parasomnia

Sleep is a complex biological process. While you are sleeping, you are unconscious, but your brain and body functions are still active. They are doing a number of important jobs that help you stay healthy and function at your best. So when you don't get enough quality sleep, it does more than just 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 more than 80 different sleep disorders. Some major types include:

• Insomnia - being unable to fall asleep and stay asleep. This is the most common sleep disorder.
• Sleep apnea - a breathing disorder in which you stop breathing for 10 seconds or more during sleep
• Restless leg syndrome (RLS) - a tingling or prickly sensation in your legs, along with a powerful urge to move them
• Hypersomnia - being unable to stay awake during the day. This includes narcolepsy, which causes extreme daytime sleepiness.
• Circadian rhythm disorders - problems with the sleep-wake cycle. They make you unable to sleep and wake at the right times.
• Parasomnia - acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating

Some people who feel tired during the day have a true sleep disorder. But for others, the real problem is not allowing enough time for sleep. It's important to get enough sleep every night. The amount of sleep you need depends on several factors, including your age, lifestyle, health, and whether you have been getting enough sleep recently. Most adults need about 7-8 hours each night.

There are different causes for different sleep disorders, including:

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

Sometimes the cause is unknown.

There are also some factors that can contribute to sleep problems, including:

• Caffeine and alcohol
• An irregular schedule, such as working the night shift
• Aging. As people age, they often get less sleep or spend less time in the deep, restful stage of sleep. They are also more easily awakened.

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 each night to fall asleep
• You regularly wake up several times each night 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, tingling, or crawling feelings 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 when you are angry or fearful, or when you laugh
• You feel as though you cannot move when you first wake up

To make a diagnosis, your health care provider will use your medical history, your sleep history, and a physical exam. You may also have a sleep study (polysomnogram). The most common types of sleep studies monitor and record data about your body during a full night of sleep. The data includes:

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

Other types of sleep studies may check how quickly you fall asleep during daytime naps or whether you are able to stay awake and alert during the day.

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

• Good sleep habits and other lifestyle changes, such as a healthy diet and exercise
• Cognitive behavioral therapy or relaxation techniques to reduce anxiety about getting enough sleep
• CPAP (continuous positive airway pressure) machine for sleep apnea
• Bright light therapy (in the morning)
• Medicines, including sleeping pills. Usually, providers recommend that you use sleeping pills for a short period of time.
• Natural products, such as melatonin. These products may help some people but are generally for short-term use. Make sure to check with your health care provider before you take any of them.

While you are sleeping, you are unconscious, but your brain and body functions are still active. Sleep is a complex biological process that helps you process new information, stay healthy, and feel rested.

During sleep, your brain cycles through five stages: stage 1, 2, 3, 4, and rapid eye movement (REM) sleep. Different things happen during each stage. For example, you have a different pattern of brain waves during each one. Your breathing, heart, and temperature may be slower or faster in some stages. Certain phases of sleep help you :

• Feel rested and energetic the next day
• Learn information, get insight, and form memories
• Give your heart and vascular system a rest
• Release more growth hormone, which helps children grow. It also boosts muscle mass and the repair of cells and tissues in children and adults.
• Release sex hormones, which contributes to puberty and fertility
• Keep from getting sick or help you get better when you are sick, by creating more cytokines (hormones that help the immune system fight various infections)

You need all of the stages to get a healthy sleep.

The amount of sleep you need depends on several factors, including your age, lifestyle, health, and whether you have been getting enough sleep recently. The general recommendations for sleep are:

• Newborns: 16-18 hours a day
• Preschool-aged children: 11-12 hours a day
• School-aged children: At least 10 hours a day
• Teens: 9-10 hours a day
• Adults (including older adults): 7-8 hours a day

During puberty, teenagers' biological clocks shift, and they are more likely to go to bed later than younger children and adults, and they tend to want to sleep later in the morning. This delayed sleep-wake rhythm conflicts with the early-morning start times of many high schools and helps explain why most teenagers do not get enough sleep.

Some people think that adults need less sleep as they age. But there is no evidence to show that older adults can get by with less sleep than people who are younger. As people age, however, they often get less sleep or they tend to spend less time in the deep, restful stage of sleep. Older adults are also more easily awakened.

And it's not just the number of hours of sleep you get that matters. The quality of the sleep you get is also important. People whose sleep is frequently interrupted or cut short might not get enough of certain stages of sleep.

