Get Rid Of Tiredness and Sleep Less
An individual's moods are sometimes characterized by extremes, or pathological deviations. But most of the time, people fall within a middle range of feelings that occur periodically during daily life patterns. These middle range feelings, which are the main focus of this book, have important biological significance, and represent essential information about personal transactions with the world. As I shal attempt to demonstrate in Chapter 3 and elsewhere, certain core mood states give vital signals about one's readiness for action and need for rest and recuperation. Feelings of energy and tiredness arc the subjective signal
Consider an experiment where a researcher is trying to find out whether it is harder to understand the writing of Joseph Conrad (reputed to be difficult) compared to Charles Dickens. The researcher might select pieces written by the two authors (matched on length at least) and give them to a group of participants to read, followed by a comprehension test. This is a related design, as each person is in both samples. This has the advantage of matching the participants with themselves, so reducing possible errors due to differences between individuals (we will not have all the English enthusiasts in one sample). However, there are other problems to watch for. If the participants read the Dickens piece first followed by the Conrad they might perform worse on the Dickens, not due to comprehensibility, but because they read it first and it is not so fresh in their minds. We have introduced the confounding factor memory time into the experiment. To overcome this we must counterbalance the...
One of the most common conditions that occurs with bulimia is depression, which affects between SO and 65 of bulimic women (T. Pearls tein, Eating disorders and comorbidity, Archives of Women's Mental Health (2002) 4 67-78.) People who suffer from depression have symptoms such as losing interest in things they used to love to do, feeling dejected or hopeless, experiencing changes in how their bodies function, feeling tired out of proportion to their physical activity, having school problems, and thinking about suicide. Bulimia often develops in response to or along with the depression.
Leg pain caused by a lack of oxygenated blood getting to the leg muscles is referred to as claudication. This typically results from the same atherosclerotic process that blocks coronary arteries. As you exercise your legs, by walking for example, they feel tired and start to ache. Resting causes the aching and tiredness to go away, and you can get up and walk further. The claudication may occur in various portions of the leg, including the calf, thigh, or buttocks, depending on where the artery is blocked. However, tiredness in the legs or leg pain can also be due to other causes, including disc problems in the lower back.
Once discharged from hospital, it can be helpful for the person to understand the possible causes of their tiredness, and discuss strategies for coping with it. These would involve keeping active and returning to or developing interests, using energy wisely, dealing with concerns and depression, organising their day and prioritising, pacing and delegating activities. Staying cool and keeping work areas well ventilated may also help.
Heath and Heath37 reviewed 122 personal patients with primary HPT who were managed conservatively. Parathyroidectomy was recommended for patients with complications and definite symptoms of the disease, whereas for asymptomatic patients and those with mild, nonspecific symptoms, surgery was offered only if they were young the threshold for being young declined during a 10-year period from 60 to 40 years. Diagnosis was based on hypercalcemia associated with elevated or high-normal serum PTH levels. The most common symptom in men was renal stones and in women tiredness and lethargy, and these symptoms were present in 10 of the conservatively monitored group. Ninety-five patients were available for follow-up after a mean of 6 years in four patients, renal stones developed but serum calcium and creatinine levels did not deteriorate. Fifteen patients died. Although no deaths were attributable to HPT, the group of patients who subsequently died had a rise in serum creatinine levels, but...
