Exercise insomnia

Hypoperfusion of skeletal muscles leads to fatigue, weakness, and exercise intolerance. Decreased perfusion of the central nervous system (CNS) is related to confusion, hallucinations, insomnia, and lethargy. Peripheral vasoconstriction due to SNS activity causes pallor, cool extremities, and cyanosis of the digits. Tachycardia is also common in these patients and may reflect increased SNS activity. Patients will often exhibit polyuria and nocturia. Polyuria is a result of increased release of natriuretic peptides caused by volume overload. Nocturia occurs due to increased renal perfusion as a consequence of reduced SNS renal vasoconstrictive effects at night. In chronic severe HF, unintentional weight loss can occur which leads to a syndrome of cardiac cachexia. This results from several factors, including loss of appetite, malabsorption due to gastrointestinal edema, elevated metabolic rate, and elevated levels of proinflammatory cytokines. 

How does physical exercise alleviate depression One possibility is that it increases the release of endorphins that produce a sense of well-being, sometimes referred to as the runner s high . Another possibility is that it is a placebo effect. But even if it is a placebo effect, consider the differences between exercise and antidepressants in side effects. Side effects of antidepressants include sexual dysfunction, nausea, vomiting, insomnia, drowsiness, seizures, diarrhoea and headaches. Side effects of physical exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone, greater life expectancy, increased strength and endurance and improved cholesterol levels. So if both antidepressants and exercise work by means of the placebo effect, which placebo would you prefer ... 

Insomnia includes a wide variety of sleep disturbances, such as difficulty in falling asleep, early or frequent awakenings, and remaining unrefreshed after sleep. Use of sedative-hypnotic drugs is one approach to the therapy of insomnia. Other measures include advice to avoid stimulants before retiring, maintenance of a proper diet, initiation of an exercise program, and avoidance of stressful or anxiety-provoking situations. 

Because insomnia is often transient and intermittent, the prolonged administration of estazolam is generally neither necessary nor recommended. Caution should be exercised in prescribing this hypnotic for elderly or debilitated patients, as well as for those with impaired renal or hepatic function, because of increased sensitivity or reduced capacity to metabolize and eliminate the drug. The recommended initial dose is 1 mg, but some may need a 2 mg dose. For the elderly, a 0.5 or 1 mg dose is appropriate. 

Contraindications to the use of 3 blockers are asthma and other bronchospastic conditions, severe bradycardia, atrioventricular blockade, bradycardia-tachycardia syndrome, and severe unstable left ventricular failure. Potential complications include fatigue, impaired exercise tolerance, insomnia, unpleasant dreams, worsening of claudication, and erectile dysfunction. 

Adverse Reactions Adverse events with a higher incidence in fiuvastatin-treated patients than placebo patients Arthropathy Exercise-related muscle pain Sinusitis Bronchitis Dyspepsia Diarrhea Abdominal pain Nausea Insomnia Fatigue Abdominal pain Asthenia Constipation Diarrhea Dyspepsia Flatulence Nausea Headache Upper respiratory tract infection Headache Constipation Flatulence Dyspepsia Abdominal pain Arthralgia Myalgia Bronchitis Pruritus Rhabdomyolysis Increases in serum transaminases and CPK... 

I 11. Many doctors recommend exercise for patients who complain that they can t sleep. Insomnia can be a major problem. A brisk walk after dinner can help you relax, which in turn helps induce sleep. You can t buy exercise in a bottle, but it is an excellent antidote for insomnia. 

We favor less toxic remedies for insomnia, such as increased exercise during the day, decreased use of stimulants, especially in the evening (remember to read labels of any pain pills, cold tablets, and other remedies to see if they contain caffeine or other stimulants), relaxation techniques, warm baths, and simple nutritional supplements such as calcium and magnesium tablets, which relax many people when taken at bedtime... 

Several classes of pharmacologic agents are available for insomnia. Barbiturates are the oldest agents that have been used for insomnia and include pentobarbital, secobarbital, and amobarbital. Barbiturates are currently not recommended because of their high abuse potential (due to rapid development of tolerance) and lethal potential in overdose situations. Barbiturates potentiate the GABAergic-induced increase in chloride ion conductance at low doses, and at high doses they depress calcium-dependent action potentials. Caution should be exercised in patients with marked renal or liver dysfunction, severe respiratory disease, suicidal tendencies, or history of alcohol/drug abuse. 

Drug therapy is not always necessary or desirable for insomnia. The cause of the insomnia should be established and, where possible, underlying factors should be treated. Alternative approaches include counselling and relaxation training and avoiding stimulants, alcohol and exercise late in the evening. 

Adequate sleep improves the quality of daytime wakefulness, and hypnotics should be used judiciously to avoid its impairment. A number of pharmacological agents are available for the treatment of insomnia. The perfect hypnotic would allow sleep to occur with normal sleep architecture rather than produce a pharmacologically altered sleep pattern. It would not cause next-day effects, either of rebound anxiety or of continued sedation. It would not interact with other medications. It could be used chronically without causing dependence or rebound insomnia on discontinuation. Regular moderate exercise meets these criteria but often is not effective by itself, and many patients may not be able to exercise. However, even small amounts of exercise often are effective in promoting sleep. 

Exercise. Remember, one of the great benefits of exercise is improved sleep. A study of elderly patients published in the Journal of the Amen-can Medical Association in 1997 showed that when they engaged in walking and other low-impact aerobics for just four days a week, they enjoyed an hour more sleep each night. Exercise is especially helpful if you re suffering from insomnia related to stress, anxiety, or muscle tension. Don t exercise right before bed, however. Exercise warms you up and energizes you, so ideally you ll do it mid- to late afternoon. 

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