Dr. Pellegrino erklärt, dass mehrere Faktoren in die Mischung einfließen können, die Energie in Fibromyalgie zieht, aber es gibt auch viele Strategien, um ihre Auswirkungen auf den Alltag zu minimieren.
In CFS-Unterstützungsgruppen und Fibromyalgie-Unterstützungsgruppen, an denen ich teilgenommen habe, sind sowohl Schmerz als auch Müdigkeit häufige Diskussionsthemen. Sie sagte, ihre Augenlider fühlten sich wie Zementgewichte an und sie fühlte sich, als würde sie Zementschuhe tragen. Müdigkeit kann bei Fibromyalgie ein überwältigendes Problem sein, und leider bekommen viele Menschen den doppelten Fluch – sowohl starke Schmerzen als auch starke Müdigkeit.
Warum haben Patienten mit Fibromyalgie (und CFS) ein derartiges Ermüdungsproblem?
Es sind mehrere Faktoren beteiligt. Diese Faktoren umfassen:
1. Nicht
erholsame Schlafstörung Eine Wiederherstellung, die im tiefen Schlafstadium erfolgen sollte, findet nicht statt. Die Herstellung von Proteinen, das Auffüllen von Energiespeichern und die Reparatur von Gewebe sind unvollständig. Schlechter Schlaf führt zu erhöhter Müdigkeit.
2. Dekonditionierte Muskeln
Dekonditionierte Muskeln in Fibromyalgie haben ihre Fähigkeit verloren, die Energiemoleküle des Körpers, ATP (Adenosintriphosphat) genannt, herzustellen. Dieses Energiemolekül wird in unseren Geweben, insbesondere in den Muskeln, gespeichert und dient als Brennstoff, damit der Körper alle seine Funktionen einschließlich der Muskelkontraktionen ausführen kann.
Je weniger ATP in der Umgebung vorhanden ist, desto weniger Energie steht zur Verfügung und sobald die gelagerten Vorräte aufgebraucht sind, tritt Ermüdung auf. Wenn dieser Prozess schnell abläuft, kann es zu einem plötzlichen, unvorhersehbaren Zusammenbruch der Energie kommen. Bei Fibromyalgie trägt unser chronisch niedriger ATP zur chronischen Müdigkeit bei.
3. Konstante Schmerzen
Der Prozess des Körpers zur Überwachung von Schmerzen, zur Aufzeichnung von Schmerzen und zum Ausdrücken von Schmerzen ist energieaufwendig und umfasst Nerven, Neurotransmitter und andere Enzyme und Hormone. Der Patient mit ständigen Schmerzen verbraucht mehr Energie und hat weniger gespeicherte Energie als normal. (Siehe “Fibromyalgie – letztendlich eine Krankheit mit verstärkten Schmerzen”.)
4. Reduzierter Sauerstoffverbrauch durch die Muskeln
Studien haben gezeigt, dass Muskeln mit Fibromyalgie keinen Sauerstoff als normale Muskeln verwenden. Dies könnte ein Problem der Muskel-Mitochondrien sein, den kleinen Organellen, die Sauerstoff verwenden und ATP herstellen. Ein biochemisches Problem kann verhindern, dass der verfügbare Sauerstoff effizient und adäquat verwendet wird, um ATP zu erzeugen.
5. Assoziierte klinische Depression Eine
Depression tritt bei fast der Hälfte der Patienten mit Fibromyalgie auf und kann zu extremer geistiger Erschöpfung führen.
6. Verbundene chronische
Erkrankungen wie Arthritis, Hypothyreose oder andere Krankheiten. Menschen mit Fibromyalgie haben möglicherweise andere Erkrankungen, die viel Energie verbrauchen und zu übermäßiger Ermüdung beitragen.
7. Kognitive Faktoren
Fibromyalgie verursacht Konzentrations- und Aufmerksamkeitsschwierigkeiten, erhöhte Angstzustände, erhöhte Anfälligkeit für Depressionen und Abgeschlagenheit. Dies ist unser Fibrofog. (Siehe „Verwalten von Fibrofog – Die kognitive Dysfunktion von Fibromyalgie.“)
8. Dysfunktionelles Autonomisches Nervensystem
Wir sind anfälliger für Angst- und Panikattacken, Raynaud-Phänomen, schnelle Herzfrequenz (besonders als Reaktion auf Stress), Hautausschläge (insbesondere als Reaktion auf Berührung), Halsschmerzen, Reizdarm, reizbar Blase und andere Symptome, die alle Folgen eines überempfindlichen autonomen Nervensystems sind. Ermüdung kann auch eine Folge unserer gestörten autonomen Nerven sein. (Das autonome Nervensystem behält die „automatischen“ Körperfunktionen bei, die von vielen Organen, Muskeln und Drüsen ausgeübt werden, und steuert die Reaktion auf körperlichen oder emotionalen Stress – Kampf oder Flucht. Siehe „Diese dysfunktionale Autonomie“.)