In postmenopausal women with primary HPT, a neuropsychiatry disability with symptoms of tiredness, lethargy, weakness, and easy fatigue is the most common feature. Although these are not traditional symptoms of HPT, they are typical for the disease, and many patients report improvement after successful parathyroidectomy.24 The oldest patients may present with mental confusion, even without profound hypercalcemia, and their mental capacity may recover dramatically after operation.48 It is important that these symptoms be recognized as features of the disease and constitute indications for surgery. The psychiatric disability is generally more evident when serum calcium levels are more markedly elevated, but the effects of surgery on the symptoms may sometimes be difficult to predict in individual patients.46
Consult this chart if you experience any involuntary or uncontrolled movements. Such movements may range from slight twitching to prolonged, repeated trembling or shaking of the arms, legs, or head. Brief episodes are often simply the result of tiredness or stress and are rarely a cause for
In healthy individuals, fatigue is a general term used to describe feelings of tiredness, reduced energy, and the increased effort needed to perform tasks effectively and avoid errors. It occurs as performance demands increase because of work intensity and work duration, but it is also a product of the quantity and quality of sleep and the time of day work occurs (Dinges, 2001). All of these factors are relevant aspects of residency training duty hours (Buysse et al., 2003). Some current aspects of resident duty hours can interfere with normal sleep patterns and lead to sleep deprivation, with the extent of this deprivation differing according to the workload demands and schedule of each residency specialty.
Describe changes in your activity and energy levels as your depressive episodes develop (examples feeling slowed down, withdrawing from people, moving more slowly, talking more slowly, doing fewer things, having little or no sex drive, feeling fatigued, feeling tired but wired ).
The traumatically brain-injured subject invariably complains of problems with memory, attention, irritability, tiredness, and vague depressive and anxious mentation. The assessor is astounded if the subject does not complain of these and if he or she does not, the assessor will invariably ask why not. In this context it is quite easy for the injured subject to learn how to play the game and present the most convincing set of symptoms to achieve the desired outcome. in the future due to its ineffectiveness in eliciting the desired outcome. The presence of ongoing compromise following mild traumatic brain injury (MTBI), chronic unremitting tiredness, ongoing pain, prolonged reactions to commonly encountered products and chemicals, or the presence of migrainous headaches may result in a more sympathetic hearing on the part of the GP and, as a consequence, validation of the problems by the world.
Psychological counseling was beneficial for parents and helped them deal with their child's illness. Counseling was cited as being particularly useful in situations in which parents felt guilty or responsible for their child's illness. Specifically, parents found it helpful to be reassured that feelings of guilt, tiredness, frustration, anger, and impatience with their ill child were normal. Many parents believed that counseling should be offered regularly rather than waiting for parents to ask for the service. Lastly, parents found it important to maintain family stability by spending some time with the well sibling while caring for their sick child. Parents also found it helpful for the well child to receive developmentally ap
Tiredness, sleepiness, and a sense that sleep is not refreshing are characteristic symptoms of sleep apnea, often accompanied by impaired memory and concentration. The sleepiness often increases gradually over several years as patients gain weight. Some patients feel mentally dull or disoriented each morning. Daytime sleepiness is usually most apparent after lunch, while driving or reading, or in other boring sedentary situations. Patients often minimize difficulties with sleepiness and describe it as no worse than in colleagues or peers. With more severe apnea, patients may fall asleep on the telephone or during sexual intercourse and may have episodes of automatic behavior during which complex activities are performed such as driving for miles with no recollection. Although daytime
The common perception that exercise results in fatigue is frequently wrong. One of the most interesting things about subjective energy is that often this feeling is immediately enhanced by moderate exercise. I am not speaking here of the enhancement that comes over time with physical conditioning. Instead, my point is that on any single occasion energy is often increased by moderate exercise, and the effect can continue for minutes if not hours. At first thought, this doesn't seem logical. After all, exercise involves energy expenditure, and therefore, it should result in tiredness. Nevertheless, on the basis of experimental data, plus some speculative biological theory, it appears that much of the time the immediate effect of moderate exercise is increased energy. Feelings of fatigue do result from exercise, of course, under certain conditions. For example, if one is already exhausted from physical labor, additional exercise is unlikely to increase energy instead, the opposite will...
Current evidence suggests at least eight essential features ought to be incorporated in any comprehensive understanding of mood. The first feature is that mood involves conscious awareness. Moods may be judged by behaviors, or they may even be inferred by bodily postures, but first and foremost, mood is part of consciousness. Certainly no conclusions concerning mood could be drawn without some sort of description or self-rating by an individual of how he or she feels. Although some moods such as low-level depression may be unrecognized by a person suffering from the malady, nevertheless, that individual would be aware of such telltale feelings as tiredness or an absence of energy. The cyclicity of moods provides fundamental evidence of their biological underpinnings. This cyclicity is most strong for certain types of mood for example, energy, tiredness, or related states of alertness but it is highly likely that all sorts of moods have cyclical characteristics. Sleep is one of the...
