Acne: Localized skin inflammation as a result of overactivity of the oil glands at the base of hair follicles. Acne happens when oil (sebaceous) glands come to life around puberty, when these glands are stimulated by male hormones that are produced in the adrenal glands of both boys and girls. See the entire definition of Acne
Allergic reaction: The hypersensitive response of the immune system of an allergic individual to a substance. See the entire definition of Allergic reaction
Anesthetic: A substance that causes lack of feeling or awareness. A local anesthetic causes loss of feeling in a part of the body. A general anesthetic puts the person to sleep.
Aspirin: A good example of a tradename that entered into the language, Aspirin was once the Bayer trademark for acetylsalicylic acid. See the entire definition of Aspirin
Asthma: A common disorder in which chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Asthma involves only the bronchial tubes and does not affect the air sacs (alveoli) or the lung tissue (the parenchyma of the lung) itself. See the entire definition of Asthma
Atrophy: Wasting away or diminution. Muscle atrophy is wasting of muscle, decrease in muscle mass. See the entire definition of Atrophy
Avascular necrosis: (AVN) A condition in which the poor blood supply to an area of bone leads to bone death. The head of the femur is often the site of AVN. Also called avascular necrosis and osteonecrosis.
Bacterial: Of or pertaining to bacteria. For example, a bacterial lung infection.
Bursa: A closed fluid-filled sac that functions to provide a gliding surface to reduce friction between tissues of the body. When the bursa becomes inflamed, the condition is known as bursitis. Bursa is the Greek word for "a wine skin."
Bursitis: Bursitis is inflammation of a bursa. A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.
Cartilage: Firm, rubbery tissue that cushions bones at joints. A more flexible kind of cartilage connects muscles with bones and makes up other parts of the body, such as the larynx and the outside parts of the ears.
Cataract: A clouding or loss of transparency of the lens in the eye as a result of tissue breakdown and protein clumping. There are many causes of cataracts, including aging, cortisone medication, trauma, diabetes, and other diseases. Cataracts affect most people who live into an old age. Symptoms include double or blurred vision and sensitivity to light and glare. A physician can diagnose cataracts by examining the eyes with a viewing instrument. Sunglasses can help to prevent cataracts. See the entire definition of Cataract
Chloride: The major anion (negatively charged substance) in the blood and extracellular fluid (the body fluid that lies outside cells). Blood and other body fluids have almost the same concentration of chloride ion as sea water. The balance of chloride ion (Cl-) is closely regulated by the body. See the entire definition of Chloride
Circulation: The movement of fluid in a regular or circuitous course. Although the noun "circulation" does not necessarily refer to the circulation of the blood, for all practical purposes today it does. Heart failure is an example of a problem with the circulation.
Corticosteroid: Any of the steroid hormones made by the cortex (outer layer) of the adrenal gland. Cortisol is a corticosteroid.
Cortisone: An adrenocorticoid hormone, a naturally occurring hormone made by and secreted by the adrenal cortex, the outer part (the cortex) of the adrenal gland. See the entire definition of Cortisone
Cure:1. To heal, to make well, to restore to good health. Cures are easy to claim and, all too often, difficult to confirm. 2. A time without recurrence of a disease so that the risk of recurrence is small, as in the 5-year cure rate for malignant melanoma. 3. Particularly in the past, a course of treatment. For example, take a cure at a spa. See the entire definition of Cure
Depigmentation: Loss of color (pigment) from the skin, mucous membranes, hair, or retina of the eye. See the entire definition of Depigmentation
Diabetes: Refers to diabetes mellitus or, less often, to diabetes insipidus. Diabetes mellitus and diabetes insipidus share the name "diabetes" because they are both conditions characterized by excessive urination (polyuria). See the entire definition of Diabetes
Diagnosis:1 The nature of a disease; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies. 3 The identification of any problem. The diagnosis was a plugged IV. See the entire definition of Diagnosis
Elbow: The juncture of the long bones in the middle portion of the arm. The bone of the upper arm (humerus) meets both the ulna (the inner bone of the forearm) and radius (the outer bone of the forearm) to form a hinge joint at the elbow. The radius and ulna also meet one another in the elbow to permit a small amount of rotation of the forearm. The elbow therefore functions to move the arm like a hinge (forward and backward) and in rotation (outward and inward). The biceps muscle is the major muscle that flexes the elbow hinge, and the triceps muscle is the major muscle that extends it. The primary stability of the elbow is provided by the ulnar collateral ligament, located on the medial (inner) side of the elbow. The outer bony prominence of the elbow is the lateral epicondyle, a part of the humerus bone. Tendons attached to this area can be injured, causing inflammation or tendonitis (lateral epicondylitis, or tennis elbow). The inner portion of the elbow is a bony prominence called the medial epicondyle of the humerus. Additional tendons from muscles attach here and can be injured, likewise causing inflammation or tendonitis (medial epicondylitis, or golfer's elbow). See also: Elbow bursitis; Elbow pain; Nursemaid's elbow.
