of the banya... 

and, as it happens, the sauna!  

— Bryon MacWilliams

We would be resting between steams, our hair wet, our skin flushed, our backs slumped against benches, our chests rising and falling with a slow, pleasant fatigue from swings in temperature, hot to cold to hot to cold.

We would talk about our jobs, and our loves. We would talk about ourselves, too, when we were able to see ourselves as independent from work, or women. 

Sometimes we would talk about what we were feeling, not emotions so much as the physical sensations common to our chosen bathhouse in Moscow. Was the steam dry enough, soft enough, light enough? Were our senses aroused more, say, by the aroma of beer with reassuring overtones of mustard, or that of wormwood with slashing accents of peppermint?

Sometimes, when the steam was just right, we would not talk at all. Great steam, like great art, has the power to bring on quiet.

Such moments, for me, were a rejuvenating confluence of communion. With myself. With others. With the divine. Every so often, though, these spells of good feeling would be broken by declarations from other bathers, always Russian, that what we were experiencing, in fact, was not special.

“You call this a banya? This isn’t a banya, this isn’t a banya. There is only one true banya, one true Russian banya — the black banya!” 

“The steam here is good. I won’t dispute that, I won’t. But you’ll never know what steam truly is until you’ve steamed in a real Russian banya, till you’ve steamed black-style!”

Most of it was hearsay, I knew. More Russians have seen the yeti than have steamed in a black banya. 

Black banyas are nearly extinct. They just barely exist. They are the truest link to the ancient Slavic steam baths of another millennium.

Black banyas are black because they do not have chimneys. Literally, they are black: the ceiling and interior walls are caked with soot, from smoke. 

I have never appreciated being ripped out of a moment by someone telling me that there was a better moment, elsewhere to be had. Over time, though, the remarks of other bathers caused the vision in my mind of a dingy, soot-encrusted black banya to shimmer with the enchanting sheen of myth. Over time, I came to regard my appreciation for the Russian cult of steam a bit like Cicero regarded his history: “Not to know what happened before one was born is always to be a child.” 

Knowledge and awareness are not peers of experience; like the dismissive remarks of the other bathers, they are only so much hearsay. 

I decided to find a black banya, and to steam in it.

The XVII International Sauna Congress is starting 07.06.

The XVII International Sauna Congress is starting 07.06.

PRESS RELEASE  28.05.2018

The International Sauna Association ISA   is organizing the International Sauna Congresses every four years in different parts of the world in the countries where there are member associations.

This XVII  rights were  given after a tight competition between China and Sweden finally to Swedish Bastuakademie.

The organizing  group headed by the Chairman of Bastuakademie Mr. Göran Honkamaa started its work about a year ago. Just now we are in a situation where we can see that the work has been succesfull and we have an outstanding program. 

Besides Honkamaa the important part of the work has been done by Hans Hägglund, Svante Spolander and Roger Häggström with Bastuakademie.

ISA  and ISA President Risto Elomaa has also been part of the organizing group controlling that  everything is done according to the bylaws of ISA as well as the traditional practices.

Over 200 people from about 24 countries have a full program starting on Thursday  07.06.2018  with an exciting full day smoke sauna tour to Soukolojärvi.

Before the opening Get to Gether event, ISA is also having its Board and General meetings deciding e.g. the Board etc. for the next term of four years starting 2019.

The get together event is a meet and greet for all those delegates that have come to the premises with an option to taste some local food and  beer in the old Lapin Kulta brewery, Lappari which is today an important place for big events in Tornio.

On Friday the day is full of presentations in three different sessions in Park hotel Tornio. The full program is available on the  page http://www.bastuakademien.se/nationalbastudag/xvii-sauna-congress-2018-35861132

At the evening party grill food is served with the option to try several saunas at Kukkolaforsen. The event is important especially for Bastuakademie, because they have their 30 Year Anniversary. This means naturally that all the saunas in Kukkola are in full use also after the party. The estimate is that there are around 18 saunas available. 

On Saturday the day is further full of presentations and workshops. After these an important meeting of international journal of Sauna Studies IJSS will take place. The idea is to restart publishing sauna research and related papers in a journal like ISA and German Saunabund were  doing for many years in the form of International Sauna Archive. Our friends in Australia have been doing a lot of basic work for this and we hope that in the meeting we can find a group that is willing to go further.

