Vol.5, No.2, 267-273 (2013) Health
http://dx.doi.org/10.4236/health.2013.52036
Effects of dry and mist saunas on circulatory and
thermoregulatory functions in humans
Satoshi Iwase1*, Yuko Kawahara2, Naoki Nishimura1, Hiroki Takada3, Mayumi Nagata4,
Yuki Niimi5, Chihiro Miwa6
1Department of Physiology, Aichi Medical University, Nagakute, Japan; *Corresponding Author:
2Group of Home Systems & Appliance R&D, Department of Home Systems & Appliance Sales, Toho Gas Co. Ltd., Nagoya, Japan
3Department of Human & Artificial Intelligent Systems, Graduate School of Engineering, University of Fukui, Fukui, Japan
4Plumbing Fixtures Technology Research Institute, Kitchen & Plumbing Fixtures Company, LIXIL Corporation, Tokoname, Japan
5Department of Neurology, Tsushima Municipal Hospital, Tsushima, Japan
6Aichi Medical College for Physical Therapy and Occupational Therapy, Kiyosu, Japan
Received 7 December 2012; revised 6 January 2013; accepted 14 January 2013
ABSTRACT
To test the hypothesis that mist sauna is a safer
way of bathing than dry sauna, we compared
changes in circulatory and thermoregulatory
functions during 10 min sauna bathing in mist
sauna at 40˚C with relative humidity of 100%,
and in dry sauna by infrared ray at 70˚C with
relative humidity of 15%. Subjects were seven
healthy young men aged 29 ± 6 yrs (mean ± SD).
We measured blood pressure, heart rate, skin
temperatures at chest, forearm, thigh, and leg,
tympanic temperature (Tty) by thermistors, skin
blood flow at forearm by laser Doppler flowmetry,
and sweat rate by ventilated capsule method at 1
min intervals throughout the experiment. Total
sweating and change of hematocrit were also
measured for dehydration analysis. Blood pres-
sure was elevated more and changes in heart
rate and total sweating were larger in dry sauna
than mist. A significant hematocrit increase was
observed in dry sauna bathing only. Mean skin
temperature and Tty in dry sauna were elevated
higher than those in mist. Heat stress of the dry
sauna may be stronger than that of the mist,
leading to dehydration and hypovolemia by
sweating. Percent plasma volume loss was sig-
nificantly larger in the dry than mist sauna.
Changes in skin blood flow and sweat rate/∆Tty
during mist sauna were significantly larger than
those during dry sauna bathing despite heat
stress of the mist sauna. The mist sauna bathing
may thus be safer physiologically, and provide
more effective vascular dilatation and sweating
than the dry sauna bathing.
Keywords: Sauna Bathing; Mist Sauna; Dry Sauna;
Heat Stress; Hemodynamic Change;
Thermoregulatory Function
1. INTRODUCTION
Sauna bathing is widely spread in Nordic and Finish
countries. It has been reported that regular sauna bathing
can deep clean the skin, promote weight loss, improve
blood circulation, accelerate muscle recovery, relieve
tension headaches, and induce a deeper and more relax-
ing sleep [1-4]. In addition to the traditional dry sauna
bathing that heats the sauna room temperature (RT) to
70˚C - 100˚C, mist sauna bathing that sparges hot water
into the sauna room and maintains the RT at 40˚C - 45˚C
has become prevalent in Japan.
Many investigations on dry sauna bathing have been
made due to its medical availability, however, few re-
ports has made mention on mist sauna bathing since its
commitment to commercial market in 1994. Sudoh et al.
[5] and Watanabe et al. [6,7] compared the dry sauna
with 90˚C - 100˚C RT and relative humidity (RH) > 20%
and the mist sauna with 42˚C - 45˚C RT and RH < 90%.
These reported that heat stress was higher in dry sauna
than mist sauna and more increase in heart rate was ob-
served, however, sweating by mist sauna was not so dif-
ferent from that by dry sauna bathing.