The interesting studies of Mickeviuiene and colleagues (Mickeviuiene et al., 2002 Mickeviuiene et al., 2004) are of particular note here. In their study, 300 participants with concussion were followed up for one year postinjury and examined with regard to the usual observed symptoms of PCS (Mickeviuiene et al., 2004). The study had the advantage of eliminating a number of the confounding factors associated with studies of PCS in the United States, United Kingdom, and Australia regarding compensation-related issues, as there was little possibility of economic gain associated with the injury in Lithuania (Mickeviuiene et al., 2002). After one year, the vast majority of symptoms demonstrated no difference between the injured and the control groups, with most of the concerns (e.g., headache, irritability, nausea, etc.) resolving by three months, but with some difference in memory, concentration, dizziness, and tiredness still noted at the one-year follow-up. The authors considered that...
Noncompliance of the peripheral arteries may cause hypertension with a widened pulse pressure. Systolic blood pressure rises progressively with age, whereas diastolic pressure levels off in the sixth decade of life these developments lead to an increased prevalence of isolated systolic hypertension. Coronary atherosclerosis may produce angina, myocardial infarction, or nonspecific symptoms such as confusion or tiredness.
Hormone therapy can also cause weight gain and muscle loss. Exercise and diet regimens can help with these problems. Hormone therapy can also cause tiredness and lethargy, memory problems, and moodiness. The lethargy and tiredness may improve over time, but regular exercise can give men more energy and help them cope.
Waking, whereas after several years the pattern tends to be more consistent with persisting somnolence. The incidence of insomnia is about 30 of TBI patients. While a number of other sleep disorders can occur in the context of TBI these tend to be relatively rare. The downstream effects of sleep disturbance including increased tiredness, irritability, and compromise in levels of attention and concentration have profound implications for the day-to-day functioning of individuals following TBI, indicating that restoration of appropriate patterns of sleep is one of the highest rehabilitation priorities for TBI-affected individuals.
This chapter is about some of these important rhythmicites as they apply to mood. It deals with the circadian rhythmicity of such subjective states as energy, alertness, tiredness, and fatigue. Multiday periods as well as cycles of one to two hours are considered. The relationship of predictable diurnal (daily) rhythms to fundamental self-perceptual processes is also discussed. In particular, it appears that circadian rhythms of energetic arousal may be key components to the subtle daily shifts in the way that people perceive the apparent seriousness of personal problems, and to variable states of optimism, individual differences in arousal rhythms in relation to personality characteristics such as morningness-evening-ness and introversion-extraversion are discussed here as well. Finally, this chapter provides some speculations about the possible applications concerning the chronobiology of energetic and tense arousal to social interaction. Although moods of energy and tiredness are...
In all these situations, the tricuspid valve itself is anatomically normal and the regurgitation is caused by right ventricular dilatation. The latter will stretch the tricuspid annulus and cause tricuspid regurgitation. The latter occurs in late stages when right ventricular hypertrophy is no longer able to compensate for the pressure load. The high-pressure tricuspid regurgitation is often less well tolerated by the right ventricle. The right ventricular hypertrophy would usually precede the development of the tricuspid regurgitation, and the right ventricular diastolic pressures, in particular the pre-a wave pressure, would be elevated. This will lead to significant elevation of the right atrial and jugular venous pressures. The raised venous pressure would cause systemic venous congestion, resulting in abdominal distension, hepatomegaly, pulsatile liver, and peripheral edema. The jugular venous contour will be abnormal, reflecting the tricuspid regurgitation showing...
