Sunday, August 28, 2011

Extreme Tiredness in Women

Extreme tiredness in women differs from tiredness associated with occasional fatigue or afternoon sleepiness. Occasional fatigue or afternoon sleepiness goes away with adequate rest and sound, deep sleep. Extreme tiredness that does not go away with rest and nutrition may indicate an underlying disorder or cause that your physician should evaluate. An ongoing physical or mental condition that causes extreme tiredness may or may not be treatable. According to the following are four reasons why women (and men) may be suffering from extreme tiredness.

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Anemia: Your red blood cells contain hemoglobin, or a protein high in iron, which carries oxygen throughout the body. Anemia is a reduction in the number of red blood cells, which causes a reduction in the oxygen-rich blood that reaches the tissues and organs of the body. Causes of anemia include blood loss, inadequate red blood cell production and destruction of red blood cells. According to the National Heart Lung and Blood Institute they stated that the most common symptom of anemia is fatigue. Anemia ranges from mild to severe, which may require a blood transfusion or blood and marrow stem cell transplants to produce new blood cells. Not getting enough sleep that causes afternoon sleepiness may also be the result of restless leg syndrome (RLS) a sleep disorder. Restless legs syndrome is more common in those with iron-deficiency anemia. Iron deficiency anemia is caused by insufficient dietary intake or absorption of iron to replace losses from menstruation or losses due to diseases. Iron is an essential part of hemoglobin, and low iron levels result in decreased absorption of hemoglobin into red blood cells. In the United States, 20% of all women of childbearing age have iron deficiency anemia, compared with only 2% of adult men. Mild to moderate iron-deficiency anemia is treated by oral iron supplementation with ferrous sulfate, ferrous fumarate, or ferrous gluconate. When taking iron supplements, it is very common to experience stomach upset and/or darkening of the feces. The stomach upset can be alleviated by taking the iron with food; however, this decreases the amount of iron absorbed. Vitamin C aids in the body's ability to absorb iron, so taking oral iron supplements with orange juice is beneficial.

Chronic Fatigue Syndrome: Chronic fatigue syndrome, or CFS, is prolonged, severe fatigue that does not go away with rest, and there are no known underlying conditions contributing to the fatigue. MedlinePlus, a service of the National Institutes of Health, reports that CFS is most common in women from age 30 to 50. Women are four times as likely as men to develop CFS. No diagnostic criteria exist for CFS. The only way to obtain a diagnosis is to rule out other causes of extreme tiredness, such as infections, autoimmune disorders, depression, muscle diseases, tumors or nerve disorders. A higher percentage of women with CFS may experience irregular and painful menstrual cycles, hormone imbalances affecting menstruation, a worsening of symptoms at menopause and ovarian cysts than healthy women. Some medical professionals suspect an association between CFS and endometriosis, but data is still very preliminary. Women and men with CFS may be at higher risk for osteoporosis, due to restrictive diets and inability to perform weight-bearing exercise.

In addition to the extreme, long-lasting fatigue, symptoms associated with CFS include a mild fever, joint pain without swelling, forgetfulness, difficulty concentrating and muscle aches. CFS treatment focuses on symptom management, such as good nutrition, muscle relaxation and sleep aids along with cognitive behavior therapy. See more information about chronic fatigue syndrome symptoms. Some people say their CFS symptoms get better with complementary or alternative treatments, such as massage, acupuncture, chiropractic care, yoga, stretching, or self-hypnosis. Treating chronic fatigue syndrome with alternative methods, dietary supplements, and herbal remedies claim to cure CFS, but they might do more harm than good. Talk to your doctor before seeing someone else for treatment or before trying alternative therapies.

Cancer-Related Fatigue: Cancer-related fatigue, or CRF, is common in all types of cancer and cancer treatment. (CRF - sometimes simply called "cancer fatigue") is one of the most common side effects of cancer and its treatments. It is often described as "paralyzing." Usually, it comes on suddenly, does not result from activity or exertion, and is not relieved by rest or sleep. It may not end - even when treatment is complete. The extent of the fatigue depends on the location of the cancer and the type of treatment regimen required. The National Cancer Institute reports that fatigue is common following chemotherapy or radiation therapy, with long-term fatigue more common in older patients with advanced cancer or those receiving both types of therapy. Other causes of CRF include underlying anemia, toxins from the treatment, anxiety, sleep disorders and medications in addition to the chemotherapy.

Relaxation techniques such as audio tapes that teach deep breathing or visualization can help reduce stress and minimize cancer fatigue. The first step in treating fatigue is knowing that the problem exists. Many people don't bother to mention fatigue to their doctors because they believe it is normal. It is vital that you discuss this and all symptoms or side effects with your health care provider. Then, efforts can be directed at determining the cause of the problem and prescribing appropriate treatment. Your particular cancer treatment regimen, with its known side effects, may provide clues for your doctor or health care professional

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Sjogren's Syndrome: Sjogren's syndrome is a chronic autoimmune disorder. Also known as "Mikulicz disease" and "Sicca syndrome", it is a systemic chronic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva. Nine out of ten Sjögren's patients are women and the average age of onset is late 40s, although Sjögren's occurs in all age groups in both women and men. It is estimated to strike as many as 4 million people in the United States alone making it the second most common autoimmune rheumatic disease.

Excessive tiredness, muscle aches and pains, joint pain, dry mouth and dry eyes are common symptoms of Sjogren's syndrome. There are two types of Sjogren's syndrome: primary--the disease is not associated with any other illness; and secondary--other diseases such as systemic lupus erythematosus or rheumatoid arthritis are present. The Cleveland Clinic reports that more than a million people in the United States have Sjogren's syndrome, and over 90 percent are women.