As the result of prevalence of family sauna, we could
easily enjoy sauna bathing; however, too much heat load
on cardiovascular system sometimes could be a risk for
cerebral/myocardial infarction coupled with dehydration
by sweating. We have previously compared the bath-
room heating systems between forced-air heating at 29˚C
RT with RH 60% and mist heating of 31˚C RT with RH
100%, and reported that mist heating provided less de-
hydration, and thus it is a safer way of bathroom heating
[8]. Therefore, the mist sauna bathing is likely a safer
system from the viewpoint of heat stress.

S. Iwase et al. / Health 5 (2013) 267-273
268
Since the effects of sauna described above are consi-
dered to be due to results of sweating, the same effects
might be obtained through mist sauna bathing. The sup-
pression of evaporative function in mist sauna bathing
might comprises highly effective heating and prevention
of dehydration.
In the present study, we compared the effects of dry
sauna bathing with 70˚C RT RH 15% by far infrared ray,
which has been reported to have the same effect as con-
ventional high temperature dry sauna (90˚C RT RH <
10%) [9], and newly developed mist sauna bathing with
40˚C RT RH 100%, on circulatory and thermoregulatory
function in humans, and examined the physiological
safety of dry and mist sauna bathing. The reason for se-
lecting 40˚C for mist sauna is that it is the most favorable
temperature for usual whole body bathing.
2. METHODS
2.1. Subjects
Subjects were seven healthy men, age: 29 ± 6 (24 - 39)
yr old, height: 172 ± 8 cm, weight: 66.1 ± 17.3 kg, body
surface area: 1.77 ± 0.24 m2 [10], body mass index: 22.2
± 3.9, (mean ± SD), with informed consent in a written
form. They were requested to refrain from caffeinated
beverages and alcoholic drinks since the evening of the
previous day of the experiment. The protocol of the pre-
sent study was approved by the Ethical Committee on
Human Research, Aichi Medical University.
2.2. Sauna Facilities
The experiment was carried out from June-July, 2000,
in the sauna room (2700  2600 mm) and bath room
(1600  2000 mm). The dry sauna facility was equipped
with the far-infrared heater (GSV-150R, Nissei Oval,
Tokyo), and RT and RH was controlled within 69.5˚C ±
0.8˚C (the globe temperature (GT) at 72.0˚C ± 3.4˚C)
and 15.9% ± 0.2% respectively. The mist sauna facility
employed hot-water membrane mist generation system
(SSD-1 GR, Yamaha Living Tec, Hamamatsu), and
maintained RT 39.6˚C ± 0.7˚C (GT 41.0˚C ± 0.7˚C), RH
100%.
2.3. Protocol of the Experiment
Subjects were requested to come to the experiment
room at 10:00, to urinate, and to wear swimming suits.
Body weight was measured with the precision to 10 g
(HW-100K, A&D, Tokyo). Then, they were applied the
electrodes, probes, and a catheter for blood sampling.
After the enough rest >30 min in the control room, and
they sat cross-legged on the floor of the control room for
10 min for baseline reading. After blood sampling, they
moved to the sauna room, and were exposed to dry or
mist sauna in a sitting position for 10 min. Blood was
again sampled at the end of the measurement in the
sauna room. Then, they moved to the control room again,
received the towel dry (5 min in total), and sat quietly for
10 min for recovery. Again they were requested to uri-
nate, and their urine volume and body weight were
measured.
2.4. Measurement
Blood was sampled from a intravenous catheter with
stopcock filled with heparinized saline. Red blood count,
hemoglobin, and hematocrit were determined with the
auto blood counter (Sysmex, Tokyo). Per cent plasma
volume change was calculated from Van Beaumont for-
mula [11]:



B
BA
%PV100100 Hct
100 HctHctHct
  

A




where %∆PV: percent change in plasma volume, Hct:
hematocrit, A: after, B: before the saunas.
Stress-related hormones, noradrenalin, adrenalin, vas-
opressin, and cortisol were measured before and after the
dry and mist saunas. To assess the metabolism, plasma
free fatty acids and plasma osmolarity were also deter-
mined.