Epidural: Outside the dura, the outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and the spinal cord. An epidural hematoma is a collection of blood beneath the skull but outside the dura.
Fluoroscopy: An x-ray procedure that makes it possible to see internal organs in motion. See the entire definition of Fluoroscopy
Hip bursitis: A bursa is a fluid-filled sac that functions as a gliding surface to reduce friction between moving tissues of the body. There are two major bursae of the hip. Bursitis is usually not infectious, but the bursa can become infected. Treatment of non-infectious bursitis includes rest, ice, and medications for inflammation and pain. Infectious bursitis is treated with antibiotics, aspiration, and surgery. See the entire definition of Hip bursitis
Infection: The growth of a parasitic organism within the body. (A parasitic organism is one that lives on or in another organism and draws its nourishment therefrom.) A person with an infection has another organism (a "germ") growing within him, drawing its nourishment from the person. See the entire definition of Infection
Inflammation: A basic way in which the body reacts to infection, irritation or other injury, the key feature being redness, warmth, swelling and pain. Inflammation is now recognized as a type of nonspecific immune response. See the entire definition of Inflammation
Injury: Harm or hurt. The term "injury" may be applied in medicine to damage inflicted upon oneself as in a hamstring injury or by an external agent on as in a cold injury. The injury may be accidental or deliberate, as with a needlestick injury. The term "injury" may be synonymous (depending on the context) with a wound or with trauma.
Insomnia: The perception or complaint of inadequate or poor-quality sleep because of one or more of the following: difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep. Individuals vary normally in their need for, and their satisfaction with, sleep. Insomnia may cause problems during the day, such as tiredness, a lack of energy, difficulty concentrating, and irritability. See the entire definition of Insomnia
Joint: A joint is the area where two bones are attached for the purpose of motion of body parts. A joint is usually formed of fibrous connective tissue and cartilage. An articulation or an arthrosis is the same as a joint. See the entire definition of Joint
Knee: The knee is a joint which has three parts. The thigh bone (the femur) meets the large shin bone (the tibia) to form the main knee joint. This joint has an inner (medial) and an outer (lateral) compartment. The kneecap (the patella) joins the femur to form a third joint, called the patellofemoral joint. The patella protects the front of the knee joint. See the entire definition of Knee
Laboratory: A place for doing tests and research procedures and preparing chemicals, etc. Although "laboratory" looks very like the Latin "laboratorium" (a place to labor, a work place), the word "laboratory" came from the Latin "elaborare" (to work out, as a problem, and with great pains), as evidenced by the Old English spelling "elaboratory" designating "a place where learned effort was applied to the solution of scientific problems."
Lightening: Not to be confused with a discharge of atmospheric electricity, lightening refers to the sensation that a pregnant woman feels when the baby drops. This is the time when the presenting (lowermost) part of the fetus descends into the maternal pelvis. See the entire definition of Lightening
Lumbar: Referring to the 5 lumbar vertebrae which are situated below the thoracic vertebrae and above the sacral vertebrae in the spinal column. The 5 lumbar vertebrae are represented by the symbols L1 through L5. There are correspondingly 5 lumbar nerves.
