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27.03.2015

Symptoms of exhaustion fatigue, insomnia related to sleep apnea - Reviews

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Mental Fatigue- A mentally fatigued person is often unable to think and concentrate properly. According to The National Institute of Health, USA, approximately one in every five Americans suffer from severe fatigue that can interfere with their normal life.
Persons suffering from certain medical issues or conditions like anemia, chronic pain, hypothyroidism (underactive thyroid), hyperthyroidism (overactive thyroid), arthritis, insomnia, sleep apnea, chronic fatigue syndrome, restless legs syndrome and others experience fatigue. Although, many of these remedies can help with fatigue, results may take time to materialize, progress may be slow and effects temporary.
Mahendra Trivedi sees these successful rates of transformation as a product of treating the root cause of disorders, rather than the peripheral symptoms. If a woman is consistently receiving the recommended amount of nightly sleep, yet still experiences a lack of energy during the daytime, it is important to look into possible causes of fatigue in order to provide relief. Fatigue is defined as an ongoing and persistent feeling of weakness, tiredness, and lowered energy level. Another distinction that must be made is that between fatigue as a symptom of menopause and chronic fatigue syndrome, which is a more serious and complicated disorder. The lack of sleep that may lead to feelings of fatigue can also manifest itself in irritability or an inability to concentrate on tasks at hand, leading to problems in the workplace or within relationships.
Fatigue is particularly frustrating, as it has this duel effect on both mind and body, making the completion of normal tasks difficult if not impossible.
Fatigue during menopause is experienced by many women as crashing fatigue, which is a sudden and extreme feeling characterized by exhaustion, weakness, and markedly decreased energy levels.
By learning more about the causes of this menopausal symptom, it is possible to manage and even cure fatigue. Fatigue is a frustrating symptom of menopause that can impact all areas of daily life and affect well-being. Fatigue is mainly caused by lack of sleep, but there are other conditions that can increase the likelihood of developing it.
The symptoms of adrenal fatigue are vast, which is one of the reasons it can be difficult to identify.
Adrenal Fatigue Syndrome has four stages the body goes through as it continues into dysregulation and eventually reaching exhaustion.
Alarm reaction or Early Fatigue stage occurs in response to more stress and increases its activity to counteract the stressors. Stage 3 or Adrenal Fatigue, begins when our body can no longer produce enough cortisol to bring our bodies back into a state of balance. Fatigue is sometimes referred to as asthenia, tiredness, lack of energy, weakness, and exhaustion. The causes of fatigue in an individual patient are often multiple, with many interrelated factors. In patients without cancer who present with fatigue, the final diagnosis is psychological (eg, depression, anxiety, and other psychological disorders) in almost 75% of patients.
Low red blood cell count related to advanced cancer or chemotherapy has been associated with fatigue, and its treatment results in improvement of fatigue and quality of life in these patients.
Administration of chemotherapy and radiotherapy for malignancy causes a specific fatigue syndrome. The fourth category in Table 1 is the most relevant for both clinical management and clinical trials in fatigue.
In addition to the assessment of the intensity of fatigue, the clinical assessment of these patients requires clinicians to determine the impact of all factors on the presence of fatigue.
To treat fatigue optimally, it is vital to identify and prioritize the different underlying factors in the individual patient. In patients with cancer treatment–related fatigue, it is important to exclude specific causes, such as hypothyroidism, hypogonadism, and anemia, and to consider other potential adverse effects of treatment.
Psychosocial interventions, such as CBT, have been found to be effective in improving cancer-related fatigue in cancer patients receiving treatment.
Excessive physical activity, excessive work load , over exertion, improper sleep, boredom, obesity, use of sedating medicines or medicines like anti-depressants, alcoholism or drug abuse, improper diet can cause fatigue. Chronic fatigue syndrome includes periods of extreme fatigue that do not improve with bed rest, may worsen with physical activity, and is often tied to other illnesses. Overall fatigue is a serious symptom of menopause, as it has such a far-reaching effect on a woman's overall health.