After the official program there is again a party at Kukkolaforsen where this time the International Sauna Association is having its 60 Years Anniversary. After the three course dinner prepared and served in this famous restaurant, there is also music and other program.

All the 18  saunas will be open as long as there is interest in using them. Actually the slogan Midnight Sun Sauna means that we use them until morning. This time of the year we have Midnight Sun in that region, as well.

Once again ISA has succeeded in getting some of the key speakers in the sauna world  to present the latest material about many aspects of sauna and sauna culture. Such names as Jari Laukkanen, Mikkel Aaland, Lasse Viinikka, Mark Timmerman are on the list. We are sure that the presentations give many new aspects for the sauna and how to use it. The presentations cover the globe from Sydney to Seattle like the delegates. And as delegates we also see people from Pakistan and Kenya, which are not traditional sauna countries.

Japan delegation is a group of 20 people. Two of whom are also having presentations on Japanese sauna and sauna culture; The Japanese Sauna Ambassador Katsuki Tanaka as well as sauna entusiast and photographer Miki Tokairin both have been publishing books and articles about various sauna.

We introduce the delegates some aspects of the Interbad exhibition which is happening in 2018 in Stuttgart.

TyloHelo is talking about the history of sauna and especially sauna stoves when having their 100 Years Anniversary in 2018.

Saturday is the SAUNA DAY in Sweden as well as in several other countries. This is celebrated by announcing the SAUNA PEACE in several languages.

We have also succeeded in getting a group of whisking specialist from Lithuania to show their skills as well as give some oral presentations about whisking generally. This group, headed by Rimas Kavaliauskas, is there at Kukkolaforsen on Saturday afternoon and also on Sunday morning.

Another interesting group with their own mobile Banya, headed by Egor Andrejev, is showing also whisking and other treatments as well as giving oral presentations about banya culture also on Saturday afternoon in Kukkolaforsen. This is something we are really waiting for.

On top of all this, participants have a chance to participate in some of the sauna tours organized  specifically for the delegates. Even fishing in the Tornio river is possible and the timing should be perfect for salmon migration. The host of Kukkolaforsen, Svante Spolander, with his group knows everything about fishing and nature, further his wife will be making sure that the restaurant there is having excellent  and absolutely fresh local food available all the time.

One special aspect for many foreigners is the fact that the Congress is happening in two different countries and you will be crossing the boarder several times when moving from the hotel to congress and further to Kukkolaforsen. Tornio river has been the boarder between Finland and Sweden for over 200 years but the saunas are similar on both sides and there is even one common language still spoken. 

We hope that the visitors can bring some of that  sauna culture and nice experiences with them back when going home.


Risto Elomaa

The International Sauna Assoaciation      E-mail: sauna@kolumbus.fi

Vaskiniementie 10 , FIN-00200 Helsinki   www.saunainternational.net

Design of Auxiliary Spaces in a Sauna by Lassi a. Liikkanen

Design of Auxiliary Spaces in a Sauna by Lassi a. Liikkanen

(Link to the original post at the end of article)

During serious sauna bathing, the majority of time is spent outside the actual hot sauna room. However modest your sauna may be, you have to take into account in its design phase how to get hot water, where the bathroom is going to be, and where your clothes and towels can be neatly stored.  This article works as a reminder for the auxiliary space requirements for the sauna. It introduces models for a modest and a luxury version of sauna structures as typically found in Finland.

As I’ve been creating Saunologia.fi for over two years, I have written a number of articles contemplating the sauna experience from many different angles. For the most part I have devoted writing about the hot sauna room and perfecting it in the Finnish style.

Recently I have realized that the hot sauna room is only an ingredient, albeit the most important ingredient, in a wholesome sauna bathing experience. At least a typical Finn is spending at least as much time outside the hot room as s/he is spending inside one.



Wood-fired stove  inside the Kaurilan sauna hot room

So this article looks beyond the heart of sauna, or to be exact, the room which Finns also call “löylyhuone” or steam room. However,

the word steam room is frequently used outside Finland to refer to totally different types of baths so this story uses the term hot room to refer to the heart of the sauna building or facility.

Other space needs

 Besides the sauna hot room, auxiliary spaces have to be designed carefully in order to guarantee a satisfactory sauna bathing experience. These spaces can include:

  • Shower room
  • Dressing room
  • Bathroom
  • Cleaning closet
  • Patio
  • Swimming pool
  • Den with a fireplace
  • Restaurant (at a public sauna)
  • Foyer (at a public sauna)
  • Log closet
  • Technical closet/ furnace room

At a public sauna establishment there can naturally be many saunas, dressing rooms and bathrooms. At Saunologia, I have chosen a residential point of view, so I will next introduce two versions of saunas, a modest sauna individual use outback and a more luxurious sauna for both individual use and socializing.