If you are wondering whether you are getting enough sleep, including quality sleep, ask yourself:

• Do you have trouble getting up in the morning?
• Do you have trouble focusing during the day?
• Do you doze off during the day?

If you answered yes to these three questions, you should work on improving your sleep.

Sleep is important for overall health. When you don't get enough sleep (sleep deprivation), it does more than just make you feel tired. It can affect your performance, including your ability to think clearly, react quickly, and form memories. This may cause you to make bad decisions and take more risks. People with sleep deprivation are more likely to get into accidents.

Sleep deprivation can also affect your mood, leading to:

• Irritability
• Problems with relationships, especially for children and teenagers
• Depression
• Anxiety

It can also affect your physical health. Research shows that not getting enough sleep, or getting poor-quality sleep, increases your risk of:

• High blood pressure
• Heart disease
• Stroke
• Kidney disease
• Obesity
• Type 2 diabetes

Not getting enough sleep can also mean that you don't get enough of the hormones that help children grow and help adults and children build muscle mass, fight infections, and repair cells.

Sleep deprivation magnifies the effect of alcohol. A tired person who drinks too much alcohol will be more impaired than a well-rested person.

You can take steps to improve your sleep habits. First, make sure that you allow yourself enough time to sleep. With enough sleep each night, you may find that you're happier and more productive during the day.

To improve your sleep habits, it also may help to:

• Go to bed and wake up at the same time every day
• Avoid caffeine, especially in the afternoon and evening
• Avoid nicotine
• Exercise regularly, but don't exercise too late in the day
• Avoid alcoholic drinks before bed
• Avoid large meals and beverages late at night
• Don't take a nap after 3 p.m.
• Relax before bed, for example by taking a bath, reading or listening to relaxing music
• Keep the temperature in your bedroom cool
• Get rid of distractions such as noises, bright lights, and a TV or computer in the bedroom. Also, don't be tempted to go on your phone or tablet just before bed.
• Get enough sunlight exposure during the day
• Don't lie in bed awake; if you can't sleep for 20 minutes, get up and do something relaxing
• See a doctor if you have continued trouble sleeping. You may have a sleep disorder, such as insomnia or sleep apnea. In some cases, your doctor may suggest trying over-the-counter or prescription sleep aid. In other cases, your doctor may want you to do a sleep study, to help diagnose the problem.

If you are a shift worker, it can be even harder to get a good sleep. You may also want to:

• Take naps and increase the amount of time available for sleep
• Keep the lights bright at work
• Limit shift changes so your body clock can adjust
• Limit caffeine use to the first part of your shift
• Remove sound and light distractions in your bedroom during daytime sleep (for example, use light-blocking curtains)

Insomnia is a common sleep disorder. If you have it, you may have trouble falling asleep, staying asleep, or both. As a result, you may get too little sleep or have poor-quality sleep. You may not feel refreshed when you wake up.

Insomnia can be acute (short-term) or chronic (ongoing). Acute insomnia is common. Common causes include stress at work, family pressures, or a traumatic event. It usually lasts for days or weeks.

Chronic insomnia lasts for a month or longer. Most cases of chronic insomnia are secondary. This means they are the symptom or side effect of some other problem, such as certain medical conditions, medicines, and other sleep disorders. Substances such as caffeine, tobacco, and alcohol can also be a cause.

Sometimes chronic insomnia is the primary problem. This means that it is not caused by something else. Its cause is not well understood, but long-lasting stress, emotional upset, travel and shift work can be factors. Primary insomnia usually lasts more than one month.

Insomnia is common. It affects women more often than men. You can get it at any age, but older adults are more likely to have it. You are also at higher risk of insomnia if you:

• Have a lot of stress
• Are depressed or have other emotional distress, such as divorce or death of a spouse
• Have a lower income
• Work at night or have frequent major shifts in your work hours
• Travel long distances with time changes
• Have an inactive lifestyle
• Are African American; research shows that African Americans take longer to fall asleep, don't sleep as well, and have more sleep-related breathing problems than Whites.

Symptoms of insomnia include:

• Lying awake for a long time before you fall asleep
• Sleeping for only short periods
• Being awake for much of the night
• Feeling as if you haven't slept at all
• Waking up too early

Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. Insomnia also can cause other serious problems. For example, it could make you feel drowsy while driving. This could cause you get into a car accident.

