The Sauna: A Good Sweat or a Bad Risk?

For millions of Americans, a few minutes in the sauna or steam room is akin to therapy: They bare themselves, get good advice, sweat a little--and walk out minutes later feeling somehow cleansed. If there are serious health risks from all that heat, they seem mostly reserved for bad guys in old mobster films who got locked in.

Yet YMCA officials now say otherwise. Late last month, the YMCA of Metropolitan Los Angeles abruptly and permanently shut down all its steam rooms and saunas. The closures, in eight of its 26 facilities, followed a June 4 fire that authorities believe started in a sauna and caused $1 million in damage at the Westchester YMCA.

The fire prompted the YMCA to closely examine all health and safety risks in the heated rooms, said Larry Rosen, president of the Los Angeles YMCAs.

“What doctors tell us is that the rooms should not be used before or after strenuous exercise--and that’s exactly when people use them,” he said. Rosen said the YMCA stopped building the heated rooms in new facilities 16 years ago, because of growing concerns over their safety. Because people in saunas and steam rooms are behind closed doors, it is difficult for YMCA staff to monitor them for signs of trouble, Rosen said. “We simply have no way of preventing people from using them improperly.”

The most serious health risk is heart failure, doctors say, and it’s significant, especially in those who have an unstable heart condition. Once in a steam room or sauna, the body works to cool itself. At first, blood pressure and heart rate go up slightly, as blood is pumped to the skin to vent fluids, according to Dr. Susan Lewis, an orthopedic surgeon at the Center for Sports Medicine in San Francisco. As muscles relax, blood pressure begins to drop, she said.

“Now the heart is working harder but getting less blood flow,” Lewis said. “If you have someone in not great shape, with a heart condition, blood flow is already restricted. That’s when you get a problem, like a heart attack.”

Rosen would not say how many serious problems have occurred in YMCA saunas and steam rooms. “All I can say is that we get about one incident a month, from dizziness to something more serious,” he said. Though he didn’t know the rate of serious injury on basketball courts or in pools, Rosen estimated that about 75% of emergency calls made from YMCA locations come from the eight facilities with saunas and steam rooms.

Other Southland clubs said they have had no problems with their saunas and steam rooms, and have no intention of closing them. “They’re very popular,” said Ken Marshall, manager of the Spectrum Club in Los Angeles. “Some people don’t even work out. They just come in to take a shower and a steam or sauna.”

Most healthy people can easily handle heat immersion of 110 degrees (in a steam room) to 180 degrees (in a sauna) for a short period--five to 10 minutes, doctors say. The exceptions include children younger than 12; people who are on medications that affect blood pressure or heart rhythm; and pregnant women, whose bodies are already diverting significant amounts of blood to the baby, said Dr. Paul Thompson, a cardiologist at Hartford Hospital in Hartford, Conn. “For most everyone else,” he said, “I don’t think [saunas and steam rooms] are dangerous at all, if they’re used responsibly.”

It’s when people “tough out” long sessions of more than 10 or 15 minutes in the heat--often after having worked out--that they can get into trouble, Lewis said. Though the first symptoms of heat exhaustion, dizziness and headache, usually send people heading for the door, some healthy people may feel more confusion than pain, she said. “They may not realize they’re not feeling so great, and pass out from heat exhaustion,” she said. “The 45-year-old CEO trying to sweat it all off, or 18-year-old on the wrestling team trying to make weight, sitting there in his sweatsuit: Those are the sorts of people we typically treat for this.”

In an analysis of 158 deaths that occurred in spas, hot tubs and saunas between 1985 and 1990, researchers at Oregon Health & Science University in Portland identified several major risk factors, besides heart disease: seizure disorders, such as epilepsy; and the use of drugs such as alcohol and cocaine, which elevate blood pressure and heart rate. Seven of the deaths occurred in saunas; and 151 in spas or hot tubs, more than a third of which were children under age 12, many of whom drowned. In a larger review of 21 of the most scientifically rigorous sauna studies, researchers at the University of Ottawa in 2000 concluded that a five- to 10-minute sauna bath at normal temperatures was safe even for heart disease patients, as long as their condition was stable, said lead author Marja Leena Keast, a heart rehabilitation specialist.

The American College of Sports Medicine recommends temperatures of between 170 and 180 degrees for saunas, and between 100 and 110 for steam rooms. For those who’ve never immersed themselves in such heat, experts recommend starting slowly. “In places like Finland and Germany and Japan, people are acclimatized,” Keast said. “They’re taking saunas or steams once a week for most of their lives.”

Many YMCA members are peeved about the closures. At the Hollywood YMCA last week, printouts of angry e-mails were pasted to the steam room door and members gathered to read and grumble. Some members have canceled memberships, others have written letters of protest and a few have accused the YMCA of trying to trim insurance or staff costs at the expense of members. Rosen says cost savings were not a consideration.

“There is a premium differential to cover the risks of saunas and steam rooms,” he said, “but we’re self-insured. It was not a money decision for us.” He said he has fielded more than 130 calls, letters and e-mails protesting the closure, and at least a third of those people have canceled their memberships or say they plan to do so. “They’re walking out really mad,” he said, “and we’re sorry to lose them.”

Longtime users believe the benefits of a sauna or steam outweigh any risk. “I know the benefits I get: It’s good for my skin, for mental clarity; I walk out feeling like a new person,” said Chuck Spain, 46, a longtime member of the Downey YMCA. “For 150 years the ‘Y’ has been teaching common sense, and now it’s trying to regulate common sense. If there’s a risk, I’m willing to take it.”

Beyond any potential health benefits, some longtime YMCA members say the sauna and steam rooms served a social purpose as well. “I’d go to the Hollywood ‘Y’ to play handball, get my clock cleaned by some guy twice my age, then go get a steam,” said Richard Beedle, a 51-year-old insurance broker. “There were always a few wise, old birds in there talking. I loved just listening to them.”

Said Spain: “There’s a camaraderie in the steam room. It’s a community in there.... It’s not only good for the body. You’re communing with people.”