Connections between the auxiliary spaces or functions of Finnish saunas: a simple sauna cabin and a luxurious one

A note about the terminology in the picture: the simple cabin has no running water, so it has a separate outhouse for toilet needs. The luxury sauna facility resembles a modern detached house in all of its functions.

The Hot Room vs. Auxiliary Space Needs

There is a rule of thumb according to which the shower room must be 1.5 times bigger than the sauna room and the dressing/ locker room should be twice as big as the sauna room.

Suggested relative sizes of the spaces inside the sauna building:



Space needs for distinct rooms of a Finnish sauna

The calculation of the room sizes starts with the hot room. It should be designed considering how many people will be using the sauna at once. In Finland, tiny apartment saunas may only accommodate 2 people, but most private saunas can seat 4 to 6 people at a time. 50 sq ft is barely enough for that.

The logic of sizing the other rooms is based on keeping them spacious. It is expected that people flow through the rooms at different paces. This means that your design may start from a four person hot room, but have three more people in the shower or dressing room, who eventually crash in the dressing room at once. Having enough space for all supports relaxation and feeling at ease in the sauna.



Spacious dressing rooms at Tykkimäki public sauna in Kouvola, Finland

You will also need cleaning closet, trash bins, water and clothes hooks

 A public sauna requires professional cleaning and maintenance. Cleanliness is one of the core elements in a Finnish sauna. Even  a personal sauna should have a cleaning closet, where the sauna’s cleaning supplies are held. It doesn’t have to be big as long as it keep things neat and tidy, preventing  equipment laying around in the sauna. Naturally you also need a trash bin for empty bottles, caps and other trash.

Lockers are the tidiest alternative for organizing the dressing room, but might feel strange in a private sauna space. Regardless, there need to be enough hooks and shelves for all sauna bathers.



Makeshift clothes hooks at my Suvikallio sauna

Warm water is needed in a Finnish style sauna. A rule of thumb is that you need 2.5 gallons of hot water per sauna bather, which gives you around 5-7 gallons of warm water for people to wash themselves. If only quick showers are needed, water consumption is less. Most saunas in Finland have a separate room for washing, which allows to use a shower stall for instance. Washing up inside the hot room is possible if you allocate enough space (10 sq ft or more) and have enough vertical space so the temperature at the floor level can be kept moderate.

Finally, don’t forget the bathroom. To be self sufficient many Finnish cottage saunas include an outhouse. In an urban environment, you will have something more modern, but you must definitely have it! (not to say that Finns would consume much sauna beers)

To sum things up, let’s create a check list of what could be needed to set up a working sauna establishment. Things like a mirror and a trash bin are important to remember, also one could have a dedicated shelf for eyeglasses as the Germans do.

Washing area:

  • Benches
  • Shower seats
  • Shelves/ lockers
  • Towel hooks
  • Shampoo holders
  • Soap dispensers
  • Guideposts (if commercial)

Dressing room:

  • Benches
  • Tables
  • Clothing hooks
  • Dress lockers
  • Shelves
  • Mirror
  • Dryer
  • Trash bin
  • Hamper
  • Guideposts (if commercial)

This post first appeared at www.saunologia.fi https://saunologia.fi/design-of-auxiliary-spaces-for-a-finnish-sauna/

Sauna Trip to Finland and Sweden

I had the privilege of traveling to Finland and Sweden from September 19th to 30th. What made this trip interesting were the opportunities to sauna bathe.


After a couple days in Helsinki, Finland, my wife and I took a ferry, the Silja Serenade, over to Stockholm, Sweden. We were happy to bump into some old friends from both New York and Helsinki. Instead of sharing a table at one of the nice restaurants on board, we had arrangements to spend some time in the ship's spa section. Luckily for us, this is the start of the off-peak season and most people on the ship were dining, so the spa was not too crowded during our visit.