Physical characteristics may include general feelings of drowsiness, or fatigue that comes on suddenly. These episodes of crashing fatigue can strike at any moment, making usual activities difficult, straining relationships, and increasing stress. Menopausal fatigue is primarily caused by hormonal fluctuations, and can be accompanied by other symptoms like irritability and difficulty concentrating. Even though the release of ACTH remains high, the adrenals begin to slow down the output of cortisol as they begin the path to exhaustion. Cortisol and DHEA levels are the best markers for identifying a sub-functional system (sub functional means you are not in the extremes of the condition, but still have symptoms even though levels may show normal range). Fatigue is also commonly associated with cancer treatment and occurs in up to 90% of patients undergoing chemotherapy. In terminally ill patients with advanced cancer, treatment of anemia may not resolve fatigue adequately because of the multifactorial nature of its etiology. Autonomic failure has also been documented in patients with severe chronic fatigue syndrome.
The pattern of fatigue reported by patients with cancer who receive myelosuppressive chemotherapy is cyclical. Combined therapy with the two modalities appears to cause worse fatigue than does either modality given alone. In addition, commonly used medications, such as opioids and hypnotics, may cause sedation and fatigue. There is agreement that self-assessment should be the “gold standard.” Because of the complex nature of the symptoms of fatigue, an effort to identify a set of diagnostic criteria similar to those for depression has been attempted. Visual analog scales, numerical scales, the Brief Fatigue Inventory (BFI), and the Piper Fatigue Self-Report Scale have been validated. A number of effective pharmacologic and nonpharmacologic symptomatic treatments are available for these patients.
There is substantial evidence that corticosteroids can reduce fatigue and other symptoms in cancer patients. Psychostimulants (eg, methylphenidate, 5 to 10 mg in the morning and at noon or 5 mg as needed) may be useful in treating fatigue in patients with advanced cancer.
Based on a preliminary study that found significant improvement of cancer-related fatigue with a dose of 2,000 mg extract of ground root of American ginseng (Panax quinquefolius), Barton et al recently completed a double-blind trial of 2,000 mg of American ginseng vs placebo for 8 weeks in 364 fatigued cancer survivors. A recent randomized controlled trial by Montogomery et al found that the benefits of CBT on cancer-related fatigue lasted long after the CBT was finished. Well, before we discover the possible causes of tiredness, let us first explore exactly what fatigue is. Fatigue can be either physical or mental, although, most of the time, physical tiredness is accompanied by mental weariness. Mental fatigue can have serious consequences, losing concentration whilst driving or operating heavy machinery can result in injury or even fatalities.
There is no easy answer to resolve fatigue especially if it occurs over prolonged periods of time.
Fatigue affects the majority of women, with up to 80% of working women reporting feeling fatigued on a regular basis. In order to distinguish how a woman can tell if she is experiencing fatigue during menopause, keep reading to learn more about the specific symptoms of this common condition. By contrast, when fatigue manifests itself mentally, a woman can feel apathetic or irritable due to a lack of energy. Getting adequate sleep and staying hydrated are a few healthy habits that can help prevent menopausal fatigue. Adrenal fatigue is a relatively new concept and as a disorder is not commonly recognized by mainstream healthcare. During this stage there may not be many noticeable symptoms with the exception of a little more tiredness than normal. Some of the symptoms at this point mirror Addison’s disease, which is adrenal insufficiency, “Fatigue becomes extreme, with weight loss, muscle weakness, loss of appetite, nausea, vomiting, hypoglycemia, headache, sweating, irregular menstrual cycles, depression, orthostatic hypotension, dehydration, and electrolyte imbalances. Moreover, different studies of fatigue and asthenia have looked at different outcomes, ranging from physical performance to the purely subjective sensation. When injected into a rested subject, blood from a fatigued subject has produced manifestations of fatigue.


The metabolic abnormalities involved in the production of cachexia and the loss of muscle mass resulting from progressive cachexia may cause profound weakness and fatigue. However, symptoms of psychological distress or adjustment disorders with depressive or anxious moods are much more frequent. Although the association between fatigue and autonomic dysfunction has not been established in cancer patients, it should be suspected in patients with severe postural hypotension or other signs of autonomic failure. Fatigue has been noted to decrease in the first 2 weeks after localized treatment for breast cancer but then to increase as radiation therapy persists into week 4. This syndromal approach has been useful to assess the presence or absence of the clinical syndrome of fatigue. For instance, patients with anemia may experience symptomatic improvement with the administration of erythropoietic therapy (epoetin alfa [Epogen, Procrit] and darbepoetin alfa [Aranesp]) at the dose and administration schedule that best fit the patient’s need.
Whilst medicines can provide some instant relief from fatigue, long-term use can harm our health by adversely affecting body organs. In most patients, the etiology of fatigue or dyspnea is multifactorial, with many contributing interrelated abnormalities.
The host production of cytokines in response to the tumor can also have a direct fatigue-inducing effect.
However, many abnormalities described in Figure 1 are capable of causing profound fatigue in the absence of significant weight loss.
Patients with an adjustment disorder or a major depressive disorder can have fatigue as their most prevalent symptom. Fatigue tends to worsen with subsequent cycles of chemotherapy, which suggests a cumulative dose-related toxic effect. As we are no longer able to release enough cortisol it will also be more difficult for our body to signal the release of glucose for energy which further exacerbates our fatigue and lack of get up and go. In one study of patients with advanced cancer, fatigue was found to be significantly correlated with the intensity of dyspnea.
Muscular or neuromuscular junction abnormalities are a possible cause of chemotherapy- or radiotherapy-induced fatigue. Compared with women who have no history of cancer, former patients with breast cancer who had received adjuvant chemotherapy reported more fatigue and worse quality of life due to this symptom. It is impossible to be certain whether one of these identified problems is a major contributor to fatigue or simply a coexisting problem in a given patient. The results of this study showed that there was no significant improvement in fatigue in the methylphenidate group compared with the placebo group. This chapter will discuss the mechanisms, clinical features, assessment, and management of both of these troublesome and often undertreated symptoms in cancer patients.
Therefore, it is of great importance to measure the intensity of fatigue and the patient’s performance before and after treating any contributing factor. In a recent double-blind placebo controlled study of 84 advanced cancer patients with fatigue, oral dexamethasone at a standard dose of 8 mg daily for 2 weeks was associated with significant improvement in cancer-related fatigue. There was also no significant benefit from methylphenidate plus a nursing telephone intervention on cancer-related fatigue. Counseling (more specifically, cognitive-behavioral therapy [CBT]) for stress management, depression, and anxiety may reduce distress and fatigue as well as improve mood. If the level of fatigue does not improve after correction of these abnormalities, it is clear then that further treatment will not result in improvement in the future.
A 148-patient study by Moraska et al also found no significant improvement in cancer-related fatigue with long-acting methylphenidate compared with placebo. Common symptoms at this stage include, “Anxiety starts to set in, and the person becomes easily irritable. Similar to the previous studies of Bruera et al and Moraska et al, fatigue improved among patients treated with modafinil but there was no significant difference between the active and placebo treatments.
Based on these results, future studies of psychostimulants should be focused on a specific patient group, such as fatigued patients with depression or drowsiness.
Infections can become recurrent, and PMS and menstrual irregularities surface, symptoms suggestive of hypothyroidism (such as a sensation of feeling cold along with a sluggish metabolism) become prevalent.” (5).



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