Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

What is myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)?

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious, long-term illness that affects many body systems. Another name for it is chronic fatigue syndrome (CFS). ME/CFS can often make you unable to do your usual activities. Sometimes you may not even be able to get out of bed.

Researchers don't yet know what causes ME/CFS. There may be more than one potential cause. It is also possible that two or more triggers might work together to cause the illness.

Researchers are studying many possible causes, including:

• Infections
• Immune system changes
• Physical or emotional stress
• Changes in the way cells in the body get their energy
• Genetics; the illness can sometimes run in families

Anyone can get ME/CFS, but it is most common in people between 40 and 60 years old. Adult women are more likely to develop it than adult men.

The primary, or core, symptoms of ME/CFS are:

• Not being able to do activities that you used to do before the illness, along with severe fatigue. The fatigue must last six months or longer, and it is not improved by rest.
• Post-exertional malaise (PEM), which means that your symptoms get worse after any physical or mental activity.
• Sleep problems.

Along with the primary symptoms, to be diagnosed with ME/CFS, you need to have one or both of these symptoms:

• Problems with thinking and memory.
• Worsening of symptoms while standing or sitting upright. This is called orthostatic intolerance. It can cause you to feel lightheaded, dizzy, weak, or faint while standing or sitting up.

Some of the other symptoms that ME/CFS can cause include:

• Pain, including muscle pain, joint pain, and headaches
• Sore throat
• Tender lymph nodes (glands) in the neck or armpits
• Digestive issues, like irritable bowel syndrome
• Chills and night sweats
• Allergies and sensitivities to foods, odors, chemicals, light, or noise

ME/CFS can be unpredictable. Your symptoms may come and go. They may change over time; sometimes they might get better, and other times they may get worse.

ME/CFS can be difficult to diagnose. There is no specific test for ME/CFS, and other illnesses can cause similar symptoms. Your health care provider has to rule out other diseases before making a diagnosis of ME/CFS.

Your provider will do a thorough medical exam, which will include:

• Asking about your medical history and your family's medical history.
• Asking about your current illness, including your symptoms. Some questions they may ask could include how often you have symptoms, how bad they are, how long they have lasted, and how they affect your life.
• Thorough physical and mental status exams.
• Blood, urine, or other tests to check for other illnesses which could be causing your symptoms.

Your provider may also ask you to see a specialist to check for other conditions which can cause similar symptoms.

There is no cure or approved treatment for ME/CFS, but you may be able to treat or manage some of your symptoms.

You, your family, and your provider should work together to decide on a plan. You should figure out which symptom causes you the most problems and try to treat that first. For example, if sleep problems affect you the most, you might first try using good sleep habits. If those do not help, you may need to take medicines or see a sleep specialist.

Strategies such as learning new ways to manage activity can also be helpful. You need to make sure that you do not "push and crash." This can happen when you feel better, do too much, and then get worse again.

When you have ME/CFS, it can be hard to help develop a treatment plan. It can also be difficult to try to take care of yourself. So it's important that you have support from family members and friends.

There are also various resources and strategies that might be helpful to you, such as:

• Getting counseling to help you cope with the illness and its impact on your life.
• Eating a healthy diet.
• Nutritional supplements, if your provider suggests them.
• Complementary therapies such as meditation, gentle massage, or relaxation therapy.

Make sure to talk to your provider before you try any new treatments. Some treatments that are promoted as cures for ME/CFS are unproven, often costly, and could be dangerous.

Centers for Disease Control and Prevention

Optic Nerve Disorders

The optic nerve is a bundle of more than 1 million nerve fibers that carry visual messages. You have one connecting the back of each eye (your retina) to your brain. Damage to an optic nerve can cause vision loss. The type of vision loss and how severe it is depends on where the damage occurs. It may affect one or both eyes.

There are many different types of optic nerve disorders, including:

• Glaucoma is a group of diseases that are the leading cause of blindness in the United States. Glaucoma usually happens when the fluid pressure inside the eyes slowly rises and damages the optic nerve.
• Optic neuritis is an inflammation of the optic nerve. Causes include infections and immune-related illnesses such as multiple sclerosis. Sometimes the cause is unknown.
• Optic nerve atrophy is damage to the optic nerve. Causes include poor blood flow to the eye, disease, trauma, or exposure to toxic substances.
• Optic nerve head drusen are pockets of protein and calcium salts that build up in the optic nerve over time

Contact your health care provider if you are having vision problems. Tests for optic nerve disorders may include eye exams, ophthalmoscopy (an examination of the back of your eye), and imaging tests. Treatment depends on which disorder that you have. With some optic nerve disorders, you may get your vision back. With others, there is no treatment, or treatment may only prevent further vision loss.

Premature Babies

Almost 1 of every 10 infants born in the United States are premature, or preemies. A premature birth is when a baby is born before 37 completed weeks of pregnancy. A full-term pregnancy is 40 weeks.