There are separate saunas for ladies and gentlemen, and in addition at least one or two private saunas that can be reserved beforehand on the shipping company's website. So off we took to the spa an hour after the ship sailed. We were greeted by very nice waitresses at the entrance and were escorted to a surprisingly spacious private dressing room with couches, etc. The sauna could easily accommodate a half dozen guests so there was plenty of room for the two of us. An added bonus was that we were served drinks and finger food directly to our private quarters, and it was not overly costly, either. The common section of the spa consists of three large jacuzzis, a steam room, and a bar. Because of the early hour of our visit we were able to have one of the jacuzzis to ourselves. What a beautiful way to spend time it was to watch the archipelago sunset in the bubbly water through floor to ceiling windows while feeling elevated and relaxed by the sauna. We were two truly happy campers. It was not a party cruise, though, jetlagged and after two hours of sauna bathing we went to sleep in our nice cabin around 9PM. Have to say, though, that the next day couldn't have been better. Unfortunately we didn't have time to take the ferry back, but had to fly to Helsinki due to a previous engagement.


The following Saturday we drove to central Finland to visit relatives and were able to fire up a very old smoke sauna twice. This sauna has been there since the 18th century. Again around 2 hours of sauna bathing each time, but this time we were sissies; no plunging into the river since the water was already a fresh 52F. You have to know what you are doing when you heat up a smoke sauna, because if you don't follow the ancient protocol, there is a chance that you will end up with carbon monoxide poisoning. However, since basically the whole humankind has been doing this for thousands of years, apparently deep down the heating process is manageable. That smoky smell on your skin afterwards is just so soothing and nice. In this busy world one can yet question the habit of heating the sauna for five hours straight and then enjoying it for only around a couple. But like in sailing, the preparation is part of the enjoyment.


The day before we left back to New York, we were also lucky enough to visit the new "Loyly" high-end sauna/restaurant establishment in downtown Helsinki, which seems to be super popular. We arrived there early, at lunchtime, and it was hard to get a table, let alone get tickets to the sauna. We started our sauna when the sauna section opened at 1PM and when we left the premises around 3PM it was already sold out for the day. However, this was Friday after all and it was refreshing to see some corporate people spending time there together, men and women. Not a problem in that part of the world and it is important to point out that bathing suits were mandatory. So like at the beach, people were sitting together, this time however by the fire with a glass of champagne in their hands.


I also met the guy who runs the sauna section. It consists of one traditional sauna that seats perhaps 25-30 people and one smoke sauna that seats 15-20. I wish I had had this conversation with him before entering the saunas. There is a hatch on both heaters that should be kept open just right. You leave the hatch open for too long and the saunas become too hot and dry, you keep them closed and the saunas are humid but lack a little bit on the heat side. This time we did dip into the sea, me once, wife twice. Apparently there is a vast difference since now the water was 55F!


All in all I wish the high-end sauna culture would start spreading more in the US as well. Here in New York, it is mostly ethnic Russian traditions that drive this type of thermal therapy. You can always of course build a sauna in your own house; then it is as high-end as you want it to be.

Eero Kilpi


President of the North American Sauna Society

Silja Line

Loyly Helsinki


Health Benefits of Sauna By Mark Timmermann


The use of heat while bathing has been an integral part of many cultures for centuries. Finland is well known as a society of avid users of the sauna, which usually produces a relatively dry heat between 70 – 100 degrees Celsius. The traditional Finnish sauna is a smoke sauna (“savusauna”) where stones are heated with a fire for several hours and then the sauna is taken after much of the smoke has cleared from the sauna building. More commonly today, saunas are heated by stoves using wood or electricity, and water is used intermittently on the stones to produce steam.

Other cultures known for their heat bathing traditions include Russia (Banya), Lithuania (Pirtis), Sweden (Bastu), and Turkey (Hammam). Here in the United States, the American Indians traditionally have used sweat lodges for spiritual ceremony. The rest of American sauna culture has been influenced by European immigration during the late 1800’s and early 1900’s. In my own case, for instance, I grew up in a northern Minnesotan town where many Finns immigrated in order to work in iron ore mines. Many of us therefore had saunas in our basements or at our lake cabins.

Sauna bathing usually involves several repetitions of alternating heat with cold, such as 15-20 minute heat exposures interrupted by dipping in a pond, taking a cool shower, or sitting outside. In some cultures, oak or birch twigs and leaves and/or steam are used to provide a more intense heating and massaging experience.

Health Benefits

There are many myths regarding the physiological and psychological affects of sauna bathing. Unfortunately, we lack sufficient large, controlled studies in the medical literature to help fully understand the science supporting these myths. We have learned a significant amount about the physiologic adaptations of the body to heat bathing, however, and there is a growing body of scientific study, especially from Germany and Finland, to help understand the real benefits and risks of the practice.

