fatigue Flashcards
drug ass with fatigue
beta blockers, TCA, benzo, hyponotics, opoids, neuropathic pain medication, sedating antihitamine, antipsychotics, caffeine, alcohol
precipitating factors of fatigue
briefment, infection,
symptoms of fatigue
lack of energy difficulty or inability to initiate activity reduced capacity to maintain activity exhaustion after usual activity difficulty with concentration and memory
what does fatigue mean
excessive sleepiness
exertional dyspnoea
muscle weakness
what sleep history to ask
Sleep quantity and quality, sleep hygiene
Insomnia, hypersomnia
Snoring, apnoea, daytime sleepiness
Risk factors for obstructive sleep apnoea
some ddx for fatigue
Fevers, change in weight, night sweats, dyspnea
Bleeding (GIT, menstrual)
Anaemia, Hypothyoridism, Diabetes Mellitus
?undiagnosed cancer, cardiac, pulmonary, renal, liver,
rheumatologic, chronic infection
investigation for fatigue
Full Blood Count
ESR or CRPRandom or fasting blood glucose
Thyroid Stimulating Hormone (TSH)
Biochemistry: electrolytes, liver function tests, renal function tests
especially if fatigue > 6 months
+/- Endomysial antibodies / tTGA
+/- Hepatitis/HIV serology
classify causes of fatigue
psychiatric, sleep disorder, stress and high demand, physical disorders
common cause of fatigue
Tiredness>Viral disease>Iron deficiency anaemia>Depressive disorder>Mental disorder>Infectious mononucleosis>Anaemia >Infectious disease
Causes of fatigue present for ≥ 2 weeks
Depression>Other psychiatric disorders (mainly anxiety, dysthymia)> Boredom, overwork, other types of unhappiness>Alcohol misuse>
Obstructive sleep apnoea>Fibromyalgia> anaemia, DM, hypothyroidism, infection, cancer
Management of fatigue < 6 months
Treat underlying cause / co-morbidities
Address underlying psychosocial stressors
Sleep Hygiene
Exercise and activity
Chronic fatigue
Non-specific (idiopathic) chronic fatigue
> 90%
Chronic Fatigue Syndrome (systemic exertion intolerance disease)
< 10%
chronic fatigue sydnrome dx
reduction in functinal compacity
post-exerional malaria, unfreshing sleep, cognitive impairment or osthostatic intolerance
Chronic Fatigue Syndrome Management
Cognitive behavioural therapy (CBT)
Graded exercise therapy
Manifestations of fatigue
Impaired performance – increased risk of errors and accidents
Increased probability of falling asleep / micro sleeps
Subjective feelings of drowsiness or tiredness
17 hrs awake: cognitive impairment ∞ BAC ̴0.05, 24 hrs – > ∞ BAC ̴0.1
Psychological, social, cardiovascular, metabolic consequences
Workplace factors predicting higher fatigue risk
> 70 hours worked in a seven day period
≥ 14 consecutive hours worked in a seven day period
One full shift of at least 24 hours
No short breaks taken on shift
Overtime > 20 hours
≥ 3 night shifts or extended hours into night shift during a seven day period
No stable shift direction
Job demands: sustained concentration for extended periods of time
Rostering
Forward shift rotation ‘Fast rotation’ ≥ 8 hours continuous sleep before commencing next shift Maximum 3-4 consecutive night shifts Regular time (≥ 24 hours) free of work in a seven day period
Individual measures for shift work
Diet: low fat, high protein, avoid high sugar Ensure well hydrated Strategic use of caffeine Strategic napping e.g. 2am – 3am beware > 30 minutes (sleep inertia) Shield morning light exposure Avoid use of sedative hypnotics to facilitate sleep Avoid driving home if fatigued
Sleep Hygiene
Preparation for sleep Avoid light emitting screens Consistent sleep-wake schedule Avoid caffeinated beverages after lunch or 4-6 hours prior to bedtime Avoid alcohol near bedtime Exercise > 4-5 hours before bedtime Air conditioning, block-out curtains, sound insulation