To diagnose insomnia, your health care provider:

• Takes your medical history
• Asks for your sleep history. Your provider will ask you for details about your sleep habits.
• Does a physical exam, to rule out other medical problems that might cause insomnia
• May recommend a sleep study. A sleep study measures how well you sleep and how your body responds to sleep problems.

Treatments include lifestyle changes, counseling, and medicines:

• Lifestyle changes, including good sleep habits, often help relieve acute (short-term) insomnia. These changes might make it easier for you to fall asleep and stay asleep.
• A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia
• Several medicines also can help relieve your insomnia and allow you to re-establish a regular sleep schedule

If your insomnia is the symptom or side effect of another problem, it's important to treat that problem (if possible).

NIH: National Heart, Lung, and Blood Institute

Caffeine is a bitter substance that occurs naturally in more than 60 plants including:

• Coffee beans
• Tea leaves
• Kola nuts, which are used to flavor soft drink colas
• Cacao pods, which are used to make chocolate products

There is also synthetic (man-made) caffeine, which is added to some medicines, foods, and drinks. For example, some pain relievers, cold medicines, and over-the-counter medicines for alertness contain synthetic caffeine. So do energy drinks and "energy-boosting" gums and snacks.

Most people consume caffeine from drinks. The amount of caffeine in different drinks can vary a lot, but it is generally:

• An 8-ounce cup of coffee: 95-200 mg
• A 12-ounce can of cola: 35-45 mg
• An 8-ounce energy drink: 70-100 mg
• An 8-ounce cup of tea: 14-60 mg

Caffeine has many effects on your body's metabolism. It:

• Stimulates your central nervous system, which can make you feel more awake and give you a boost of energy
• Is a diuretic, meaning that it helps your body get rid of extra salt and water by urinating more
• Increases the release of acid in your stomach, sometimes leading to an upset stomach or heartburn
• May interfere with the absorption of calcium in the body
• Increases your blood pressure

Within one hour of eating or drinking caffeine, it reaches its peak level in your blood. You may continue to feel the effects of caffeine for four to six hours.

For most people, it is not harmful to consume up to 400mg of caffeine a day. If you do eat or drink too much caffeine, it can cause health problems, such as:

• Restlessness and shakiness
• Insomnia
• Headaches
• Dizziness
• Fast heart rate
• Dehydration
• Anxiety
• Dependency, so you need to take more of it to get the same results

Some people are more sensitive to the effects of caffeine than others.

Energy drinks are beverages that have added caffeine. The amount of caffeine in energy drinks can vary widely, and sometimes the labels on the drinks do not give you the actual amount of caffeine in them. Energy drinks may also contain sugars, vitamins, herbs, and supplements.

Companies that make energy drinks claim that the drinks can increase alertness and improve physical and mental performance. This has helped make the drinks popular with American teens and young adults. There's limited data showing that energy drinks might temporarily improve alertness and physical endurance. There is not enough evidence to show that they enhance strength or power. But what we do know is that energy drinks can be dangerous because they have large amounts of caffeine. And since they have lots of sugar, they can contribute to weight gain and worsen diabetes.

Sometimes young people mix their energy drinks with alcohol. It is dangerous to combine alcohol and caffeine. Caffeine can interfere with your ability to recognize how drunk you are, which can lead you to drink more. This also makes you more likely to make bad decisions.

You should check with your health care provider about whether you should limit or avoid caffeine if you:

• Are pregnant, since caffeine passes through the placenta to your baby.
• Are breastfeeding, since a small amount of caffeine that you consume is passed along to your baby.
• Have sleep disorders, including insomnia.
• Have migraines or other chronic headaches.
• Have anxiety.
• Have GERD or ulcers.
• Have arrhythmia (a problem with the rate or rhythm of your heartbeat).
• Have high blood pressure.
• Take certain medicines or supplements, including stimulants, certain antibiotics, asthma medicines, and heart medicines. Check with your health care provider about whether there might be interactions between caffeine and any medicines and supplements that you take.
• Are a child or teen. Neither should have as much caffeine as adults. Children can be especially sensitive to the effects of caffeine.

If you have been consuming caffeine on a regular basis and then suddenly stop, you may have caffeine withdrawal. Symptoms can include:

• Headaches
• Drowsiness
• Irritability
• Nausea
• Trouble concentrating

These symptoms usually go away after a couple of days.