9. Visuelle Überladung
Ich benutze diesen Begriff, um die überwältigenden Informationen zu beschreiben, die unsere Augen erhalten, und haben Schwierigkeiten beim Interpretieren. (In Kapitel 4 von Fibromyalgie: Nah und persönlich beschrieben .)
Wir versuchen, ein bestimmtes Objekt ausfindig zu machen, sehen uns jedoch mit einer Vielzahl von Formen, Größen, Farben und Linien in verschiedenen Richtungen konfrontiert, die unsere visuellen Sinne buchstäblich überwältigen und manchmal ein Gefühl von Schwindel, Benommenheit und zunehmender Angst verursachen. Ich glaube, dass dies zur Ermüdung beiträgt, indem so viel Energie gefordert wird, um diese Informationen zu sortieren.
10. Abnehmende Atemwegsausdauer
Viele Patienten mit Fibromyalgie klagen über Kurzatmigkeit mit kurzen Aktivitätsstößen wie Steigstufen, Laufen oder schnelles Gehen. Sie können tatsächlich Schwierigkeiten haben, zu Atem zu kommen. Diese Atembeschwerden können auf eine plötzliche, durch Bewegung ausgelöste Ermüdung der Atemmuskulatur zurückzuführen sein, die den Atemrhythmus stört.
Die Beschwerde scheint unabhängig davon zu sein, ob die Person nicht in einem Zustand ist oder einen sitzenden Lebensstil hat. Da ein effizienter Atmungsprozess erforderlich ist, um den Blutkreislauf mit Sauerstoff zu versorgen, wird jedes Problem in diesem Bereich sicherlich Ermüdungspotenzial schaffen.
11. Konstante Muskelbewegungen
Menschen mit Fibromyalgie verschieben häufig ihren Körper, um bequemere Positionen zu finden. Gewohnheitsbewegungen wie das Antippen mit den Fingern auf dem Tisch, das Klopfen mit den Füßen auf dem Boden, das häufige Kreuzen der Beine und das Treten eines Beins sind wahrscheinlich unbewusste Bewegungen, um Muskelstress abzubauen, das Blut in Fluss zu halten und die Muskeln und die Haltung neu einzustellen zu versuchen, den Schmerz zu lindern. Der Nebeneffekt dieser Bewegungsmuster ist jedoch ein erhöhter Energieverbrauch.
12. Hormonelle Probleme
Eine verminderte Zufuhr von Hormonen oder eine ineffiziente Verwendung verfügbarer Hormone kann zu Ermüdung führen. Niedriges Wachstumshormon und niedrige Schilddrüsenwerte sind bei Fibromyalgie üblich und können den Energiestoffwechsel verringern und dadurch die Müdigkeit erhöhen. Veränderte Stressmechanismen in unserem Körper erhöhen den Energieverbrauch und beeinträchtigen die effiziente Nutzung von Energie, wodurch die Ermüdung verschlimmert wird. Andere Hormone, die Ermüdung verursachen können, sind Östrogen und Serotonin.
13. Hypoglykämie / Insulin-Überempfindlichkeit
Unser Gehirn benötigt eine gleichmäßige Dosis von Glukose (Blutzucker). Wenn unsere Ernährungsstörungen zu Hypoglykämie führen, wird unser Gehirn darauf hinweisen: “Sie fühlen sich mürrisch, bis ich mehr Glukose bekomme!” (Siehe Diskussion von Hypoglykämie in “Warum Gewichtszunahme ein Problem bei Fibro ist und was dagegen zu tun ist.”)
14. Niedriger Magnesiumgehalt von
Magnesium in den Zellen ist bei den meisten Fibromyalgie-Patienten niedrig. Magnesium ist ein Schlüsselmineral bei der Bildung von ATP / Energiemolekülen in den Muskeln. Ein niedriger Magnesiumgehalt bedeutet einen niedrigen ATP-Gehalt, was zu mehr Ermüdung führt. (Siehe “Ernährungsansätze bei Fibromyalgie: Mängel, Symptome, Ergänzungsstrategien.”)
