6/11/2019 Fatigue - Wikipedia

Fatigue
Fatigue is a subjective feeling of tiredness that has a gradual
Fatigue
onset. Unlike weakness, fatigue can be alleviated by periods of
rest. Fatigue can have physical or mental causes. Physical Other Exhaustion, tiredness, languidness,
fatigue is the transient inability of muscles to maintain optimal names languor, lassitude, listlessness
physical performance, and is made more severe by intense
physical exercise.[1][2][3] Mental fatigue is a transient decrease
in maximal cognitive performance resulting from prolonged
periods of cognitive activity. It can manifest as somnolence,
lethargy, or directed attention fatigue.[4]

Medically, fatigue is a non-specific symptom, meaning it has

many possible causes and accompanies many different
conditions. Fatigue is considered a symptom, rather than a
sign, because it is a subjective feeling reported by the patient,
rather than an objective sign that can be observed by others.
Fatigue and 'feelings of fatigue' are sometimes confused.[5] Sleeping students. Occupations that require an
individual to work long hours or stay up
overnight can lead to fatigue.
Contents Specialty Psychiatry

Classification
Physical fatigue
Mental fatigue
Presentation
Complications
Causes
Chronic fatigue
Diagnosis
Comparison with sleepiness
Measurement
See also
References
Further reading
External links

Classification

Physical fatigue
Physical fatigue, or muscle fatigue, is the temporary physical inability of muscles to perform optimally. The onset of
muscle fatigue during physical activity is gradual, and depends upon an individual's level of physical fitness – other
factors include sleep deprivation and overall health. Fatigue can be reversed by rest.[6] Physical fatigue can be caused
by a lack of energy in the muscle, by a decrease of the efficiency of the neuromuscular junction or by a reduction of the
drive originating from the central nervous system.[7] The central component of fatigue is triggered by an increase of

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the level of serotonin in the central nervous system.[8] During motor activity,
serotonin released in synapses that contact motoneurons promotes muscle
contraction.[9] During high level of motor activity, the amount of serotonin
released increases and a spillover occurs. Serotonin binds to extrasynaptic
receptors located on the axon initial segment of motoneurons with the result
that nerve impulse initiation and thereby muscle contraction are inhibited.[10]

Muscle strength testing can be used to determine the presence of a

neuromuscular disease, but cannot determine its cause. Additional testing, such
as electromyography, can provide diagnostic information, but information
gained from muscle strength testing alone is not enough to diagnose most
neuromuscular disorders.[11]

People with multiple sclerosis experience a form of overwhelming lassitude or

tiredness that can occur at any time of the day, for any duration, and that does
not necessarily recur in a recognizable pattern for any given patient, referred to
as "neurological fatigue".[12][13]

Mental fatigue
Mental fatigue is a temporary inability to maintain optimal cognitive performance. The onset of mental fatigue during
any cognitive activity is gradual, and depends upon an individual's cognitive ability, and also upon other factors, such
as sleep deprivation and overall health. Mental fatigue has also been shown to decrease physical performance.[4] It can
manifest as somnolence, lethargy, or directed attention fatigue. Decreased attention may also be described as a more
or less decreased level of consciousness.[14] In any case, this can be dangerous when performing tasks that require
constant concentration, such as operating large vehicles. For instance, a person who is sufficiently somnolent may
experience microsleep. However, objective cognitive testing can be used to differentiate the neurocognitive deficits of
brain disease from those attributable to tiredness.

The perception of mental fatigue is believed to be modulated by the brain's reticular activating system (RAS).

Presentation

Complications
Fatigue impacts a driver's reaction time, awareness of hazards around them and their attention. Drowsy drivers are
three times more likely to be involved in a car crash and if they are awake over 20 hours, is the equivalent of driving
with a blood-alcohol concentration level of 0.08%.[15]

Causes
Fatigue is a normal result of working, mental stress, overstimulation and understimulation, jet lag or active recreation,
depression, boredom, disease, and lack of sleep. It may also have chemical causes, such as dehydration, poisoning, low
blood sugar, or mineral or vitamin deficiencies. Chronic blood loss frequently results in fatigue, as do other conditions
that cause anemia. Fatigue is different from drowsiness, where a patient feels that sleep is required. Fatigue is a
normal response to physical exertion or stress, but can also be a sign of a physical disorder.

Temporary fatigue is likely to be a minor illness like the common cold as one part of the sickness behavior response
that happens when the immune system fights an infection.