The questions about distress and well-being illustrate the psychometric technique of balancing in that a positive answer is sometimes the pathological indicator and sometimes a negative response is. The questions to which a positive response is indicative of illness concern ''nervousness,'' ''being in the dumps,'' ''feeling downhearted and blue,'' ''feeling worn out,'' ''feeling tired.'' The questions to which a negative response points in the direction of illness are ''feeling full of pep,'' ''feeling calm and peaceful,'' ''feeling full of energy,'' ''being a happy person.''
Patients with brain tumors experience a number of adverse symptoms that negatively affect their ability to function in usual work, leisure, and social roles. These include cognitive impairment, neurologic signs and symptoms, fatigue, mood disturbance, sleep disturbance, and sexual dysfunction. These symptoms occur in a majority of patients on active therapy, and occasionally are the first symptoms that herald the initial diagnosis. In addition, these symptoms often persist after treatment is discontinued. Most patients who have a brain tumor experience cognitive impairment, including restricted working memory capacity (e.g., how much information the person can process on-line ), distractibility, and problems multitasking. They often experience generalized slowing and must exert increased effort when performing even routine activities. In addition, many patients experience fatigue related to their disease and treatment that compounds cognitive impairment. This fatigue is an unusual,...
The patient returns to your clinic 2 years later with complaints of feeling tired all of the time. She had been trying to exercise more, but has not had enough energy to exercise for the past 6 months or so. She also complains that she feels cold all of the time, despite increasing the temperature in her house.
By contrast, the symptoms of chronic leukemias are generally far more subtle. It is not uncommon for the disease to be discovered accidentally when a blood test is carried out for an unrelated reason. The most common symptoms are loss of energy, tiredness, fever, night sweats, and loss of appetite. There may also be enlargement of the liver and spleen and the lymph nodes.
Patients with neurogenic claudication report tiredness, heaviness, and discomfort in the lower extremities with ambulation. The distance walked until symptoms begin and the maximum distance that the patient can walk without stopping varies from day to day and even during the same walk. Patients report that leaning forward relieves symptoms. These patients may not experience symptoms during activities performed in a flexed posture such as riding a bicycle or walking uphill. In contrast, activities performed in extension such as walking downhill tend to worsen symptoms. Patients with vascular claudication describe cramping or tightness in the calf associated with ambulation. The distance they are able to walk before symptoms occur is constant. Their symptoms are not affected by posture. They are unable to tolerate walking uphill, walking downhill, or cycling.
A scientifically unacceptable study of the effect of aromatherapy on endometriosis, reported only at an aromatherapy conference (Worwood, 1996), involved 22 aromatherapists who treated a total of 17 women in two groups over 24 weeks. One group was initially given massage with essential oils and then not touched for the second period, while the second group had the two treatments reversed. Among the many parameters measured were constipation, vaginal discharge, fluid retention, abdominal and pelvic pain, degree of feeling well, renewed vigor, depression, and tiredness. The data were presented as means (or averages, possibly, as this was not stated) but without standard errors of mean (SEM) and lacked any statistical analyses. Unfortunately, the study has been accepted by many aromatherapists as being a conclusive proof of the value in treating endometriosis using aromatherapy.
Involves blockages of the lower aorta as well as the arteries in the pelvis coming off the aorta, including the iliac arteries. It is characterized by claudication, which is pain, aching, and tiredness of the legs and buttocks. It is associated with erectile dysfunction.
Kreutzer, Seel, and Gourley (2001) for example, noted in their extensive review of the literature that the most frequently endorsed depressive symptoms after TBI were tiredness (46 ), frustration (41 ), and poor concentration (38 ). As noted above, these symptoms are core symptoms of postconcussional syndrome (PCS) discussed in chapter 2. Kreutzer et al. (2001) further noted that the symptoms of irritability, lack of interest, slowness of movement, fatigue, and forgetfulness were the most common symptoms observed after TBI irrespective of the presence or absence of
Although often conflated, motives and needs should be distinguished from each other. For example, we need to sleep in order to replenish our body. However, the motive for going to sleep is generally not to replenish our body but rather to respond to a feeling of tiredness or sleepiness or perhaps to escape a burdensome task. A child may want to stay up most of the nighty but he or she needs to get enough sleep. The child does not know-that he or she is tired or sleepy and therefore is not motivated to go to sleep, yet the child nevertheless needs to sleep. Likewise, although we need to eat to meet nutritional requirements, we are often motivated to eat not by nutritional needs but because the food tastes good or because we have a lunch appointment with pleasant company.