Mouth:1. The upper opening of the digestive tract, beginning with the lips and containing the teeth, gums, and tongue. Foodstuffs are broken down mechanically in the mouth by chewing and saliva is added as a lubricant. Saliva contains amylase, an enzyme that digests starch. 2. Any opening or aperture in the body. The mouth in both senses of the word is also called the os, the Latin word for an opening, or mouth. The o in os is pronounced as in hope. The genitive form of os is oris from which comes the word oral.
Muscle: Muscle is the tissue of the body which primarily functions as a source of power. There are three types of muscle in the body. Muscle which is responsible for moving extremities and external areas of the body is called "skeletal muscle." Heart muscle is called "cardiac muscle." Muscle that is in the walls of arteries and bowel is called "smooth muscle."
Necrosis: The death of living cells or tissues. Necrosis can be due, for example, to ischemia (lack of blood flow). From the Greek "nekros" (dead body).
Onset: In medicine, the first appearance of the signs or symptoms of an illness as, for example, the onset of rheumatoid arthritis. There is always an onset to a disease but never to the return to good health. The default setting is good health. See the entire definition of Onset
Osteoporosis: Thinning of the bones with reduction in bone mass due to depletion of calcium and bone protein. Osteoporosis predisposes a person to fractures, which are often slow to heal and heal poorly. It is more common in older adults, particularly post-menopausal women; in patients on steroids; and in those who take steroidal drugs. Unchecked osteoporosis can lead to changes in posture, physical abnormality (particularly the form of hunched back known colloquially as "dowager's hump"), and decreased mobility. See the entire definition of Osteoporosis
Pain: An unpleasant sensation that can range from mild, localized discomfort to agony. Pain has both physical and emotional components. The physical part of pain results from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it can be more diffuse, as in disorders like fibromyalgia. Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors. See the entire definition of Pain
Piercing: Using a sharp instrument, usually a needle, to make a temporary or permanent hole through an earlobe or other body part. Humans have practiced piercing for body decoration since prehistoric times. Unless it is performed using a sterile needle (preferably disposable), piercing can carry a risk of infection. A piercing should be kept clean; antibiotic cream may be applied if the area becomes inflamed. See the entire definition of Piercing
Plantar: Having to do with the sole of the foot. See the entire definition of Plantar
Plantar fasciitis: Inflammation of the plantar fascia (fasciitis), the "bowstring-like" tissue in the sole of the foot stretching from the heel to the front of the foot. See the entire definition of Plantar fasciitis
Recur: To occur again. To return. Any symptom (such as fatigue), any sign (such as a heart murmur), or any disease can recur.
Remedy: Something that consistently helps treat or cure a disease. From the Latin "remedium" meaning that which heals again (and again). See the entire definition of Remedy
Rheumatoid arthritis: An autoimmune disease which causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Autoimmune diseases occur when the body tissues are mistakenly attacked by its own immune system. The immune system is a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with these diseases have antibodies in their blood which target their own body tissues, where they can be associated with inflammation. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. While rheumatoid arthritis is a chronic illness (meaning it can last for years) patients may experience long periods without symptoms. See the entire definition of Rheumatoid arthritis
Rotator cuff: A group of four tendons that stabilize the shoulder joint. See the entire definition of Rotator cuff
Shoulder: A structure made up of two main bones: the scapula (shoulder blade) and the humerus (the long bone of the upper arm). The end of the scapula, called the glenoid, is a socket into which the head of the humerus fits, forming a flexible ball-and-socket joint. The scapula is an unusually shaped bone. It extends up and around the shoulder joint at the rear to create a roof called the acromion and around the shoulder joint at the front to constitute the coracoid process. The shoulder joint is cushioned by cartilage that covers the face of the glenoid socket and the head of the humerus. The joint is stabilized by a ring of fibrous cartilage around the glenoid socket that is called the labrum. Ligaments connect the bones of the shoulder and tendons join these bones to surrounding muscles. The bicepstendon attaches the biceps muscle to the shoulder and helps stabilize the joint. Four short muscles that originate on the scapula pass around the shoulder where their tendons fuse together to form the rotator cuff.