Skin temperatures were measured at the chest, upper
arm, thigh, and lower leg with thermistors (Web-5000,
Nihon Kohden, Tokyo), and stored in a data recorder
(KS-616, Sony Precision Technology, Tokyo). Mean skin
temperature was calculated from the equation of Rama-
nathan [12] as
chest arm thighleg
MST0.3 T0.3 T0.2T0.2T


where MST: mean skin temperature [˚C], Tchest: chest
temperature [˚C], Tarm: upper arm temperature [˚C], Tthigh:
thigh temperature [˚C], and Tleg: lower leg temperature
[˚C].
The tip of the thermistors were covered by water and
heat proof pad, and pasted on the skin with surgical tape.
Skin blood flow was measured by laser Doppler flow-
metry (ALF 21, Advance, Tokyo), applying the probe at
the forearm. Sweating was determined by ventilated
capsule method (AMU-3, Fourtion, Aichi) with dry ni-
trogen drainage. Total sweat volume was estimated by
the difference of body weight and urine volume before
and after the bathing (Total sweat volume = body weight
change − urine volume). For the core temperature mea-
surement, tympanic temperature (Tty, PZL-64S, Sensor
Technica, Seto) was monitored with insulation by ear pad
at the ear orifice. Blood pressure was measured by oscil-
lometric method (BP-203i, Nippon Collin, Komaki). All
values were recorded and averaged in 1 min interval, and
stored in a data recorder.

S. Iwase et al. / Health 5 (2013) 267-273 269
2.5. Statistics
All data were expressed as mean ± SD. Student’s
paired-t test was employed to compare the individual
data in various conditions, and two-way repeated meas-
ures ANOVA was used for comparison between mist and
dry saunas. Any p-values less than 0.05 were considered
statistically significant.
3. RESULTS
3.1. Changes in Blood Count,
Stress-Related Hormones, and Plasma
Fatty Acids and Osmolarity after Sauna
Bathings
Erythrocyte count, hemoglobin concentration and he-
matocrit were significantly elevated in dry sauna (p <
0.05), but not in mist sauna. Per cent change in plasma
volume was significantly greater in dry sauna than mist
sauna bathings (p < 0.01, Table 1).
Noradrenalin was increased significantly both after
dry (p < 0.05) and mist sauna bathings (p < 0.01), and
the increase was greater in dry sauna (p < 0.05). Vaso-
pressin was also significantly elevated in both after dry
and mist saunas, while the difference between dry and
mist sauna was not significant. Cortisol showed no sig-
nificant changes after saunas (Table 2).
Plasma free fatty acids exhibited increase both after
dry and mist saunas, and the increases were significantly
larger in dry sauna than in mist sauna. No significant
difference was observed in plasma osmolarity between
before and after both dry and mist saunas (Table 3).
3.2. Changes in Blood Pressure (Figure 1)
Systolic pressure by oscillometric method in 1 min in-
terval showed significant increases from the baseline
level at 1, 9, and 10 min after the sauna entry, and 0 min
at the recovery in dry sauna bathing, and only 4 min after
sauna entry in mist sauna bathing. Diastolic pressure
exhibited significant increases in 1 min after the sauna
entry, 2 min after the recovery, and significant decreases
in 2, 5 - 7 min after the sauna exit during recovery in dry
sauna bathing. In mist sauna bathing, significant in-
creases was observed in 1 min after the sauna entry, sig-
nificant decreases were recorded in 6 min after the sauna
entry, and 7, 10 min after the sauna exit during recovery.
No significant difference was observed between dry
and mist saunas in systolic (p = 0.06) and diastolic (p =
0.13) pressures.
3.3. Changes in Heart Rate (Figure 2)
Significant increases from the baseline level in heart
rate were observed from 1 min after the sauna entry in
dry sauna bathing to the end of the recovery. In mist
sauna bathing, heart rate change was less. It showed sig-
Table 1. Changes in blood cell count before and after dry and mist saunas.