Cancer is a common disease. Almost 40 percent of Americans will be diagnosed with cancer during their lifetimes. Even though cancer may be life-threatening, many people have successful treatment. Others live with cancer for a very long time.

For most people with cancer, learning to live with the disease is one of the biggest challenges they've ever faced. That's because having cancer touches just about every part of your life and the lives of those around you.

Cancer and its treatment may change:

• Your daily routines and ability to work
• Your important relationships
• The way you look, feel, and think about yourself

You may feel more in control and prepared to cope with these changes if you learn about what to expect. Your health care provider can help you find information and support services that are right for you.

Having cancer may cause a range of strong emotions, such as sadness, anger, fear, worry, or guilt. These feelings are normal, and they're likely to change over time. It's helpful to sort out your feelings in a way that's comfortable for you. You might try:

• Talking openly with someone you trust
• Writing about your feelings
• Using relaxation methods, such as meditation and other complementary and alternative medicine (CAM)
• Doing things you enjoy to give yourself a break from focusing on cancer

If your emotions seem to take over your life, tell your provider. You may need extra support if you have symptoms of depression, stress, anxiety, or panic disorder.

During cancer treatment, you usually have a team of providers. Along with doctors and nurses, you may be able to talk with social workers, pharmacists, dietitians, and other health professionals.

These professionals are prepared to help you deal with the issues that cancer brings up, including concerns about finances. But it's up to you to let your team know what's on your mind.

Good communication with your providers may help you feel more in control and satisfied with your care. Your communications may be better if you:

• Tell your providers how much you want to know about your cancer and its treatment. Do you want all the details or just the big picture?
• Write down your questions and concerns before your visits.
• Bring a family member or a friend to your visits. This person can help by listening, taking notes, and asking questions.

Cancer changes the daily routines and roles of the people who love and support you. They may need to start doing the things you've always done for them. And you may need their help doing things you've always done for yourself. These changes can be difficult for everyone.

It may help to have an honest talk about changing roles and needs. If that sounds too difficult, ask a social worker or other member of your care team to help you talk with family and friends who are helping with your care. These caregivers may need some support, too.

Cancer and its treatment may cause some big changes in how you look, feel, and think about yourself. For example, you may have:

• Less energy
• Temporary or permanent changes in your body, such as scars, or hair loss from chemotherapy
• Problems being sexually close or doubts about dating

Coping with these changes can be hard. But most people find ways to feel more positive over time. If you feel well enough, you might try:

• Exercise. Walking, yoga, or other movement may help you feel stronger and more in control of your body. But check with your provider first.
• Staying involved in life and helping others. Think about volunteering, hobbies, or other activities that might make you feel good about yourself.
• Counseling for sexual problems. Talking with a professional, either with a partner or on your own, may help.

After treatment, you'll have regular cancer follow-up care. Your provider will explain the schedule of checkups and tests you'll need. This is a good time to discuss the challenges you may face ahead. Knowing what to expect may help you make plans as you find a "new normal" with cancer as part of your life.

NIH: National Cancer Institute

Drug use, or misuse, includes:

• Using illegal substances, such as
  • Anabolic steroids
  • Club drugs
  • Cocaine
  • Heroin
  • Inhalants
  • Marijuana
  • Methamphetamines
• Misusing prescription medicines, including opioids. This means taking the medicines in a different way than the health care provider prescribed. This includes
• Taking a medicine that was prescribed for someone else
• Taking a larger dose than you are supposed to
• Using the medicine in a different way than you are supposed to. For example, instead of swallowing your tablets, you might crush and then snort or inject them.
• Using the medicine for another purpose, such as getting high
• Misusing over-the-counter medicines, including using them for another purpose and using them in a different way than you are supposed to.

Young people's brains are growing and developing until they are their mid-20's. This is especially true of the prefrontal cortex, which is used to make decisions. Taking drugs when young can interfere with developmental processes occurring in the brain. It can also affect their decision-making. They may be more likely to do risky things, such as unsafe sex and dangerous driving.

The earlier young people start using drugs, the greater their chances of continuing to use them and become addicted later in life.Taking drugs when you are young can contribute to the development of adult health problems, such as heart disease, high blood pressure, and sleep disorders.

The drugs that are most commonly used by young people are alcohol, tobacco, and marijuana. Recently, more young people have started vaping tobacco and marijuana. There is still a lot we don't know about the dangers of vaping. Some people have unexpectedly gotten very ill or have even died after vaping. Because of this, young people should stay away from vaping.