15. Candidiasis (Hefeinfektion)
Unter normalen Umständen lebt Candida albicans im Darmtrakt von 80% der menschlichen Bevölkerung ohne schädliche Auswirkungen. Bei Fibromyalgie kann Candida im Darm überwachsen und „unfreundlich“ werden. Dies kann zu systemischen Symptomen führen, einschließlich Ermüdung. (Siehe „Candidiasis – Hefeinfektion und ernährungsbedingte Reparatur“.)
Müdigkeit verursacht Probleme in unseren täglichen Aktivitäten, unabhängig von der Ursache oder den Ursachen. Ein wesentlicher negativer Effekt von Müdigkeit ist der verstärkte Schmerz, der wiederum mehr Energie verbraucht und weitere Müdigkeit verursacht – ein sich selbst erhaltender Zyklus von Schmerz und Müdigkeit. Müdigkeit beeinträchtigt unsere Fähigkeit und Motivation, Kontakte zu knüpfen, tägliche Routinearbeiten auszuführen und unsere Jobs ordnungsgemäß auszuführen.
BEHANDLUNG VON FATIGUE
Es gibt viele Strategien, um Müdigkeit zu behandeln. Müdigkeit wird wahrscheinlich nie ganz beseitigt, aber es gibt viele Möglichkeiten, um die Folgen zu kontrollieren und die Auswirkungen auf den Alltag zu minimieren.
Ihr Arzt wird möglicherweise zuerst nach Grunderkrankungen wie Hypothyreose, Schlafstörungen, Anämie und Bindegewebserkrankungen suchen, die unterschiedliche Behandlungsansätze beinhalten. Wenn keine wesentlichen zugrunde liegenden Erkrankungen vorliegen, kann die Müdigkeit auf das Fibromyalgiesyndrom (oder das chronische Müdigkeitssyndrom) zurückzuführen sein.
Einige spezifische Labore, die ich häufig bei Fibromyalgie-Patienten mit erheblicher Müdigkeit bestelle, sind:
• Komplettes Blutbild (zur Beurteilung von Anämie oder Blutkrankheiten)
• Sedimentationsrate (zur Beurteilung einer zugrunde liegenden Entzündung)
T4, TSH-Spiegel (zur Beurteilung auf Schilddrüsenanomalien)
• Insulinähnlicher Wachstumsfaktor 1 (zur Messung von Wachstumshormonmangel)
• Magnesium RBC (zur Messung auf intrazellulären Magnesiummangel).
Wenn sich die Labore im normalen Bereich befinden, aber niedrig / normal sind, kann ich dies für einen einzelnen Patienten als „abnormal“ interpretieren. Das heißt, das Niveau des Patienten ist immer noch zu niedrig für das, was der Patient benötigt, auch wenn das Niveau im normalen Bereich liegt.
Welche Schritte können unternommen werden, um mögliche schwächende Auswirkungen von Müdigkeit zu minimieren?
Nachfolgend finden Sie eine Liste von Strategien, die ich als hilfreich empfunden habe.
1. Gute
Schlafgewohnheiten entwickeln Ein guter Schlaf ist notwendig, damit der Körper Energie produzieren kann. Entwickeln Sie eine gute Schlafroutine. (In Kapitel 22 von Fibromyalgie: Nah und persönlich beschrieben .)
2. Vermeiden Sie lange
Nickerchen während des Tages Obwohl Müdigkeit manchmal zwingend sein kann, sollten Sie am besten ein Nickerchen machen, da dies den Schlafrhythmus des Körpers verändert. Nickerchen sind oft nicht erfrischend und zeitaufwändig. Beim Erwachen fühlen sich viele Menschen noch weniger energisch und haben mehr Schwierigkeiten, wieder in Gang zu kommen. Sie können sogar eine Periode von verstärkter Verwirrung und geistiger Vernebelung haben.
Bei einigen Menschen erreicht ein strategisches Nickerchen (weniger als eine Stunde) jedoch sein Ziel, indem es die Person auffrischt und wiederherstellt, um den Rest des Tages erfolgreicher abzuschließen. Solange der primäre Nachtschlaf nicht mehr als üblich gestört ist , dürfen diese Nickerchen nicht entmutigt werden.