Changes in blood count before and after saunas
RBC (×104/µl) Hgb (g/100ml) Hct (%)
pre-sauna post-sauna pre-sauna post-sauna pre-sauna post-sauna
%PV change (%)
Dry sauna 510 ± 21 528 ± 21* 15.3 ± 0.5 15.9 ± 0.5 45.4 ± 1.7 46.9 ± 1.5* −5.9 ± 1.9
Mist sauna 484 ± 12 489 ± 14 14.6 ± 0.3 14.8 ± 0.3 43.3 ± 0.8 43.8 ± 0.9 −2.0 ± 1.2†
*: p < 0.05, vs. pre-sauna. †: p < 0.05, vs. dry sauna.
Table 2. Changes in stress-related hormones before and after saunas.
Changes in stress-related hormones before and after saunas
Noradrenalin (pg/ml) Vasopressin (pg/ml) Cortisol (pg/ml)
pre-sauna post-sauna pre-sauna post-sauna pre-sauna post-sauna
Dry sauna 361 ± 51 485 ± 54* 3.5 ± 1.0 4.3 ± 1.2* 13.8 ± 3.0 13.8 ± 3.5
Mist sauna 348 ± 50 444 ± 65**,† 5.3 ± 0.8 6.4 ± 1.2* 12.7 ± 3.6 11.7 ± 2.6
*: p < 0.05, **p < 0.01, vs. pre-sauna. †: p < 0.05, vs. dry sauna.
Table 3. Changes in plasma free fatty acids and plasma osmolarity before and after saunas.
Changes in plasma free fatty acids and osmolarity before and after saunas
Free fatty acids (mEq/l) Plasma osmolarity (mOSM/kgh)
pre-sauna post-sauna pre-sauna post-sauna
Dry sauna 0.20 ± 0.08 0.24 ± 0.09* 281 ± 1.3 283 ± 1.1
Mist sauna 0.24 ± 0.08 0.44 ± 0.10*,† 284 ± 1.1 285 ± 1.3
*
: p < 0.05, vs. pre-sauna. †: p < 0.05, vs. dry sauna.

S. Iwase et al. / Health 5 (2013) 267-273
270
Figure 1. Changes in blood pressure before (baseline), during
and after sauna bathing. Systolic (upper lines) and diastolic
(lower lines) blood pressures are shown in dry () and mist
() sauna bathings. SBP: dry vs. mist, p < 0.1, DBP: dry vs.
mist, p < 0.2, by repeated measures ANOVA. *: dry vs. base-
line, #: mist vs. baseline, p < 0.05 by paired t test.
Figure 2. Changes in heart rate before (baseline), during and
after sauna bathing. Heart rate (beats/min) in dry sauna ()
was significantly higher from that of mist sauna () bathings.
Dry vs. mist, p < 0.01 by repeated measures ANOVA. *: dry vs.
baseline, #: mist vs. baseline p < 0.05 by paired t test.
nificant increase in 3, 5 - 10 min after the sauna entry
while it return to the baseline level after sauna exit to the
end of the recovery.
A significant difference was denoted in heart rate be-
tween dry and mist sauna bathing. Heart rate change was
32 ± 10 bpm in dry sauna, and 18 ± 6 bpm in mist sauna,
which shows a significant difference (p < 0.05).
3.4. Changes in Averaged Skin Temperature
(Figure 3)
Averaged skin temperature increased from 1 min after
Figure 3. Changes in averaged skin temperature before
(base- line), during and after sauna bathing. Averaged skin
tempera- ture by Ramanathan’s formula in dry sauna ()
bathing showed significantly higher than that in mist sauna
() (p < 0.01 by repeated measures ANOVA). *: dry vs.
baseline, #: mist vs. baseline p < 0.05 by paired t test.
the sauna entry in both dry and mist sauna bathing, and
the increase was continued to the end of the recovery.
A significant difference between dry and mist saunas
were observed by ANOVA (p < 0.01), and averaged skin
temperature rise was 4.7˚C ± 0.9˚C for dry and 2.3˚C ±
0.7˚C for mist sauna.
3.5. Changes in Tympanic Temperature
(Figure 4)
Tympanic temperature measured as the core tempera-
ture increased significantly from the baseline level 1 min
after the dry sauna entry, and 2 min after the mist sauna
entry.