Carbon monoxide is the best understood of the classic air pollutants, at least as far as its mechanism of effect is concerned (Maynard 1999). It binds to haemoglobin in precisely the same way as oxygen and thus reduces the oxygen-carrying capacity of the blood. In addition, the oxy-haemoglobin dissociation curve is displaced to the left, making the release of such oxygen as is carried more difficult. Exposure to low concentrations produces headaches and flu-like symptoms high concentrations kill. Concentrations of carbon monoxide outdoors are generally too low to cause serious effects on health but indoor concentrations can be high and each year many deaths and hospital admissions are caused by accidental exposure to this gas. Damage to the brain may be due to the direct effect of the reduced supply of oxygen but further injury after exposure to carbon monoxide has stopped may also occur. This is an example of re-perfusion injury and is due in part to the formation of oxidative free...
Symptoms may include blood or mucus in the faeces, changes in bowel habits (diarrhoea constipation or both), anything abnormal or that lasts for more than 2 weeks, the feeling of needing to go to the toilet even if the bowels have just been emptied, pain or discomfort in the abdominal area, a mass in the abdomen or extreme tiredness, which could be the result of anaemia. These symptoms may well be caused by other conditions, e.g. a common cause of bleeding is haemorrhoids. However, it is important that anyone experiencing these symptoms should see their doctor (Cancer Research UK website, 2002b).
One of the best indications of the relationship between mood and illness comes from an extensive study that was conducted in a large primary care general medical facility. In this research, 37 percent of the patients studied reported that they had experienced severe tiredness and fatigue prior to their illness, often for many months before seeking treatment (Buchwald, Sullivan, & Komaroff, 1987 also see Kroenke et al., 1988). Specific illnesses have also been linked to moods. For example, in one study conducted by Harrigan et al. (1984) seventeen middle-aged people who suffered periodic migraine headaches completed mood measurements three times daily for twenty-one to seventy-five days. Headache periods were correlated with negative mood shifts as expected, but it was also possible to predict headaches from twelve to thirty-six hours prior to the headache. Feelings of constraint and fatigue were the best predictors, particularly in the afternoon.
This may result from primary thyroid failure, Hashimoto's thyroiditis, as a consequence of thyroid surgery, or secondary to pituitary failure. The diagnosis is suggested by tiredness, cold intolerance, loss of appetite, dry skin and hair loss. It may be confirmed by the finding of a low serum thyroxine concentration, associated, in primary thyroid failure, with a raised serum TSH concentration.
A number of chronic symptoms have also been reported by people affected by the incident, including impaired memory, joint pains and or swelling, tiredness lethargy, and problems with coordination and concentration. A number of expert groups have been convened by the government over the years to investigate whether chronic effects such as these are likely to have resulted from exposure to the contaminants released during the incident. Full details are given in the draft report of the Committee on Toxicity of Chemicals in Food Consumer Products and the Environment's Subgroup Report on the Lowermoor incident (COT 2005 ).
During the period 1993-1996, a follow-up at the 1981 Baltimore site of the Epidemiologic Catchment Area Study found an incidence of DIS DSM-IV major depression to be 3.0 per 1000 per year, with incidence peaks occurring when subjects were in their 30s and in their 50s. The gender distribution reflected true differences in new cases, rather than chronicity of major depression. Women were at higher risk of new onset major depression, but had neither higher rates of recurrence nor longer episodes of major depression than men (Eaton et al., 1997). Prodromal periods were assessed in this follow-up study (n 71) for the various symptoms of depression. The prodromal period for symptoms of anhedonia, slowness or restlessness, tiredness, feelings of worthlessness, difficulty concentrating, and sleep disturbance was found to be one year. The prodromal period for appetite disturbance, suicidal thoughts or behavior was found to be two years. The longest prodromal period occurred for the symptoms...