There are many different reasons why a young person may take drugs, including:

• To fit in. Young people may do drugs because they want to be accepted by friends or peers who are doing drugs.
• To feel good. Abused drugs can produce feelings of pleasure.
• To feel better. Some young people suffer from depression, anxiety, stress-related disorders, and physical pain. They may do drugs to try to get some relief.
• To do better in academics or sports. Some young people may take stimulants for studying or anabolic steroids to improve their athletic performance.
• To experiment. Young people often want to try new experiences, especially ones that they think are thrilling or daring.

Different factors may raise a young person's risk for drug use, including:

• Stressful early life experiences, such child abuse, child sexual abuse, and other forms of trauma
• Genetics
• Prenatal exposure to alcohol or other drugs
• Lack of parental supervision or monitoring
• Having peers and/or friends who use drugs

• Changing friends a lot
• Spending a lot of time alone
• Losing interest in favorite things
• Not taking care of themselves - for example, not taking showers, changing clothes, or brushing their teeth
• Being really tired and sad
• Eating more or eating less than usual
• Being very energetic, talking fast, or saying things that don't make sense
• Being in a bad mood
• Quickly changing between feeling bad and feeling good
• Missing important appointments
• Having problems at school - missing class, getting bad grades
• Having problems in personal or family relationships
• Lying and stealing
• Memory lapses, poor concentration, lack of coordination, slurred speech, etc.

Drug use and addiction are preventable. Prevention programs involving families, schools, communities, and the media may prevent or reduce drug use and addiction. These programs include education and outreach to help people understand the risks of drug use.

You can help prevent your children from using drugs through:

• Good communication with your children
• Encouragement, so your children can build confidence and a strong sense of self. It also helps parents promote cooperation and reduce conflict.
• Teaching your children problem-solving skills
• Setting limits, to teach your children self-control and responsibility, provide safe boundaries, and show them that you care
• Supervision, which helps parents recognize developing problems, promote safety, and stay involved
• Knowing your children's friends

NIH: National Institute on Drug Abuse

Fatigue is a feeling of weariness, tiredness, or lack of energy. It can interfere with your usual daily activities. Fatigue can be a normal response to physical activity, emotional stress, boredom, or lack of sleep. But sometimes it can be a sign of a mental or physical condition. If you have been feeling tired for weeks, contact your health care provider. They can help you find out what's causing your fatigue and recommend ways to relieve it.

Fatigue itself is not a disease; it's a symptom. It can have many different causes, including pregnancy and various medical problems, treatments, and lifestyle habits such as:

• Medical problems:
  • Chronic (long-lasting) diseases such as diabetes, COPD (chronic obstructive pulmonary disease), and heart, liver, kidney and thyroid diseases
  • Untreated pain and diseases like fibromyalgia
  • Anemia
  • Infections
  • Parkinson's disease
  • Sleep apnea and other sleep disorders
  • Recent stroke
  • Mental disorders such as depression and anxiety
• Treatments:
  • Cancer treatments such as chemotherapy, radiation, and bone marrow transplants
  • Recovering from major surgery
  • Taking certain medicines, such as antidepressants, antihistamines, and medicines for nausea and pain
• Lifestyle habits:
  • Not getting enough sleep
  • Staying up too late
  • Drinking too much alcohol
  • Substance use
  • Having too much caffeine (which can keep you from getting a good night's sleep)
  • Getting too little or too much exercise

Overwhelming fatigue is part of a disorder called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The fatigue caused by this disorder is different from a tired feeling that goes away after you rest. Instead, the fatigue in ME/CFS lasts a long time, does not get better with rest, and limits your ability to do ordinary daily activities.

If you've had fatigue that does not get better after several weeks, call your provider. They will ask questions about your sleep, daily activities, appetite, and exercise. They will likely do a physical exam and order lab tests. Once they decide on a diagnosis, they can tell you what treatments might help.

You can also make some lifestyle changes to feel less tired:

• Get regular physical activity
• Improve your sleep habits
• Stop smoking (if you smoke), since smoking is linked to many diseases that can cause fatigue
• Manage stress
• Eat a healthy diet and avoid alcohol

It also may be helpful for you to keep a fatigue diary. This can help you find patterns throughout the day, such as when you feel more tired and when you have more energy. It can also help you plan for activities that may give you more energy.