Important growth and development happen throughout pregnancy - especially in the final months and weeks. Because they are born too early, preemies weigh much less than full-term babies. They may have health problems because their organs did not have enough time to develop. Problems that a baby born too early may have include:

• Breathing problems
• Feeding difficulties
• Cerebral palsy
• Developmental delay
• Vision problems
• Hearing problems

Preemies need special medical care in a neonatal intensive care unit, or NICU. They stay there until their organ systems can work on their own.

Centers for Disease Control and Prevention

Sciatica

Sciatica is a symptom of a problem with the sciatic nerve, the largest nerve in the body. It controls muscles in the back of your knee and lower leg and provides feeling to the back of your thigh, part of your lower leg, and the sole of your foot. When you have sciatica, you have pain, weakness, numbness, or tingling. It can start in the lower back and extend down your leg to your calf, foot, or even your toes. It's usually on only one side of your body.

Causes of sciatica include:

• A ruptured intervertebral disk
• Narrowing of the spinal canal that puts pressure on the nerve, called spinal stenosis
• An injury such as a pelvic fracture.

In many cases no cause can be found.

Sometimes sciatica goes away on its own. Treatment, if needed, depends on the cause of the problem. It may include exercises, medicines, and surgery.

Sleep Disorders

What is sleep?

While you are sleeping your brain and body functions are still active. Sleep is a natural process that helps your body restore energy, supports learning and memory, and keeps you healthy.

It's not just the number of hours of sleep you get that matters. The quality of your sleep is also important. During the night, your brain cycles through different stages of non-rapid eye movement (non-REM) sleep and rapid eye movement (REM) sleep. If your sleep is often interrupted, you may not get enough time in certain stages of sleep. Poor-quality sleep does more than make you feel tired. It can affect your physical and mental health, thinking, and daily functioning.

Sleep disorders are conditions that disturb your normal sleep patterns. There are many types of sleep disorders. Some general types include:

• Insomnia, which is trouble falling asleep or staying asleep.
• Sleep-related breathing disorders such as sleep apnea, a condition in which you stop breathing for 10 seconds or more during sleep.
• Sleep-related movement disorders such as restless leg syndrome (RLS), which involves tingling or prickling sensations in your legs, and a strong urge to move them.
• Hypersomnia, which is extreme daytime sleepiness. This includes narcolepsy.
• Circadian rhythm sleep-wake disorders, which are problems falling asleep or waking up at the right times. This may be due to shift work or jet lag.
• Parasomnia, which is unusual behaviors during sleep or while falling asleep or waking up. This may include sleepwalking, talking, or eating during sleep.

Some people who feel tired during the day have a true sleep disorder, while others simply don't get enough sleep. The amount of sleep you need depends on your age, lifestyle, health, and sleep patterns. Most adults need about 7-9 hours each night.

There are different causes for different sleep disorders. They may include:

• Other health conditions, such as heart disease, lung disease, nerve disorders, or pain
• Mental illnesses, including depression and anxiety
• Medicines
• Genetics

Sometimes the cause is unknown.

Other factors that may contribute to sleep problems include:

• Using caffeine or alcohol
• Having an irregular schedule, such as working the night shift
• Aging, since older adults may sleep less, spend less time in deep sleep, and wake easily

The symptoms of sleep disorders depend on the specific disorder. Some signs that you may have a sleep disorder include that:

• You regularly take more than 30 minutes to fall asleep.
• You regularly wake up several times and then have trouble falling back to sleep, or you wake up too early in the morning.
• You often feel sleepy during the day, take frequent naps, or fall asleep at the wrong times during the day.
• Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods.
• You have creeping or tingling sensations in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall asleep.
• Your bed partner notices that your legs or arms jerk often during sleep.
• You have vivid, dreamlike experiences while falling asleep or dozing.
• You have episodes of sudden muscle weakness triggered by strong emotions.
• You feel as though you cannot move or speak for a brief time when you first wake up.

To diagnose a sleep disorder, your health care provider will review your medical and sleep history and do a physical exam. You may also have a sleep study (polysomnogram). Most sleep studies monitor and record data about your body during a full night of sleep. The data includes:

• Brain wave activity
• Eye movements
• Breathing rate
• Blood pressure
• Heart rate and electrical activity in the heart and other muscles

Other types of sleep studies may check how quickly you fall asleep during daytime naps or how well you can stay awake during the day.

Treatments for sleep disorders depend on which disorder you have. They may include:

• Practicing good sleep habits and other lifestyle changes, such as eating a healthy diet and getting regular exercise
• Reducing anxiety about sleep with cognitive behavioral therapy or relaxation techniques
• Using a CPAP (continuous positive airway pressure) machine for sleep apnea
• Using bright light therapy (in the morning)
• Taking sleep aid medicines, or natural products such as melatonin

Always check with your provider before taking any medicine or supplement. Most sleep aid medicines are generally for short-term use.