In relation to the model that we have presented in this chapter, although there is much less research to draw on, there nevertheless seems to be some support for the SPAARS approach. If the occurrence of pregnancy and childbirth leads to the loss of or conflict with other valued roles and goals, then the mother will experience sadness because of those losses. This reaction will be exacerbated by a poor marital relationship. In addition, the ambivalent mother is likely to experience negative feelings towards the newborn child and towards her own reactions to motherhood. The physical and mental stresses involved in supporting a newborn child with little or no other support, will make the direct route to emotion more likely, as tiredness and exhaustion reduce the capacity for appraisal-based emotional responses. The mother may catch herself reacting in completely ego-alien ways, such as shouting at the newborn. These shame-disgust-based reactions to herself and to her child may provide...
IRREGULARITIES OF THE heartbeat (cardiac arrhythmias) are the most common maladies affecting the heart. Because the heart does not pump blood as efficiently when it has an irregular heartbeat, patients with cardiac arrhythmias usually complain of tiredness and shortness of breath, especially with physical exertion. More serious cardiac arrhythmias may result in heart failure, strokes, and death. Fortunately, many cardiac arrhythmias can be successfully treated with medicines or catheters. However, when arrhythmias are not responsive to drug therapy and cannot be treated with catheters, heart surgery may be required if the symptoms are particularly severe or life threatening.
Neck pain associated with traffic accidents has been epidemic for the last two to three decades in Western societies. The complaint is usually difficult to explain from a biomechanical point of view, and there are no particular pathophysiologic changes or clinical signs. These complaints seem to be less frequent in athletes who frequently are exposed to similar or more pronounced biomechanical forces during sports. By unduly focusing on the injury mechanism, somatic symptoms, imaging and prolonged treatment and rest, physicians, physiotherapists and chiropractors may actually have reinforced symptoms i5,i6 . Thus, this epidemic in Western societies may be at least partly iatrogenic. The patient may become overcautious and complain about diffuse symptoms of tiredness, dizziness and pulsation in the neck together with chronic pain and disability.
Another common and disabling late sequel of stroke is general fatigue 90, 91 . It is important to distinguish between normal fatigue, which is a state of general tiredness that is a result of overexertion and can be ameliorated by rest, and pathological fatigue, which is a more chronic condition, not related to previous exertion and not ameliorated by rest. Many other central and peripheral neurological conditions, beside stroke, are known to be a cause of fatigue, including multiple sclerosis, amyotrophic lateral sclerosis, Parkinson's disease, post-polio syndrome, HIV, collagen diseases and others 92-95 . It is important to emphasize that post-stroke fatigue is not always a part of post-stroke depression and can occur in the absence of depressive features 90, 96 . It is estimated that about 70 of post-stroke patients experience pathological fatigue. Fatigue was also rated by 40 of stroke patients as either their worst symptom or among their worst symptoms. Fatigue was found to be an...
Although the relationship between eating and mood is of intense interest in the general culture, this area of study is highly underrepresented in the scientific literature. Popular science writers commonly assume that mood is directly affected by certain food groups (Dufty, 1975 Fredericks & Goodman, 1969), but there is a surprisingly small amount of data to support this. For example, sugar consumption is widely believed to result in tension, but recently, biochemical studies have suggested that, contrary to belief, the primary effect of sugar ingestion may be tiredness (Spinweber, 1981 Wurtman, Hefti, & Malemed, 1981 see also review by Spring, Chiodo, & Bowen, 1987). In a recent study of mine, however, sugar ingestion was immediately followed by an increase in energy, and by tiredness and increased tension after an hour (Thayer, 1987a). I have argued that tiredness could be the primary biological effect of sugar ingestion, but that observed tension increases could be a secondary...