It is important to rule out hypothyroidism (which may develop in up to 20% of Sjögren's syndrome patients), anemia (due to decreased production of blood cells as well as blood loss from taking medicines such as aspirin, Advil or Naproxen for the joint pains), and poor sleeping patterns (especially due to frequent trips to the bathroom at night because of large oral fluid intake during the day). Decrease in memory and concentration sometimes occurs and may be to the release of inflammatory substances by the immune system. They can also occur due to disrupted sleep pattern. Skin rashes, lung inflammation, swollen lymph nodes, and other symptoms also occur.

The initial trigger that sets off the autoimmune conditions remains unknown. Circumstantial evidence suggests that a virus is involved. One possible candidate is the Epstein-Barr virus (EBV), which causes infectious mononucleosis, a condition characterized by sore throat and swollen glands, joint aches and fatigue. Virtually all adults have been infected with Epstein Barr infection by the age 20 years. After the initial infection, this virus normally resides in the salivary glands for life but causes no problems. Some experts have speculated that this virus (or a closely-related virus) may trigger an autoimmune response in genetically susceptible individuals. It needs to be emphasized that there is no direct proof that those with Epstein Barr virus symptoms or EBV itself plays a significant role in Sjögren's syndrome.

Fatigue is probably the most common complaint in patients with Sjögren's syndrome. Fatigue may have many causes, including those related directly and indirectly to the Sjögren's syndrome. Two types of fatigue should be considered. The first type is late morning or early afternoon sleepiness. In this case, the patient arises with adequate energy but simply "runs out of gas." This type of fatigue suggests an inflammatory or metabolic development. Patients describe this type of fatigue as "flu-like" symptoms, and it results from an active immune system producing specific hormones of inflammation called interleukins. To help determine whether fatigue is due to active inflammation, blood tests called "sedimentation rate" or "C-reactive protein" are ordered by your physician, since these tests are usually elevated by the same interleukins that cause fatigue.

A second type of fatigue is "morning fatigue," where the patient arises in the morning and does not feel that he/she has obtained an adequate night's sleep. This is also quite common in Sjögren's syndrome and may exist in addition to "inflammatory" fatigue. For example, patients may have inadequate sleep due to joint or muscle pain. Also, Sjögren's patients often drink a great deal of liquid during the day because of dry mouth and throat. Then at night, the patient may be awakened three or four times to urinate. This disrupts the sleep pattern and leads to morning fatigue. When this is the case, it is best to treat the symptoms directly and better sleep should follow. For example, humidifiers and oral lubricants (i.e., saliva substitutes) at night might be beneficial. Nonetheless, there may be periods when one doesn't sleep well, and it is important not to allow certain negative sleep rituals to become habits. All persons, especially those with a tendency to poor sleep or daytime fatigue should adhere to the following general suggestions for good sleep:

1. Maintain a regular and consistent wake-up time. Do not oversleep or spend excessive amounts of time in bed.

2. If unable to sleep, it is better to get up and do something else that is quiet, restful, and enjoyable, such as reading, knitting, or doing a puzzle. Do not lay in bed and try too hard to sleep.

3. A steady daily amount of exercise probably deepens sleep.

4. Stress reduction techniques such as meditation, biofeedback, or progressive relaxation are encouraged.

5. Caffeine should be avoided after lunch, and alcohol should be avoided after dinner. In some people, even one cup of coffee or one alcoholic beverage is enough to disturb sleep.

6. The bedroom should be quiet, dark, and comfortable. During the daytime, exposure to sunlight for even one hour at a regular time can strengthen circadian rhythms and improve the quality of sleep. Especially in San Diego, get outside for your lunch hour or take a walk after dinner.

Sometimes following good sleep habits is not enough to improve afternoon sleepiness and poor sleep due to extreme tiredness. If this is the case, a specific evaluation for sleep disorders can be done. Certain people may have a higher risk of physiologic sleep disorders including muscle cramping, including RLS which requires additional treatment on its own. Treatment can vary depending on the severity of the muscle spasms. Some patients respond to quinine and vitamin E at bedtime, while others require prescription medication like Klonopin. Klonopin (clonazepam), a member of a drug family called benzodiazepams (that includes Valium and Ativan) have the ability to prevent muscle spasms and were first developed to prevent muscle rigidity associated with seizures. Medications such as Elavil (amitriptyline) or Pamelor (nortriptyline) are commonly prescribed for sleep disorders but are generally not well tolerated by Sjögren's patients due to their side effect of increased dryness.

Finally, sleep disruption can occur due to sleep apnea. Sleep apnea is suspected in patients who snore loudly or awake at night gasping for breath. Patients with recent weight gain (often due to corticosteroids) may develop sleep apnea. This problem requires the expertise of a sleep center for evaluating and treating chronic fatigue. See more information regarding sleep apnea in: Sleep Apnea vs Depression. The content provided in Extreme Tiredness in Women is for information purposes only, intended to raise the awareness of different solutions for you or your families sleep problems and should not be considered medical advice. For medical diagnosis and treatment, please see your qualified health-care professional.

Resources: Various Wikipedia data, LiveStrong’s author Norene Anderson a registered nurse with intensive care experience in a wide range of medical conditions and treatments. Anderson received her associate degree in nursing from Lincoln University, Jefferson City, Missouri and

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