Physiologic Response

Essentially, the effects of heat bathing are the body’s way to deal with heat stress. In other words, heat exposure causes a person’s physiology to react to that form of stress out of self-defense in order to prevent injury. The systemic adaptations that occur over time can indeed make a person stronger, similar to adaptations to regular exercise.

Initially, as the body is exposed to the heat of a sauna, the skin temperature increases. As a way to dissipate the heat and protect the internal organs, the body decreases blood flow to those organs and increases circulation to the skin. In addition, sweat glands are stimulated in order to allow for evaporation and further cooling effect.

Because the blood volume to the periphery and skin is increased, the heart rate must also increase so that the internal blood pressure can be maintained. While the overall work of the heart does not change significantly, the pulse can increase up to double the normal rate.

Breathing becomes more rapid and shallow in the sauna, and the overall flow rate and lung capacity increases, suggesting more efficient pulmonary ventilation and allowing for additional heat dissipation.

The sympathetic nervous system is also stimulated as skin temperature rises, causing a “flight or fight” response. Stimulation of the hypothalamus and pituitary glands in the brain, which communicate with the adrenal glands near the kidneys, causes release of cortisol (“adrenaline”), creating a heightened sense of alertness, reduced perception of pain, and elevated mood. Interestingly, when a sauna is followed by a plunge into cold water, this adrenaline response is elevated even more.

Cardiovascular Benefits

There is good scientific data to support the beneficial effects of repeated sauna exposure for the heart. In particular, a person’s resting systolic blood pressure can decrease as much as 10 points after just three 20 minute sauna sessions several days apart. Some studies have found up to a 20-point systolic blood pressure decrease with regular sauna exposure (such as twice per week) over a several month period.

Congestive heart failure, which is related to poor pump function of the heart, has also been shown to benefit from regular sauna exposure. Both symptoms and heart rhythm abnormalities improve predictably with regular sauna use.

Importantly, because the workload on the heart is generally not increased in the sauna, the risk of myocardial infarction (“heart attack”) in the general population is not higher during sauna bathing. While it is usually recommended that a person who has had a cardiac event or procedure should wait at least 6 weeks before going back to sauna bathing, it is considered to be safe practice for people with heart disease.

Training Effect

Because many of the body’s adaptations to sauna are similar to its response to exercise, many people wonder if taking a sauna can improve cardiovascular fitness. While one recent study has suggested that endurance performance does improve for runners who recover in the sauna after training, in general one’s fitness does not improve with routine sauna bathing alone.

With regular sauna bathing, however, the body does adapt to heat stress, so that one can tolerate longer and hotter sauna exposures without injury. People who are new to saunas are therefore encouraged to moderate their heat exposure by limiting their time in the sauna, or by sitting on a lower bench. In addition, athletes who use the sauna routinely are able to exercise more efficiently and perform better in warm temperatures.

Respiratory Benefits

Part of the sympathetic nervous system response also relaxes smooth muscle in the bronchioles of the lungs, allowing for more efficient respiratory function. Patients with both asthma and chronic obstructive pulmonary disease generally report improved symptoms and ease of breathing while in the sauna, although longer-term studies have not generally shown an overall improvement in lung function with regular sauna use.

Musculoskeletal Benefits

During a sauna, joint synovial fluid becomes less viscous, allowing for improved joint mobility, and skeletal muscle is relaxed. These changes, along with the increased pain tolerance that one experiences, provide for a significant subjective decrease in musculoskeletal pain. Interestingly, for patients with rheumatoid arthritis and other autoimmune disorders, pain and inflammation have found to be increased on the day after taking a sauna – unless the sauna bath is followed by a cold immersion. For patients with arthritis that use cold-water bathing after sauna, there can be an overall improvement in symptoms.

Immune System

There are some studies that support the notion that regular sauna use stimulates the immune system. During a sauna session, white blood cells increase in the bloodstream, suggesting an elevation of the body’s natural defense against illness. With routine sauna practice, at least one study has shown a decrease in the incidence of the common cold.

Psychological Benefits

One of the most common reactions to taking a sauna is that it simply seems to make people feel better. As it turns out, there are some measurable scientific reasons behind that.