With non-neurological symptoms classically associated with pernicious anemia, including tiredness, syncope, palpitations, sore tongue, diarrhea, and other bowel disturbances. On examination, patients demonstrated a neuropathy alone (25 percent), isolated myelopathy (12 percent), and a combined neuropathy and myelopathy in 41 percent. Memory dysfunction and affective and behavioral changes were seen in 8 percent, whereas 14 percent had a normal examination.
Back pain is the third most common bodily symptom, after headache and tiredness. So it is not surprising that people with back pain often report other symptoms. The Nuprin Pain Report (Taylor & Curran 1985) found that 90 of those with frequent back pain had multiple pains, though half of them said that back pain was the most troublesome . Bergenudd (1989) found that back pain was the most common musculoskeletal complaint in 55-year-old men and women in Sweden, but it was often associated with other pains (Table 5.3). Clinical and epidemiologic studies show that up to 60 of people with low back pain also report some neck symptoms. Makela (1993) found that many chronic musculoskeletal pains go together. The strongest association was between back pain, neck pain, and osteoarthritis of the hips and knees, though inflammatory joint disease was quite separate.
Nifedipine is a dihydropyridine derivative which is a systemic and coronary arterial vasodilator. It is effective in countering coronary artery spasm, thought to be an important component of all forms of angina, and it may bring symptomatic relief in patients with peripheral vasospastic (e.g. Raynaud's) disease. Its anti-anginal effect is additive with that of p-adrenergic blocking drugs and nitrates. Adverse effects related to the vasodilating action of nifedipine include flushing, headaches, ankle oedema, dizziness, tiredness and palpitations. Nifedipine is absorbed rapidly, particularly when the stomach is empty, with an onset of action of 20 min. This may produce reflex tachycardia and increased myocardial contractility, although nifedipine is cardiopressant in vitro. It is well absorbed ( 90 ), but undergoes significant hepatic firstpass metabolism. It is metabolized in the liver to inactive metabolites and is excreted mainly via the kidneys with an elimination
Examination of the pulse played an important role in diagnosis and prognosis in Hindu medicine. But the nature of circulation and cardiac function was not well understood, which helps to explain the sketchy nature of the descriptions of cardiac diseases in the texts. Moreover, the descriptions in the Sushruta and the Caraka do not exactly correspond. Heart disease due to disturbed Vayu that caused palpitations, pain, slowing of the heart rate, fainting fits, and murmuring sounds in the heart constitutes the only condition that truly suggests a cardiac disorder. Other diseases of the heart seem more like gastrointestinal disorders in that they could be caused by bad eating habits, and their symptoms included a sense of heaviness in the precordium, a bitter or acid taste in the mouth, tiredness, and belching. Another type of heart disease was due to parasites arising in putrefied food. Here, the parasites were thought to invade one portion of the heart and gradually destroy the rest.
Insulin is a hormone produced by the pancreas and used by the body to regulate glucose (sugar). Diabetes occurs when the body does not produce enough insulin, or cannot use it properly, leading to too much sugar in the blood. Symptoms include thirst, excessive urination, tiredness, and unexplained weight loss.
Neck pain that may radiate to the shoulder or upper extremity. In patients with pain-inhibited active range of motion a full range of motion is commonly found by passive examination with the patient in a relaxed supine position. Typical stress-related symptoms such as tiredness, concentration difficulties, dizziness and nausea may predominate.
Sleepiness should be distinguished from tiredness, fatigue, apathy, and weakness. Sleepiness is more likely to occur in boring sedentary situations, is relieved to some extent by movement or stimulation, and is associated with a feeling of impending sleep or a need to fight against sleep onset. Descriptions of daytime sleep episodes as periods of loss of awareness may suggest a diagnosis of syncope, partial complex, or absence seizures. Premonitory drowsiness, sleeplike appearance with absence of pallor, ease of arousability, and the association with sedentary situations are useful differentiating features. There are several causes of excessive sleepiness ( Ia bie 5.i-5 ). Unplanned daytime sleep episodes, or so-called sleep attacks, are an indication of severity of sleepiness rather than a marker of a qualitatively different process. They can occur with any disorder that causes severe sleepiness and are not specific for narcolepsy.
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