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Chronic fatigue
Prolonged fatigue is a self-reported, persistent (constant) fatigue lasting at least one month. Chronic fatigue is a self-
reported fatigue lasting at least six consecutive months. Chronic fatigue may be either persistent or relapsing.[16]
Chronic fatigue is a symptom of many diseases and conditions. Some major categories of conditions that feature
fatigue include:

Autoimmune diseases such as celiac disease, lupus, multiple sclerosis, myasthenia gravis, Sjögren's syndrome,
and spondyloarthropathy
Blood disorders such as anemia and hemochromatosis
Cancer, in which case it is called cancer fatigue
Chronic fatigue syndrome (CFS)[17]
Drug abuse including alcohol abuse[17]
Depression and other mental disorders that feature depressed mood
Developmental disorders such as autism spectrum disorder
Eating disorders, which can produce fatigue due to inadequate nutrition
Endocrine diseases like diabetes mellitus and hypothyroidism
Fibromyalgia
Gulf War syndrome
Heart disease
HIV
Inborn errors of metabolism such as fructose malabsorption.[18][19]
Infectious diseases such as infectious mononucleosis.
Irritable bowel syndrome
Leukemia or lymphoma
Liver failure
Lyme disease
Neurological disorders such as narcolepsy, Parkinson's disease and post-concussion syndrome
Physical trauma and other pain-causing conditions, such as arthritis
Sleep deprivation or sleep disorders
Spring fever
Stroke
Thyroid diseases
Uremia, which is caused by kidney disease
Fatigue may also be a side effect of certain medications (e.g., lithium salts, ciprofloxacin); beta blockers, which can
induce exercise intolerance; and many cancer treatments, particularly chemotherapy and radiotherapy.

Diagnosis
One study concluded about 50% of people who have fatigue receive a
diagnosis that could explain the fatigue after a year with the condition. In
those people who have a possible diagnosis, musculoskeletal (19.4%) and
psychological problems (16.5%) are the most common. Definitive physical
conditions were only found in 8.2% of cases.[20]

If a person with fatigue decides to seek medical advice, the overall goal is to Minor dark circles, in addition to a
identify and rule out any treatable conditions. This is done by considering hint of eye bags, a combination
the person's medical history, any other symptoms that are present, and which is suggestive of sleep
deprivation and/or mental fatigue.
evaluating of the qualities of the fatigue itself. The affected person may be
able to identify patterns to the fatigue, such as being more tired at certain
times of day, whether fatigue increases throughout the day, and whether fatigue is reduced after taking a nap.

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Because disrupted sleep is a significant contributor to fatigue, a diagnostic evaluation considers the quality of sleep,
the emotional state of the person, sleep pattern, and stress level. The amount of sleep, the hours that are set aside for
sleep, and the number of times that a person awakens during the night are important. A sleep study may be ordered to
rule out a sleep disorder.

Depression and other psychological conditions can produce fatigue, so people who report fatigue are routinely
screened for these conditions, along with drug abuse, poor diet, and lack of physical exercise, which paradoxically
increases fatigue.

Basic medical tests may be performed to rule out common causes of fatigue. These include blood tests to check for
infection or anemia, a urinalysis to look for signs of liver disease or diabetes mellitus, and other tests to check for
kidney and liver function, such as a comprehensive metabolic panel.[21] Other tests may be chosen depending on the
patient's social history, such as an HIV test or pregnancy test.

Comparison with sleepiness

Fatigue is generally considered a more long-term condition than sleepiness (somnolence).[22] Although sleepiness can
be a symptom of medical issues, it usually results from lack of restful sleep, or a lack of stimulation.[23] Chronic
fatigue, on the other hand, is a symptom of a greater medical problem in most cases. It manifests in mental or physical
weariness and inability to complete tasks at normal performance.[24] Both are often used interchangeably and even
categorized under the description of 'being tired.' Fatigue is often described as an uncomfortable tiredness, whereas
sleepiness is comfortable and inviting.

Measurement
Fatigue can be quantitatively measured. Devices to measure medical fatigue have been developed by Japanese
companies, among them Nintendo.[25] Nevertheless such devices are not in common use outside Japan.