A significantly difference between dry and mist saunas
were denoted by ANOVA (p < 0.01), and the increase
from the baseline was 0.88˚C ± 0.35˚C in dry, and
0.45˚C ± 0.11˚C in mist sauna.
3.6. Changes in Skin Blood Flow and
Sweating (Figures 5 and 6)
Skin blood flow by laser Doppler flowmetry increased
significantly from the baseline level 1 min after in the
dry sauna entry, and 1 min after the mist sauna entry, and
the increase continued to the end of the recovery. No
significant difference was observed between dry and mist
sauna bathings by ANOVA (p < 0.2). The increase of
skin blood flow from the baseline level was 14.9 ± 7.0
ml/(min·100 g tissue) in dry, and 12.6 ± 5.2 ml/(min·100
g tissue) in mist sauna bathings.
Sweat rate increased significantly from the baseline
level 2 min after the dry sauna entry, and 1 min after the
mist sauna entry. These increases continued to the end of
the recovery. A significant difference was shown between
total sweating volumes in dry and mist sauna bathings (p
< 0.01), and the total sweat volume was 262 ± 17 g in dry,
and 177 ± 34 g in mist sauna bathing for 10 min.

S. Iwase et al. / Health 5 (2013) 267-273 271
Figure 4. Changes in tympanic temperature before (base-
line), during and after sauna bathing. Tympanic temperature
was significantly higher in dry sauna () than in mist sauna
() bathings (p < 0.01, by repeated measures ANOVA). *:
dry vs. baseline, #: mist vs. baseline, p < 0.05 by paired t test.
Figure 5. Changes in skin blood flow before (baseline), during
and after sauna bathing by laser Doppler flowmetry at the fore-
arm. There is a tendency of difference between skin blood flow
at the forearm in dry () and mist () sauna bathings but not
significant (0.1 < p < 0.2, by repeated measures ANOVA). *:
dry vs. baseline, #: mist vs. baseline, p < 0.05 by paired t.
Figure 6. Changes in sweat rate at the dorsum manus before
(baseline), during and after sauna bathing by ventilated cap-
sule method. Dry sauna () induced more sweat rate than
mist sauna () (p < 0.01, repeated measures ANOVA). *:
dry vs. baseline, #: mist vs. baseline, p < 0.05 by paired t test.
3.7. Skin Temperature and Sweating Change
against Tympanic Temperature Rise
(Figure 7)
In order to standardize the changes in peripheral pa-
rameters against the core temperature change between
the dry and mist sauna bathings, changes in skin blood
flow and sweat rate against tympanic temperature rise
were examined. The times for increase in core tempera-
ture rise of 0.1˚C, 0.2˚C, and 0.3˚C were 2.1 ± 1.3 min,
3.6 ± 2.1 min, and 4.6 ± 2.1 min respectively in dry
sauna bathing, and 4.0 ± 1.9 min, 6.1 ± 1.6 min, and 7.9
± 1.7 min in mist sauna bathing, and there exists a sig-
nificant difference between dry and mist (p < 0.01).
The increases in skin blood flow per core temperature
rise between dry and mist sauna were not significantly
different in core temperature rise of 0.1˚C and 0.2˚C (p =
0.2 and p = 0.11 respectively), while that in core tem-
perature rise of 0.3˚C was significantly greater in mist
sauna bathing (p < 0.05). There were no significant dif-
ference in the increase in sweat rate per core temperature
rise between mist and dry sauna bathings.
4. DISCUSSION
In the present study, we compared the effect of dry and
mist sauna bathings on cardiovascular and thermore-
gulatory function in seven young men in order to ex-
amine the hypothesis that mist sauna bathing is to pro-
vide more effective sweating and vasodilating (thermore-
gulatory) function while less influence on cardiovascular
function than dry sauna bathing in humans.
