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Sleepiness, tiredness and fatigue are complaints which must be thoroughly analyzed to eliminate blur and ambiguity.
Physiological sleepiness (“sleep pressure”) increases while being awake and additionally underlies the circadian rhythm with a lower threshold to fall asleep during night time.
Excessive daytime sleepiness (EDS) is considered normal only after sleep deprivation. Clinically, EDS manifests by frequents daytime napping and/or reduced alertness with automatic behavior or - in its extreme form - in recurrent attacks of sudden, uncontrollable compulsion to sleep also in inappropriate situations (= “sleep attacks”).
EDS is “objectively” addressed by measuring the mean sleep latency to four to five nap opportunities throughout the day using the multiple sleep latency test (MSLT) or the maintenance of wakefulness test (MWT).
EDS denotes both, a ready entrance into sleep as well as difficulty in staying awake during daytime or accordingly in inappropriate situations. These two partially independent aspects of EDS are separately assessed by the “passive” MSLT and the “active” MWT respectively.
For that reason the MSLT and MWT only weakly correlate with each other when tested over a broad range of patients with EDS. It is important to keep in mind, that these tests are importantly influenced by a great variety of factors such as mood, anxiety, and motivation.
“Vigilance” comprises wakefulness, alertness and attention and therefore is more than just the reciprocal to sleepiness. Cognitive performance tasks such as Steer Clear Reaction Time Test (SCRTT) or driving simulators require the complete integrity of vigilance to achieve normal results. Hypersomnia is usually broadly defined as the combination of abnormally prolonged night-time sleep (regularly >10 h) with EDS during ≥1 months.
On the other hand, the term hypersomnia has also been used in a narrower scene for the isolated abnormality of a prolonged night-time sleep need (>10 h). “Tiredness”, also in colloquial language often used for sleepiness, in a broader sense also describes the feeling of lack of energy, motivation and initiative.

These patients seek rest rather than sleep. They often cannot fall asleep when given the opportunity in spite of feeling tired, and hence, in an MSLT, do not show an abnormally short sleep latency. Furthermore, tiredness (and fatigue) as opposed to sleepiness has a mental (“central”) and physiological (bodily or “peripheral”) component, which the patients can readily distinguish. Patients with insomnia, mild sleep apnea syndrome, or depression rather suffer from mental tiredness than sleepiness during the day.
The simple subjective self-assessment using the Epworth Sleepiness Scale (ESS) quite reliably differentiates between sleepiness and mental tiredness (without sleepiness), which makes it a widely used test. The term “fatigue” is also heterogeneously used.
In physiology the “fatigue” implied a “time on task performance decrement” to describe decreasing muscle force during a sustained physical effort. In clinical medicine one distinguishes physical (“peripheral”) from mental (“central”) fatigue and the term usually denotes a chronic and more abnormal situation than tiredness.
In a broad sense “fatigue” implies a deficiency in coping satisfactorily with mental and physical work load. The chronic fatigue syndrome entails both mental as well as a physical fatigue (so called “leaden paralysis” of limbs). Depressive states are often associated with insomnia and fatigue, but there are also cases with hypersomnia rather than insomnia ( non organic hypersomnia , “atypical depression” or “hypersomnolent depression”)
Sometimes these patients have a tendency to spend much of the day lying in the bed without actually sleeping (so called clinophilia). The basic and clinical aspects of fatigu

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A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed.

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Toxic shock syndrome is a rare, life-threatening complication of certain types of bacterial infections. Often toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but the condition may also be caused by toxins produced by group A streptococcus (strep) bacteria. Toxic shock syndrome historically has been associated primarily with the use of superabsorbent tampons. However, since manufacturers pulled certain types of tampons off the market, the incidence of toxic shock syndrome in menstruating women has declined. Toxic shock syndrome can affect men, children and postmenopausal women. Risk factors for toxic shock syndrome include skin wounds and surgery.

A ventricular septal defect (VSD), a hole in the heart, is a common heart defect that's present at birth (congenital). The hole occurs in the wall that separates the heart's lower chambers (septum) and allows blood to pass from the left to the right side of the heart. The oxygen-rich blood then gets pumped back to the lungs instead of out to the body, causing the heart to work harder. A small ventricular septal defect may cause no problems, and many small VSDs close on their own. Larger VSDs need surgical repair early in life to prevent complications.

Atopic dermatitis (eczema) is a condition that makes your skin red and itchy. It's common in children but can occur at any age. Atopic dermatitis is long lasting (chronic) and tends to flare periodically and then subside. It may be accompanied by asthma or hay fever.

The increased risk of thrombosis in patients with active cancer has multiple causes. Acute thrombosis of the aorta is an exceedingly rare but potentially devastating complication in patients with cancer receiving cisplatin-based chemotherapy. Prompt diagnosis and definitive treatment are imperative to decrease morbidity and mortality. Early diagnosis is difficult because initial presentation is often nonspecific, requiring a high degree of clinical suspicion. We report 4 cases of acute thrombosis of the abdominal aorta in patients with cancer receiving cisplatin-based chemotherapy. We review the clinical aspects, recommended investigation, and treatment of this potentially fatal complication.

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The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement. Doctors aren't sure why this happens to some people, although it's more likely to occur in people who have diabetes or those who recently had to immobilize their shoulder for a long period, such as after surgery or an arm fracture.

Subarachnoid hemorrhage is bleeding in the space between your brain and the surrounding membrane (subarachnoid space). Bleeding usually results from the rupture of an abnormal bulge in a blood vessel in your brain (brain aneurysm). Sometimes an abnormal tangle of blood vessels in your brain (arteriovenous malformation), trauma or other events cause bleeding. A subarachnoid hemorrhage may lead to permanent brain damage or death if not treated.

Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. You can do Kegel exercises, also known as pelvic floor muscle training, just about anytime. Start by understanding what Kegel exercises can do for you — then follow step-by-step instructions for contracting and relaxing your pelvic floor muscles.