What are some common causes of drowsiness
What is actually behind ... abnormal fatigue?
If someone complains that they are constantly tired, it helps to clarify a few points in advance:
- Is there really tiredness or rather exhaustion in the sense of exhaustion and listlessness?
- How is sleep Are you having trouble falling asleep or staying asleep?
- What other symptoms and illnesses does the person affected have?
The background to these questions is the exclusion of chronic and mental illnesses, v. a. depression. Because even chronic sinusitis is usually associated with a decline in performance and abnormal fatigue.
Depression. 15% of all people suffer from depression that requires treatment at least once in their lifetime. Typical symptoms are listlessness, loss of interest, easy fatigue, attention and concentration disorders, feelings of inner emptiness, reduced self-esteem, feelings of guilt and fear of the future. Often, however, those affected only describe physical symptoms such as tiredness or pain. The high risk of suicide is dangerous: every second suicide is committed by depressed patients.
Dementia. Dementia developments are often accompanied by fatigue. One reason is the disturbed day-night rhythm.
Burnout syndrome. The cause is constant stress, which is often job-related, but pupils, students and athletes are also affected. The focus is on mental exhaustion: You feel burned out and empty. Those affected often experience apathy and listlessness as inexplicable tiredness.
Chronic somatic diseases. Any long-term illness threatens abnormal fatigue. The causes are varied:
- The disease and the recovery process cost strength, e.g. B. Even with antibiotics, the body needs at least two weeks to cure pneumonia.
- Pain and other complaints prevent restful sleep.
- The cardiovascular system is restricted and with it the basic functions of the metabolism. With severe heart failure, those affected are often exhausted and tired all the time.
- Constant pain and limitations frustrate and trigger or exacerbate depression.
Vicious circle of illness - sleep disorder - fatigue
In practice, breaking the cycle of chronic illness, unrefreshing sleep and abnormal fatigue is a priority.
Here it is v. a. In the case of chronic illnesses, it makes sense to specifically treat complaints that severely limit the quality of life through tiredness and exhaustion, such as depression or pain.
Drug side effect. Many drugs that act on the central nervous system can cause or worsen tiredness. Above all, benzodiazepines and other tranquilizers and hypnotics lead to pronounced daytime sleepiness. In addition, after a few days, but at the latest after two to three weeks, the quality of recovery of the forced night sleep deteriorates. Sometimes it helps to change the substance to a drug with a shorter half-life. The better alternative is the patient-controlled interval intake: The tranquilizer is only taken every two to three days or when necessary.
Sleep apnea syndrome. The cause is a breathing regulation disorder, which leads to breathing pauses in deep sleep phases. Those affected are almost always overweight and often drink too much alcohol. During the day in particular, they are extremely tired and often nod off.
The brain then repeatedly sounds the alarm at night due to the lack of oxygen. Sleep is interrupted, but usually without the person fully waking up. The result is an increased sympathetic tone and often associated hypertension and cardiac arrhythmias.
For treatment, the patient must reduce weight and limit alcohol consumption. Otherwise he is ventilated during the night. The patient is given a mask that supplies oxygen-rich air with a slight excess pressure. If he cannot cope with this nightly ventilation, a mouth splint can be adjusted. This keeps the mouth almost closed and pulls the lower jaw forward so that the tongue does not slide back and the airways remain free.
Narcolepsy. This rare clinical picture is characterized by sleep attacks during the day. Affected people lose their body tension completely for 10 to 30 minutes, so that they collapse. Then they cannot remember it.
A cure is not possible. Symptomatically, those affected receive stimulants such as Modafinil to combat daytime sleepiness and sodium oxybate to counteract the loss of body tension. It is important to have a very regular daily rhythm with one or two short naps.
Chronic Fatigue Syndrome. This chronic fatigue syndrome, observed especially in cancer patients, is characterized by a lack of resilience and rapid exhaustion. In contrast to sleep apnea and narcolepsy, those affected do not fall asleep spontaneously, but rather suffer from nocturnal sleep disorders, concentration disorders, chronic pain and all the signs of depression. Since the pathophysiology of chronic fatigue syndrome is unknown, it can only be treated symptomatically. Acetylsalicylic acid or paracetamol help against pain, and mood enhancers such as St. John's wort help against depression.
Endocrinological diseases. Hypothyroidism is the most common endocrinological cause of fatigue; others are very rare.
conclusion for practice
Abnormal fatigue has many causes. Often there are serious illnesses behind it. It should be taken seriously, especially as an indication of depression. The accompanying symptoms usually point the way to diagnosis. If it is possible to treat the cause, the tiredness disappears and the joy of life returns.
A. S. Fauci et al .: Harrison's internal medicine, ABW, Berlin, 17th edition 2009
A. Sturm and W. Zidek (eds.): Checklist XXL differential diagnosis internal medicine. Thieme, Stuttgart 2003.
A. Schäffler (Ed.): Gesundheit heute, 2nd edition 2009, Deutscher Apotheker Verlag, Stuttgart
Schäffler & Kollegen: What is ... behind sleep disorders ?, DAZ 22/2009
Dr. med. A. Schäffler & Koll.,
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