Sodium: The major positive ion (cation) in fluid outside of cells. The chemical notation for sodium is Na+. When combined with chloride, the resulting substance is table salt. See the entire definition of Sodium
Spine: 1) The column of bone known as the vertebral column, which surrounds and protects the spinal cord. The spine can be categorized according to level of the body: i.e., cervical spine (neck), thoracic spine (upper and middle back), and lumbar spine (lower back). See also vertebral column. 2) Any short prominence of bone. The spines of the vertebrae protrude at the base of the back of the neck and in the middle of the back. These spines protect the spinal cord from injury from behind.
Steroid: A general class of chemical substances that are structurally related to one another and share the same chemical skeleton (a tetracyclic cyclopenta[a]phenanthrene skeleton). See the entire definition of Steroid
Stomach:1. The sac-shaped digestive organ that is located in the upper abdomen, under the ribs. The upper part of the stomach connects to the esophagus, and the lower part leads into the small intestine. See the entire definition of Stomach
Sweating: The act of secreting fluid from the skin by the sweat (sudoriferous) glands. These are small tubular glands situated within and under the skin (in the subcutaneous tissue). They discharge by tiny openings in the surface of the skin. See the entire definition of Sweating
Syringe: A device used in medicine to inject fluid into or withdraw fluid from the body. Medical syringes consist of a needle attached to a hollow cylinder that is fitted with a sliding plunger. The downward movement of the plunger injects fluid; upward movement withdraws fluid. See the entire definition of Syringe
Systemic: Affecting the entire body. A systemic disease such as diabetes can affect the whole body. Systemic chemotherapy employs drugs that travel through the bloodstream and reach and affect cells all over the body.
Tendinitis: Inflammation of a tendon (the tissue by which muscle attaches to bone). Tendinitis most commonly occurs as a result of injury, such as to the tendons around the shoulder or elbow. It can also occur as a result of an underlying inflammatory rheumatic disease, such as reactive arthritis or gout. Tendinitis is synonymous with tendonitis.
Tendon: The tissue by which a muscle attaches to bone. A tendon is somewhat flexible, but fibrous and tough. When a tendon becomes inflamed, the condition is referred to as tendinitis or tendonitis. Inflamed tendons are at risk for rupture. See the entire definition of Tendon
Vein: A blood vessel that carries blood low in oxygen content from the body back to the heart. The deoxygenated form of hemoglobin (deoxyhemoglobin) in venous blood makes it appear dark. Veins are part of the afferent wing of the circulatory system which returns blood to the heart. See the entire definition of Vein
X-ray:1. High-energy radiation with waves shorter than those of visible light. X-rays possess the properties of penetrating most substances (to varying extents), of acting on a photographic film or plate (permitting radiography), and of causing a fluorescent screen to give off light (permitting fluoroscopy). In low doses X-rays are used for making images that help to diagnose disease, and in high doses to treat cancer. Formerly called a Roentgen ray. 2. An image obtained by means of X-rays.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
Acne is a localized skin inflammation as a result of overactivity of oil glands at the
base of hair follicles. This inflammation, depending on its location, can take the form
of a superficial pustule (contains pus), a pimple, a deeper cyst, congested pores, whiteheads, or blackheads. Treatments vary depending on the severity of the acne.
Bursitis of the hip results when the fluid-filled sac (bursa) near the hip becomes inflamed due to localized soft tissue trauma or strain. Symptoms include stiffness and pain around the hip joint. If the hip bursa is not infected, hip bursitis can be treated with ice compresses, rest, and antiinflammatory and pain medications.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Elbow pain is most often the result of tendinitis, which can affect the inner or outer elbow. Treatment includes ice, rest, and medication for inflammation. Inflammation, redness, warmth, swelling, tenderness, and decreased range of motion are other symptoms associated with elbow pain. Treatment for elbow pain depends upon the nature of the patient's underlying disease or condition.
Neck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Sacroiliac joint (SI) dysfunction is a general term to reflect pain in the SI joints. Causes of SI joint pain include osteoarthritis, abnormal walking pattern, and disorders that can cause SI joint inflammation including gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. Treatment includes oral medications, cortisone injections, and surgery.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
A Baker cyst, also called a popliteal cyst, is swelling caused by knee joint fluid protruding to the back of the knee (popliteal area of the knee). Not uncommon, baker cysts can be caused by virtually any type of joint swelling (arthritis). They are often resolved with removal of excess knee fluid in conjunction with cortisone injections.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Bursitis is inflammation of a bursa. A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. There are 160 bursae in the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
A keloid is a scar that doesn't know when to stop. When the cells keep on reproducing, the result is an overgrown (hypertrophic) scar or a keloid. A keloid looks shiny and is often dome-shaped, ranging in color from slightly pink to red. It feels hard and thick and is always raised above the surrounding skin.