Sauna exposure causes a significant release of Dopamine, a neurotransmitter, and Beta-Endorphin, a neuropeptide hormone. These substances cause a sense of euphoria, as well as improved mood, energy, sense of calm, and pain tolerance. (Endorphin is a combination of the words “ENDOgenous”, or occurring naturally in the body, and “moRPHINe”, a pain-relieving compound). The level of endorphins released during sauna bathing can be three times normal, similar to a middle distance training run. This “runners’ high” that occurs can be somewhat addictive and may affect regular sauna users in the same way it affects regular exercisers.

Sleep is also improved after a sauna, with some research showing longer stage 4 sleep, which provides a deeper, more restful sleep and healthier dream activity. Sleep affects so many other aspects of health, including mood, immune function, and ability to handle stress, that this alone would seem to suggest a significant health benefit from regular sauna use.

The psychosocial aspects of group activity such as sauna bathing may also be an important part of the health benefits of sauna. Social connection, sharing with friends and feeling a part of a community, as well as the personal nature of conversation that is fostered in the sauna, all play parts in the cultural validity of group sweating that has existed in so many cultures over time. In addition, for those cultures that promote nudity in the sauna, a sense of equality and openness exists that one does not normally experience in every day life.


While quite safe if done in moderation, sauna bathing can present health risks.

Because the body uses sweat to help regulate core temperature during a sauna, dehydration can be a problem with excessive sauna use. Some athletes, such as wrestlers, have used the sauna for rapid weight loss through loss of water through sweat, and this has occasionally led to heat stroke and sudden cardiac death. When combined with the misuse of diuretic pills, this practice can be especially dangerous.

Alcohol consumption creates many potential risks for the sauna user. Alcohol counteracts the anti-diuretic hormone that the body normally secretes during heat stress in order to help the kidneys retain fluid. In addition, alcohol causes the peripheral blood vessels to become even more dilated than usual in the sauna, which can lead to rapid fall in blood pressure and cause falls or fainting. Alcohol also excites cardiac muscle and reduces coronary artery flow, increasing the risk of both arrhythmia and myocardial infarction.

Cold-water immersion is a common practice following sessions in the sauna. This causes rapid constriction of the skin blood vessels, which causes blood pressure to increase (as opposed to in the sauna where it remains stable). There is also a significant stimulation of the sympathetic nervous system, with rapid increase in adrenaline, heart rate, and also endorphins. Hence, the sense of euphoria and well being that one experiences following cold immersion intensifies that from taking a sauna alone.

Data is mixed regarding the benefit of cold immersion for muscular tissue following exercise, but there are several studies that support improved blood flow and more rapid recovery of muscular damage and soreness with cold immersion. As mentioned above, those with inflammatory conditions like rheumatoid arthritis demonstrate benefit with cold water immersion following sauna bathing.

Of concern however, is the fact that cold immersion can lead to cardiac arrhythmia and coronary artery spasm, making it potentially dangerous to those with heart disease. There are cold receptors in the face and scalp that respond to a rapid fall in temperature. This stimulates the “diving reflex”, which is a complex cardio respiratory reaction that causes apnea and a sense of shortness of breath, decreased cardiac output, and rapid decrease in pulse. Heart arrhythmias are common during this response, and can pose a danger to those prone to dangerous heart rhythms or at risk for heart attack.

As we can see, while people with heart disease can generally use the sauna safely, this is a population that should absolutely avoid alcohol before and during sauna bathing. In addition, these individuals should take extra caution when plunging in cold water to avoid exposing the face and head. A cool shower or slower cooling simply by sitting outside is generally considered safer practice for this group.


Sauna bathing causes the body undergo many physiologic changes in attempt to protect itself against heat stress. Some of those adaptations can provide health benefit, most notably to resting blood pressure. There also evidence to suggest improved function in other aspects of cardiac, respiratory, musculoskeletal, and immune function. Regular sauna use increases the ability for athletes to train or perform in heat, and post exercise saunas may improve endurance. Many of the benefits of sauna bathing are psychological, including improved sleep, mood, and pain tolerance. Cold plunging following a sauna can accentuate some of these benefits, but caution is advised regarding immersion of the face and head. Alcohol use before and during the sauna is also ill advised, as is the practice of using the sauna for rapid weight loss. Otherwise, sauna bathing is considered very safe and regular use can benefit overall physical and mental health.

(Dr. Mark Timmerman is a Family Physician and Sports Medicine Specialist in Wisconsin, USA. He has a wood heated sauna in his home and takes a sauna at least three times each week).