Get Rid Of Tiredness and Sleep Less
Management of fatigue and breathlessness should go hand in hand as the two are inextricably linked in heart failure. The fatigue of heart failure is multi-factorial and potentially reversible factors should be sought and treated. Side-effects related to medication including hypokalaemia from loop diuretics, over-diuresis and the tiredness associated with beta-blockade are common. Timing and intensity of diuretic use may impinge on quality of sleep, and exacerbate a common problem contributing to impaired quality of life in patients with heart failure.
Cancer-related fatigue is defined as an unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning. It can occur during active cancer treatment and it can persist long after treatment has ended. The causes are myriad and overlap considerably with those that can cause cognitive disorders. Fatigue may be physical in that the person has very little stamina or energy to perform usual activities. Fatigue can also be mental. Similar to patients with cognitive dysfunction, patients who suffer from mental fatigue often report that they are easily overwhelmed, that they have difficulty being organized and efficient in their daily activities, and that they have difficulty meeting deadlines or getting things done on time. Activities that used to be automatic now require more effort so that the patients become exhausted even performing routine tasks.
Iron deficiency is the most common cause of anaemia but the cause is often multifactorial. Those patients in whom anaemia should be suspected include all females of child bearing age (due to menstrual loss), the elderly (due to poor diet and other diseases) and all patients who are undergoing gastro-intestinal or gynaecological surgery (due to blood loss). Most patients suffering from anaemia are completely asymptomatic. If severely anaemic, symptoms may include tiredness and dyspnoea on exertion and in the elderly angina, heart failure and confusion may be precipitated.
Daytime sleepiness was assessed in 30 adults with epilepsy using the MSLT (Drake et al., 1994). Of those, 23 subjects reported intermittent tiredness or difficulty sleeping and 20 described feelings of depression and irritability. Another 20 subjects reported feeling sleepy during some of the naps. A mean sleep latency of greater than 8 min was considered normal. The mean sleep latency was greater than 8 min in 10, between 5 and 8 min in 7, and less than 5 min in 3 of the 20 subjects reporting sleepiness. Of the patients who denied feeling sleepy during the test, two failed to sleep during the MSLT, 7 had a mean sleep latency greater than 8 min, and one had a mean sleep latency between 5 and 8 min. The mean sleep latency of the entire cohort was 8.4 min, which is suggestive of mild to moderate hypersomnia, using 10 min as a cutoff by conventional scoring standards (Carskadon et al., 1986). Pathological hypersomnia (mean sleep latency less than 5 min) was found in 10 of cases. Patients...
Your patient is treated with daily INH and vitamin B6. She increasingly complains of tiredness and headaches, and difficulty concentrating on her university studies. After 5 months, she has decided that she will not continue with treatment. You convince her to complete 6 months of therapy, which you know to be an acceptable alternative to the full 9 months recommended by the CDC, and she agrees to this. You emphasize to her that treatment for latent TB infection is imperfect and that a small chance of future TB remains. You recommend that, should she ever develop symptoms compatible with TB, she will need to be investigated for this. You estimate that her baseline lifetime risk of TB reactivation was up to 5 , and following treatment, you have reduced this risk to 2 or less.
Typically, the patient is a normal-weight woman of 20-50 years whose main complaint is of vague feelings of distress occurring predominantly mid morning, about 11.00 a.m.-12.00 noon, but occasionally mid afternoon or evening and never before breakfast. In between attacks, characterized by feeling of faintness, anxiety, nervousness, irritability, inner trembling, rapid heart beat, headache, and sweatiness, either alone or in combination, they may be completely well. More often they describe themselves as suffering from increased tiredness, lacking in zest for life, and apathetic much, or all, of the time symptoms often associated with depression or chronic alcohol abuse.
The commonest presentation of oesophageal cancer is dysphagia, which is progressive. Initially patients notice that certain solid foods stick as they swallow, then they become unable to swallow solids and rely on soft, sloppy foods, then they can only tolerate liquids, until eventually complete dysphagia develops and they cannot even swallow their own saliva. Dysphagia is a very distressing symptom, and is invariably linked with weight loss, which worsens as dyspha-gia progresses. Tiredness and lethargy develop, linked both to the gradual starvation, and to anaemia from chronic low-grade blood loss. Occasionally, patients are diagnosed during investigation for anaemia, at endoscopy for other upper GI symptoms, and from screening programmes for Barrett's oesophagus.
