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=== Physical effects === Even people who are experienced with sweat rituals, or who attend a ceremony led by a properly trained and authorized traditional Native American ceremonial leader, could suddenly experience problems due to underlying health issues. It is recommended by Lakota spiritual leaders that people only attend lodges with authorized, traditional spiritual leaders.<ref name=lookinghorse1 /> There have been reports of lodge-related deaths resulting from overexposure to heat, [[dehydration]], [[smoke inhalation]], or improper lodge construction leading to suffocation.<ref name="Dehydration and heat-related death">{{cite journal |last1=Byard |first1=RW |last2= Riches |first2=KJ |title=Dehydration and heat-related death: sweat lodge syndrome |journal= The American Journal of Forensic Medicine and Pathology|volume=26 |issue=3 |pages=236β9 |date=September 2005 |pmid=16121078 |url=https://dx.doi.org/10.1097/01.paf.0000163838.92053.fb |doi=10.1097/01.paf.0000163838.92053.fb}}</ref><ref name="2 die in new-age sweat lodge">{{cite news|first=Suzanne|last=Herel|work=[[San Francisco Chronicle]]|publisher=[[Hearst Communications]]|title=2 seeking spiritual enlightenment die in new-age sweat lodge|url=http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2002/06/27/BA212763.DTL|date=2002-06-27|accessdate=2006-09-26}}</ref> If rocks are used, it is important not to use river rocks, or other kinds of rocks with air pockets inside them. Rocks must be completely dry before heating. Rocks with air pockets or excessive moisture could crack and possibly explode in the fire or when hit by water. Previously used rocks may absorb humidity or moisture leading to cracks or shattering.
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