NIH: National Institute on Aging

Lewy body dementia (LBD) is one of the most common types of dementia in older adults. Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include:

• Memory
• Language skills
• Visual perception (your ability to make sense of what you see)
• Problem solving
• Trouble with everyday tasks
• The ability to focus and pay attention

There are two types of LBD: dementia with Lewy bodies and Parkinson's disease dementia.

Both types cause the same changes in the brain. And, over time, they can cause similar symptoms. The main difference is in when the cognitive (thinking) and movement symptoms start.

Dementia with Lewy bodies causes problems with thinking ability that seem similar to Alzheimer's disease. Later, it also causes other symptoms, such as movement symptoms, visual hallucinations, and certain sleep disorders. It also causes more trouble with mental activities than with memory.

Parkinson's disease dementia starts as a movement disorder. It first causes the symptoms of Parkinson's disease: slowed movement, muscle stiffness, tremor, and a shuffling walk. Later on, it causes dementia.

LBD happens when Lewy bodies build up in parts of the brain that control memory, thinking, and movement. Lewy bodies are abnormal deposits of a protein called alpha-synuclein. Researchers don't know exactly why these deposits form. But they do know that other diseases, such as Parkinson's disease, also involve a build-up of that protein.

The biggest risk factor for LBD is age; most people who get it are over age 50. People who have a family history of LBD are also at higher risk.

LBD is a progressive disease. This means that the symptoms start slowly and get worse over time. The most common symptoms include changes in cognition, movement, sleep, and behavior:

• Dementia, which is a loss of mental functions that is severe enough to affect your daily life and activities
• Changes in concentration, attention, alertness, and wakefulness. These changes usually happen from day to day. But sometimes they can also happen throughout the same day.
• Visual hallucinations, which means seeing things that are not there
• Problems with movement and posture, including slowness of movement, difficulty walking, and muscle stiffness. These are called parkinsonian motor symptoms.
• REM sleep behavior disorder, a condition in which a person seems to act out dreams. It may include vivid dreaming, talking in one's sleep, violent movements, or falling out of bed. This may be the earliest symptom of LBD in some people. It can appear several years before any other LBD symptoms.
• Changes in behavior and mood, such as depression, anxiety, and apathy (a lack of interest in normal daily activities or events)

In the early stages of LBD, symptoms can be mild, and people can function fairly normally. As the disease gets worse, people with LBD need more help due to problems with thinking and movement. In the later stages of the disease, they often cannot care for themselves.

There isn't one test that can diagnose LBD. It is important to see an experienced doctor to get a diagnosis. This would usually be a specialist such as a neurologist. The doctor will:

• Do a medical history, including taking a detailed account of the symptoms. The doctor will talk to both the patient and caregivers.
• Do physical and neurological exams
• Do tests to rule out other conditions that could cause similar symptoms. These could include blood tests and brain imaging tests.
• Do neuropsychological tests to evaluate memory and other cognitive functions

LBD can be hard to diagnose, because Parkinson's disease and Alzheimer's disease cause similar symptoms. Scientists think that Lewy body disease might be related to these diseases, or that they sometimes happen together.

It's also important to know which type of LBD a person has, so the doctor can treat that type's particular symptoms. It also helps the doctor understand how the disease will affect the person over time. The doctor makes a diagnosis based on when certain symptoms start:

• If cognitive symptoms start within a year of movement problems, the diagnosis is dementia with Lewy bodies
• If cognitive problems start more than a year after the movement problems, the diagnosis is Parkinson's disease dementia

There is no cure for LBD, but treatments can help with the symptoms:

• Medicines may help with some of the cognitive, movement, and psychiatric symptoms
• Physical therapy can help with movement problems
• Occupational therapy may help find ways to more easily do everyday activities
• Speech therapy may help with swallowing difficulties and trouble speaking loudly and clearly
• Mental health counseling can help people with LBD and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
• Music or art therapy may reduce anxiety and improve well-being

Support groups can also be helpful for people with LBD and their caregivers. Support groups can give emotional and social support. They are also a place where people can share tips about how to deal with day-to-day challenges.

NIH: National Institute of Neurological Disorders and Stroke

Migraines are a recurring type of headache. They cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head. You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound.