Shoulder bursitis is inflammation of the shoulder bursa. Bursitis may be caused by injury, infection, or a rheumatic condition. Symptoms include pain, swelling, tenderness, and pain with movement of the shoulder joint. Treatment may involve ice compresses, rest, and antiinflammatory medications and depends on whether there is an infection.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Bursitis of the knee results when any of the three fluid-filled sacs (bursae) become inflamed due to injury or strain. Symptoms include pain, swelling, warmth, tenderness, and redness. Treatment of knee bursitis depends on whether infection is involved. If the knee bursa is not infected, knee bursitis may be treated with ice compresses, rest, and antiinflammatory and pain medications.
A herniated disc may be caused by injury or degeneration from age. Symptoms depend on the location of the herniation and whether nerve tissue is being irritated. An MRI or CT scan is performed to diagnose a herniated disc. Treatment may involve physical therapy, cortisone injection, pain medications, antiinflammatory medications, muscle relaxants, and surgery.
Coccydynia is an inflammation of the bony area (tailbone or coccyx) located between the buttocks. Coccydynia is associated with pain and tenderness at the tip of the tailbone between the buttocks. Pain is often worsened by sitting. There are many causes of tailbone pain that can mimic coccydynia including: fracture, pilonidal cysts, infection, and sciatica. Treatment methods include medication and rest.
Erythema nodosum is a skin inflammation that results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. Erythema nodosum can resolve on its own in 3 to 6 weeks, leaving a bruised area. Treatments include anti-inflammatory medications and cortisone by mouth or injection.
A frozen shoulder (adhesive capsulitis) is when the shoulder joint experiences a significant loss in its range of motion due to inflammation, scarring, or injury. Treatment involves anti-inflammatory medication, cortisone injections, and physical therapy.
A Morton's neuroma is an inflamed nerve between the bones at the ball of the foot. Symptoms include a burning, sharp pain on the bottom of the foot. Treatment involves resting the foot, wearing better-fitting shoes, ice packs, and cortisone injection.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Pseudogout, a form of arthritis, results when deposits of crystals collect in and around the joints. Symptoms of pseudogout include pain, stiffness, warmth, and joint swelling of the knees, ankles, hips, shoulders, and/or wrists. Treatment for pseudogout aims to decrease inflammation through the use of nonsteroidal antiinflammatory drugs, ice, and rest.
The hand has several bones to include the wrist, palm, and fingers. Fingers are the most commonly injured part of the hand. The most common causes of broken fingers are a traumatic injury to the finger or fingers such as playing sports, injury in the workplace, falls, and accidents. Treatment for a broken finger may be as simple as buddy taping the broken finger to the adjacent finger, or if the fracture is more serious, surgery.
Calcific bursitis is the calcification of the bursa caused by chronic inflammation of the bursa. Calcific bursitis most commonly occurs in the shoulder. Calcific bursitis treatment includes medication for inflammation, ice, immobilization, cortisone injections, and occasionally surgical removal of the inflamed bursa.
Fibromyalgia causes pain, stiffness, and tenderness
of muscles, tendons, and joints without detectable inflammation.
Fibromyalgia does not cause body damage or deformity.
Fatigue occurs in 90% of patients with fibromyalgia.
Irritable bowel syndrome can occur with fibromyalgia.
Sleep disorder is common in patients with
fibromyalgia.
There is no test for the diagnosis of fibromyalgia.
Fibromyalgia can be associated with other rheumatic
conditions.
Fibromyalgia treatment is most effective with
combinations of education, stress reduction,
exercise, and medications.
What is fibromyalgia?
Fibromyalgia is a chronic condition that causes pain, stiffness, and tenderness of the muscles, tendons, and
joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, chronic fatigue, anxiety...
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