Es ist jedoch meine Erfahrung (und Schlafstudien zeigen), dass die meisten Menschen, die versuchen, Müdigkeit mit einem Nickerchen zu überwinden, tatsächlich nicht die erfrischende und wiederherstellende Stimmung erreichen, nach der sie suchen, und das abendliche Schlafmuster unterbrochen wird.
3. Richtige Ernährung
Eine Diät mit höherem Protein- und niedrigeren Kohlenhydratgehalt hat vielen Menschen geholfen, ihre Energie zu verbessern. Zu fettreiche Diäten können den Körper in einen faulen Modus versetzen, aber wenn Sie Ihre Fette auf Kosten von zu wenig Eiweiß reduzieren, haben Sie möglicherweise mehr Müdigkeit, also finden Sie Ihr Gleichgewicht. (Einzelheiten finden Sie unter “Warum Gewichtszunahme ein Problem bei Fibro ist und was Sie dagegen tun können.”)
4. Natürliche
Nahrungsergänzungsmittel – und verschreibungspflichtige Medikamente Die Dutzende natürlicher Nahrungsergänzungsmittel, die zur Steigerung der Energieeffizienz angekündigt werden, sind für manche Menschen erfolgreich. Viele Energieprodukte enthalten jedoch die Stimulanzien Koffein oder Ephedrin, die langfristig schädliche Wirkungen auf den Körper haben können und bei gemeinsamer Einnahme gefährlich sein können. Bevor Sie ein natürliches Energieprodukt ausprobieren, empfiehlt es sich, zunächst mit Ihrem Arzt zu sprechen.
• Ich empfehle eine Kombination aus Magnesium und Äpfelsäure und Colostrum als die ersten beiden Ergänzungen, um das Energieniveau zu verbessern. Magnesium- und Äpfelsäurekombinationen wirken durch Erhöhung der im Muskel gebildeten Energie. Colostrum fördert den Stoffwechsel und die Energie durch Erhöhung des Wachstumshormonspiegels.
• Wenn der B-12-Spiegel niedrig / normal ist, kann ich Vitamin B-12 entweder als Lutschtablette, sublingual (unter der Zunge) oder als Injektionsform empfehlen . B-12-Pillen können vom Magen nicht gut aufgenommen werden, während die anderen Formen von B-12 unterschiedlich absorbiert werden (Lutschtabletten und sublinguale Formen werden von den Kapillaren im Mund und unter der Zunge in das Blut absorbiert und die Injektion B-12.) vom Muskel in den Blutstrom aufgenommen).
• Wenn die Schilddrüse schwach oder niedrig / normal ist, kann ich morgens eine Schilddrüse der Rüstung vorschreiben . Coenzym Q10 (CoQ10) ist eine weitere Nahrungsergänzung, die dazu beitragen kann, die ATP / Energie in den Muskeln zu erhöhen.
• Verschriebene Arzneimittel, die den Serotoninspiegel erhöhen, können ebenfalls dazu beitragen, die Energie zu verbessern. Dazu gehören die selektiven Serotonin-Wiederaufnahmehemmer (SSRI) wie Prozac, Zoloft, Paxil, Celexa, Lexapro und Effexor.
• Welbutrin ist ein anderer Typ von Antidepressivum, von dem berichtet wird, dass es den Noradrenalin-Spiegel anstelle des Serotonin-Spiegels erhöht. Noradrenalin ist wichtig, um unsere Konzentration, Konzentration und Energie zu verbessern.
• 5-HTP ist ein natürlicher Ernährungsbaustein für Serotonin, der den Schlaf und die Stimmung verbessert und die Schmerzen lindert. All dies kann zur Ermüdung beitragen. Johanniskraut und SAM-e sind andere natürliche pflanzliche Antidepressiva, die zur Erhöhung des Serotoninspiegels beitragen können. Wenn die zugrunde liegende Depression ein Problem darstellt, kann Ihr Arzt ein Antidepressivum verschreiben, da die Verbesserung der Depression in der Regel auch die Müdigkeit verbessert.
• Bestimmte verschreibungspflichtige Arzneimittel, die als Stimulanzien des zentralen Nervensystems bezeichnet werden, können von Ihrem Arzt verschrieben werden, wenn extreme Müdigkeit zu Funktionsstörungen führt. Diese Arzneimittel ähneln denen, die für Kinder mit Aufmerksamkeitsstörungen verwendet werden. Dazu gehören Ritalin, Cylert und Provigil.