Many investigators contend that irritability or prolonged aggressive temper outbursts rather than euphoria are the hallmarks of the disorder in children and adolescents 39 . However, episodic irritability can also be seen in depressed children and chronic irritability is common in attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder and some variants of pervasive developmental disorder. Other investigators have suggested the episodic decreased need for sleep being a hallmark of bipolar disorder. Of all the symptoms of mania, decreased need for sleep is the one that has been shown to have pathophysiological significance 40,41 . Decreased need for sleep characteristic of mania should be distinguished from nonspecific insomnia (which is generally accompanied by feeling tired) or chronically decreased need for sleep that may be seen in ADHD. Also, stimulant-induced insomnia (generally early insomnia) needs to be ruled out.
Morning sickness, nausea, occasional vomiting, tiredness, and exhaustion are common to about 70 of pregnant women. It is vital to manage morning sickness during your pregnancy, because vomiting can interfere with anti-epileptic drug intake, absorption, and compliance. Most nausea occurs during the first trimester and goes away during the second trimester. Morning sickness does not always happen in the morning. You can get morning sickness for no apparent reason, and at any time of day. For some women, it might last longer than the early stage of pregnancy. Some women experience morning sickness throughout the entire 9 months. No one understands exactly what causes morning sickness, but many factors are known to contribute to morning sickness, including low blood sugar, low blood pressure, hormonal changes, nutritional deficiencies (vitamin B6 and iron), nutritional excess (spicy, sugary, and refined foods), fatigue, and stress.
Cataplexy is usually triggered by emotions. A survey (Anic-Labat, 1998) of 300 narcoleptics indicated that laughter, feelings of amusement, or being tickled by oneself, repartee, or a joke induced cataplexy in 93 of the patients. Other emotions found to trigger cataplexy include anger (90 of patients), excitement and elation (82 ), surprise (61 ), athletic activities with an emotional content, such as winning or hitting a good shot (60 ), elation (59 ), response to a call for action (38 ), sexual intercourse (37 ), and embarrassment (36 ). Surprisingly, driving an automobile was reported to trigger cataplexy in less than 1 of the patients. Sleepiness and tiredness was cited as a trigger in 50 of the patients, and 36 of the patients said that in some attacks they could not identify the immediate trigger. A given individual usually reports several different triggers over time.
A number of antidiarrheal compounds, drugs that generally act by prolonging intestinal transit time through an effect on bowel motility, have been evaluated in clinical trials. These agents include difenoxin, diphenoxylate-atropine,51 lidamidine,52,53 loperamide,53-57 and loperamide-oxide.55-59 These trials of patients with acute diarrhea have generally been conducted among general practice networks. Trials evaluating loperamide or loperamide oxide have generally used time to first relief and time to complete relief as endpoints, the latter indicating the time between taking the loading dose and the start of the 24-hour period in which no watery or loose stools were passed. The majority of these reports have indicated a benefit of antidiarrheals on symptoms. Some have reported the benefit being experienced in the early phase of the illness, with no impact on total duration of symptoms. The most common adverse effect of these medications was constipation. Two RCTs found that...
Cataplexy can precede the appearance of the other symptoms of the narcolepsy syndrome by months or even years. Most commonly the other symptoms are seen preceding the appearance of cataplexy or occur concomitantly with its development. The most common symptom is daytime sleepiness. Initially it may be referred to as hypersomnia, tiredness, and fatigue however, over time, the hypersomnolence becomes apparent, with the need to take short naps in the daytime to maintain vigilance to perform adequately at work or at school. Hypnagogic hallucinations, sleep paralysis, and automatic behavior are not pathognomonic of narcolepsy. They are seen in association with other sleep disorders and are also noted in the general population.
Louis encephalitis also has a higher rate of complications, typically in elderly people. There are mild and subjective consequences (tiredness, forgetfulness, weakness of concentration, defects of speech), but also dangerous complications such as convulsions, paralysis,
Sleep apnea is a disordered breathing condition that is characterized by the constriction of the airway during sleep. Due to disrupted sleep throughout the night, individuals report tiredness, fatigue, sleepiness, memory and judgment problems, irritability, difficulty concentrating, and personality changes. Medical treatments involve nasal continuous positive airway pressure (CPAP), oral dental devices, and surgical procedures to eliminate sleep fragmentation, apneas, and oxygen desaturation. CPAP, one of the most effective and widely used therapies, requires the patient to wear a mask. This mask fits over the apneic's face during sleep to assist with breathing. Despite the effectiveness of CPAP, the discomfort associated with wearing the mask, its cumbersome nature, and, for some, the sensation or fear of suffocation, often deters patients from its use. Therefore, compliance with utilization of the CPAP device is low and is an obstacle to effective management of sleep apnea (Sage,...
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