As the result, the thermal influence on cardiovascular
function was greater in dry sauna because there was a
tendency of systolic blood pressure rise (0.05 < p < 0.1)
only in dry sauna, and it continued to the exit. Heart rate
change was also larger in the dry sauna significantly, and
in the latter half of the sauna, the increase in heart rate
plateaued in mist while that in dry sauna continued to
increase to the end of the exit.
The phasic effect of dry and mist sauna bathings were
denoted by significant blood pressure rise on entry to the
sauna, but the effect soon disappeared because this blood
pressure rise was caused by the sudden thermal environ-
mental change, leading to the heart rate increase and
vasoconstriction. Increase in blood pressure in the course
of dry sauna bathing was also reported by Watanabe et al.
[7] in 90˚C - 100˚C dry sauna bathing. We set the lower
temperature of dry sauna bathing not to provide a
thermal stress to the subjects, however, thermal stress
still exists even in 70˚C dry sauna bathing.
In spite of no significant difference (although p < 0.1)
in blood pressure between dry and mist sauna bathings,
heart rate increase exhibited a significant difference be-
tween dry and mist sauna bathings. This change may be

S. Iwase et al. / Health 5 (2013) 267-273
272
Figure 7. Changes in skin blood flow (upper panel) and sweat rate (lower panel)
against Tty changes by 0.1˚C, 0.2˚C, and 0.3˚C from the baseline. The data
were calculated from the average of skin blood flow and sweat rate at the in-
crease by 0.1˚C, 0.2˚C, and 0.3˚C from the baseline.
attributed to the young aged subjects in the present study.
Well compliant blood vessels would buffer the blood
pressure change.
Tty increased with the rise in skin temperature in both
dry and mist sauna bathings, and the increase was signi-
ficantly greater in dry sauna, showing that the thermal
stress was greater in dry sauna as observed in heart rate
change.
Skin blood flow tended to be increased more in dry
sauna than in mist sauna (0.1 < p < 0.2), and total sweat
volume was more obtained in dry sauna than in mist
sauna. The hematocrit change was significantly more
increased in dry sauna than in mist sauna. These results
suggested that mist sauna dilated skin vessels more,
accelerated sweating more, and increased the Tty more,
however, when it is standardized as change per Tty
change, the thermoregulatory effect has turned to be
greater in mist sauna (RT = 40˚C, RH = 70%) than dry
sauna (RT = 70˚C, RH = 16%) bathings. This reverse
might be attributed that heat loss of mist sauna bathers is
dependent on vasodilatation dominantly than evaporation
by sweating due to wet skin by hidromeiosis as pre-
viously reported [8]. It means that mist sauna induces
vasodilative and sweating functions more effectively
than dry sauna.
The thermal stress during saunas was greater in dry
sauna than in mist assessed by the release of noradrenalin
although the vasodilative response from the dry and mist
saunas were not significantly different according to laser
Doppler flowmetry. The total sweat production during
saunas larger in dry sauna than mist sauna. Therefore it is
likely that hypovolemia (reduction in circulatory blood
volume calculated from the hematocrit) as well as
dehydration (calculated from the body weight loss after
saunas) in dry sauna was induced by this hyperhidrosis
due to higher thermal stress by dry sauna than by mist
sauna. However, this thermal stress seemed to be not so
strong to change the plasma osmolarity. Therefore the
increase in vasopressin might be attributed to thermal
stress, and the duration of thermal stress for 10 min
seemed not to be so long to induce the difference in
vasopressin secretion between dry and mist saunas.
In conclusion, mist sauna provides less heat stressful
environment than dry sauna, inducing less blood pressure
rise, less heart rate increase, less dehydration by sweat-
ing, less circulatory plasma volume reduction, and more
efficacy in vasodilatation and sweating. This means mist
sauna is more tender and safer sauna bathing system to
the circulatory function than dry sauna with more effi-
ciency on thermoregulatory function.
In the present study, since we aimed to clarify the dif-
ference of sauna bathing under moderate heat stress, we
compared mist and dry saunas with different room tem-
perature and different relative humidity. Therefore, we
could not determine whether the changes were dependent
on temperature or humidity, however, it provided impor-
tant findings on the difference between mist and dry
saunas under mild condition.
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