See also
Cancer-related fatigue Malaise
Combat stress reaction Microsleep
Directed attention fatigue Museum fatigue
Effects of fatigue on safety Presenteeism
Gaucher's disease Sleep-deprived driving
Heat illness

References
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2. Hagberg, M. (July 1981). "Muscular endurance and surface electromyogram in isometric and dynamic exercise".
Journal of Applied Physiology. 51 (1): 1–7. doi:10.1152/jappl.1981.51.1.1 (https://doi.org/10.1152%2Fjappl.1981.5
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4. Marcora, Samuele M.; Staiano, Walter; Manning, Victoria (January 2009). "Mental fatigue impairs physical
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function" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2375565). The Journal of Physiology. 586 (1): 11–23.
doi:10.1113/jphysiol.2007.139477 (https://doi.org/10.1113%2Fjphysiol.2007.139477). PMC 2375565 (https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC2375565). PMID 17702815 (https://www.ncbi.nlm.nih.gov/pubmed/17702815).
12. Comi, G.; Leocani, L.; Rossi, P.; Colombo, B. (March 2001). "Physiopathology and treatment of fatigue in multiple
sclerosis". Journal of Neurology. 248 (3): 174–9. doi:10.1007/s004150170222 (https://doi.org/10.1007%2Fs00415
0170222). PMID 11355149 (https://www.ncbi.nlm.nih.gov/pubmed/11355149).
13. Mills, Roger J.; Young, Carolyn A.; Pallant, Julie F.; Tennant, Alan (February 2010). "Development of a patient
reported outcome scale for fatigue in multiple sclerosis: The Neurological Fatigue Index (NFI-MS)" (https://www.n
cbi.nlm.nih.gov/pmc/articles/PMC2834659). Health and Quality of Life Outcomes. 8: 22. doi:10.1186/1477-7525-
8-22 (https://doi.org/10.1186%2F1477-7525-8-22). PMC 2834659 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
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14. Giannini, A.J. (1991). "Fatigue, Chronic". In Taylor, Robert B. (ed.). Difficult Diagnosis 2. Philadelphia: W.B.
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15. "Drowsy Driving is Impaired Driving" (https://www.nsc.org/road-safety/safety-topics/fatigued-driving). National
Safety Council. Retrieved 31 January 2019.
16. Fukuda, Keiji; Straus, Stephen E.; Hickie, Ian; Sharpe, Michael C.; Dobbins, James G.; Komaroff, Anthony
(December 1994). "The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study" (htt
p://www.ncf-net.org/patents/pdf/Fukuda_Definition.pdf) (PDF). Annals of Internal Medicine. 121 (12): 953–9.
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19. Gibson, P. R.; Newnham, E.; Barrett, J. S.; Shepherd, S. J.; Muir, J. G. (November 2006). "Review article:
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21. Davis, Charles Patrick (11 September 2017). Doerr, Steven (ed.). "Fatigue" (https://www.emedicinehealth.com/fati
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22. Shen, Jianhua; Barbera, Joseph; Shapiro, Colin M. (February 2006). "Distinguishing sleepiness and fatigue: focus
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24. Mayou, Richard (January 1999). "Chronic fatigue and its syndromes" (https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC1114599). The BMJ. 318 (7176): 133A. doi:10.1136/bmj.318.7176.133a (https://doi.org/10.1136%2Fbmj.318.7
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25. "Nintendo's first health care device will be sleep and fatigue tracker" (https://www.japantimes.co.jp/news/2014/10/
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Reuters. 30 October 2014. Retrieved 29 June 2017.

Further reading
Byung-Chul Han: Müdigkeitsgesellschaft. Matthes & Seitz, Berlin 2010, ISBN 978-3-88221-616-5. (Philosophical
essay about fatigue as a sociological problem and symptom).

Danish edition: Træthedssamfundet. Møller, 2012, ISBN 9788799404377.

Dutch edition: De vermoeide samenleving. van gennep, 2012, ISBN 9789461640710.
Italian editions : La società della stanchezza. nottetempo, 2012, ISBN 978-88-7452-345-0.
Korean edition: 한병철 지음 | 김태환 옮김. Moonji, 2011, ISBN 9788932023960.
Spanish edition: La sociedad del cansancio. Herder Editorial, 2012, ISBN 978-84-254-2868-5.

External links
Fatigue — Information for Patients (http://www.cancer.gov/cancertopics/p
Classification ICD-10: R53 (htt D
dq/supportivecare/fatigue/patient), U.S. National Cancer Institute
p://apps.who.int/cla
ssifications/icd10/br
owse/2016/en#/R5
3) · ICD-9-CM:
780.7 (http://www.ic
d9data.com/getICD
9Code.ashx?icd9=7
80.7) · MeSH:
D005221 (https://w
ww.nlm.nih.gov/cgi/
mesh/2015/MB_cg
i?field=uid&term=D

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005221) ·
DiseasesDB:
30079 (http://www.d
iseasesdatabase.co
m/ddb30079.htm)
External MedlinePlus:
resources 003088 (https://ww
w.nlm.nih.gov/medli
neplus/ency/article/
003088.htm)

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