Researchers believe that migraine has a genetic cause. There are also a number of factors that can trigger a migraine. These factors vary from person to person, and they include:

• Stress
• Anxiety
• Hormonal changes in women
• Bright or flashing lights
• Loud noises
• Strong smells
• Medicines
• Too much or not enough sleep
• Sudden changes in weather or environment
• Overexertion (too much physical activity)
• Tobacco
• Caffeine or caffeine withdrawal
• Skipped meals
• Medication overuse (taking medicine for migraines too often)

Some people have found that certain foods or ingredients can trigger headaches, especially when they are combined with other triggers. These foods and ingredients include:

• Alcohol
• Chocolate
• Aged cheeses
• Monosodium glutamate (MSG)
• Some fruits and nuts
• Fermented or pickled goods
• Yeast
• Cured or processed meats

About 12% of Americans get migraines. They can affect anyone, but you are more likely to have them if you:

• Are a woman. Women are three times more likely than men to get migraines.
• Have a family history of migraines. Most people with migraines have family members who have migraines.
• Have other medical conditions, such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.

There are four different phases of migraines. You may not always go through every phase each time you have a migraine.:

• Prodome. This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination.
• Aura. If you have this phase, you might see flashing or bright lights or zig-zag lines. You may have muscle weakness or feel like you are being touched or grabbed. An aura can happen just before or during a migraine.
• Headache. A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, which is often on one side of your head. But sometimes you can have a migraine without a headache. Other migraine symptoms may include
• Increased sensitivity to light, noise, and odors
• Nausea and vomiting
• Worsened pain when you move, cough, or sneeze
• Postdrome (following the headache). You may feel exhausted, weak, and confused after a migraine. This can last up to a day.

Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.

To make a diagnosis, your health care provider will:

• Take your medical history
• Ask about your symptoms
• Do a physical and neurological exam

An important part of diagnosing migraines is to rule out other medical conditions which could be causing the symptoms. So you may also have blood tests, an MRI or CT scan, or other tests.

There is no cure for migraines. Treatment focuses on relieving symptoms and preventing additional attacks.

There are different types of medicines to relieve symptoms. They include triptan drugs, ergotamine drugs, and pain relievers. The sooner you take the medicine, the more effective it is.

There are also other things you can do to feel better:

• Resting with your eyes closed in a quiet, darkened room
• Placing a cool cloth or ice pack on your forehead
• Drinking fluids

There are some lifestyle changes you can make to prevent migraines:

• Stress management strategies, such as exercise, relaxation techniques, and biofeedback, may reduce the number and severity of migraines. Biofeedback uses electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension.
• Make a log of what seems to trigger your migraines. You can learn what you need to avoid, such as certain foods and medicines. It also help you figure out what you should do, such as establishing a consistent sleep schedule and eating regular meals.
• Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle
• If you have obesity, losing weight may also be helpful

If you have frequent or severe migraines, you may need to take medicines to prevent further attacks. Talk with your health care provider about which drug would be right for you.

Certain natural treatments, such as riboflavin (vitamin B2) and coenzyme Q10, may help prevent migraines. If your magnesium level is low, you can try taking magnesium. There is also an herb, butterbur, which some people take to prevent migraines. But butterbur may not be safe for long-term use. Always check with your health care provider before taking any supplements.

NIH: National Institute of Neurological Disorders and Stroke

Parkinson's disease (PD) is a type of movement disorder. It happens when nerve cells in the brain don't produce enough of a brain chemical called dopamine. Sometimes it is genetic, but most cases do not seem to run in families. Exposure to chemicals in the environment might play a role.

Symptoms begin gradually, often on one side of the body. Later they affect both sides. They include:

• Trembling of hands, arms, legs, jaw and face
• Stiffness of the arms, legs and trunk
• Slowness of movement
• Poor balance and coordination

As symptoms get worse, people with the disease may have trouble walking, talking, or doing simple tasks. They may also have problems such as depression, sleep problems, or trouble chewing, swallowing, or speaking.

There is no specific test for PD, so it can be difficult to diagnose. Doctors use a medical history and a neurological examination to diagnose it.

PD usually begins around age 60, but it can start earlier. It is more common in men than in women. There is no cure for PD. A variety of medicines sometimes help symptoms dramatically. Surgery and deep brain stimulation (DBS) can help severe cases. With DBS, electrodes are surgically implanted in the brain. They send electrical pulses to stimulate the parts of the brain that control movement.

NIH: National Institute of Neurological Disorders and Stroke