6. Planen Sie geplante Aktivitäten vor allem am Abend
Der späte Nachmittag und der frühe Abend sind für ermüdete Personen oft die schwierigsten Zeiten. Nach dem Abendessen kann eine besonders schwierige Zeit sein, insbesondere wenn sich die Person setzt, um sich zu entspannen oder die Zeitung zu lesen. ‘Absturz’ und die Unfähigkeit, für den Rest des Abends nützliche Aktivitäten auszuführen, können eintreten.
Mein Rat ist, routinemäßig Aktivitäten zu planen, vor allem nach dem Abendessen. Dazu gehören Besorgungen zu erledigen, nach draußen zu gehen, Menschen zu besuchen oder einfach nur auf den Beinen zu bleiben. Sie werden überrascht sein, wie oft ein zweiter Wind kommt. Viele Menschen haben einen natürlichen Rhythmus, der am späten Nachmittag und am frühen Abend zu schwacher Energie führt, aber dann steigen die Stimmung und das Energieniveau wieder an.
Wenn Sie eine Nachteule sind, fühlen Sie sich um 9 Uhr nachmittags besser und energischer. Vielleicht haben Sie ein paar gute Stunden, in denen Sie sich wachsam fühlen und viel erreichen können.
Erkennen Sie Ihren eigenen Biorhythmus und nutzen Sie ihn, um:
• Planen Sie Ihre beste Arbeit rund um Ihre Höhepunkte
• Versuchen Sie, sich durch die niedrigen Punkte zu stimulieren, indem Sie sich an einer Aktivität beteiligen.
7. Teilen Sie Ihre Aufgabe in kleinere Projekte anstatt in ein großes.
Tun Sie etwas nach dem anderen und tun Sie mehr zur besten Zeit. Die Arbeit im Garten kann beispielsweise in verschiedene Aufgaben für verschiedene Nächte der Woche unterteilt werden. Sie können den vorderen Rasen in einer Nacht mähen, den hinteren anderen und in einer dritten Nacht einschneiden, anstatt alle drei an einem Tag zu erledigen. Wenn wir umziehen und uns für unsere eigene Verpackung entscheiden, ist es viel einfacher, sechs Wochen vor dem tatsächlichen Umzugstermin eine Schachtel pro Tag zu packen, als alle ein bis zwei Tage vor dem Umzug zu versuchen . Diese Art von Selbstdisziplin wird auch benötigt, wenn Sie Urlaub machen und während der Ferien dekorieren. (Eigentlich könnte Selbstdisziplin eine Menge helfen!)
8. Regelmäßige Bewegung und Entspannung üben Die
Übung erhöht die Ausdauer, die kardiovaskuläre Kondition und das Wohlbefinden. In der Tat ist regelmäßige Bewegung der beste Weg, um die ATP / Energieproduktion in unseren Muskeln zu verbessern. Entspannung reduziert Stress und Schmerzen. Ein 30-minütiger zügiger Spaziergang nach dem Abendessen sorgt für körperliche und geistige Entspannung und wirkt gleichzeitig dem niedrigen Biorhythmuspunkt entgegen.
Man muss nicht vollkommen still sitzen, um sich körperlich und geistig zu entspannen; In der Tat erhöht dies oft die Ermüdung und die Tendenz zum Schlafen. Denken Sie daran sich zu entspannen und nicht zu schlafen.
9. Erstellen Sie einen täglichen Zeitplan und überprüfen Sie die Dinge, während Sie sie
erledigen. Lassen Sie viel Zeit, um die Aufgabe abzuschließen. Wenn Sie eine strukturierte Liste führen, haben Sie eine bessere Chance, sich für die Erreichung der täglichen Ziele zu motivieren.
10. Aufgaben an andere delegieren
Eine der besten bekannten Energiespartechniken besteht darin, dass jemand anderes seine Energie für seine Aufgabe verwendet! Das Delegieren von Verantwortlichkeiten ist für viele schwierig, aber es gibt andere, die gerne bestimmte Aufgaben für Sie erledigen. Es ist am besten, so unabhängig wie möglich zu sein, aber es ist besser, jemandem zu helfen, wenn es bedeutet, dass Sie Energie für einen längeren Teil Ihres Tages haben.
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