In general, Addison’s disease treatment requires corticosteroid replacement therapy. The medications are taken for life. Corticosteroid treatment typically taken by mouth orally, replaces cortisol and aldosterone, which the body does not produce.
Some drugs, usually in the form of tablets, provide treatment options for Addison’s disease, depending on the particular hormones that are lacking from the body.
If the corticosteroid replacement treatment is retained, the outlook is positive-it is vital that patients obey the orders of the doctor.
Fast facts on Addison’s disease treatment
Here are some key points about Addison’s disease treatment. The main article provides more comprehensive and supporting material.
- Treatment focuses on corticosteroid replacement therapy, usually in the form of tablets once or twice daily.
- Home treatments, including injectable corticosteroids, may be required for emergencies.
- Treatment lasts for the rest of a patient’s life and focuses on managing symptoms.
- Prognosis is good, so long as medications are taken as directed, but regular doctor consultations are required.
What medications are available for Addison’s disease?
Addison’s relies on the hormones that in the adrenal glands are no longer developed effectively.
The following are some possible medications:
- Hydrocortisone – these tablets replace the missing cortisol. Prednisolone or dexamethasone are prescribed less commonly.
- Fludrocortisone – might be prescribed for missing aldosterone.
- Dehydroepiandrosterone (DHEA) – these pills may be prescribed if there is an androgen (the male sex hormone) deficiency.
Medication side effects
Side effects of hydrocortisone and fludrocortisone: include issues with sleep, acne, slow healing of wounds, dizziness, nausea, and increased perspiration.
Side effects of DHEA in women: similar to the above, but may also include menstrual cycle modifications, deeper voice development, and growth of facial hair.
The frequency of medication a patient needs to take depends on their hormone deficiency level and the severity of their symptoms. As a consequence, over time patients will have their treatment programme tweaked by a healthcare professional.
Complications during treatment
Because the disease is treated with drugs that must be used for the remainder of the life of a patient, there are many risk factors that need to be taken into account.
When a person with Addison’s disease experiences the following, caution must be exercised:
- Illness – if the patient becomes unwell, their hormonal levels may be impacted, meaning that their medications may be less effective in alleviating symptoms.
- Surgery – a dysfunction of the adrenal gland is an important consideration during surgery; patients will need to be carefully monitored and have their treatment adjusted during and when recovering from surgery.
- Pregnancy – if a patient becomes pregnant, hormone levels change. During pregnancy, medications may have to be adjusted regularly to be effective.
The dosage may need to be increased during periods of stress, injury, or infection. The drugs might need to be injected if the patient suffers from vomiting.
The patient may have to add additional salt to their daily diet as well.
Adrenal crisis (Addisonian crisis) treatment
The patient will need medical emergency therapy, typically requiring intravenous injections of:
- saline solution
- sugar (dextrose)
The adrenal crisis is an emergency and should be urgently handled.
Medical alert bracelet/necklace
Many physicians encourage patients to wear a bracelet or necklace that informs healthcare providers that they have the disease of Addison; this is particularly important for elderly patients who may be more likely to fall or harm themselves.
Patients with Addison’s disease do not produce enough cortisol, so medical personnel need to know what drug the person urgently needs (cortisol) to avoid any complications when they have an accident or serious injury.
Read more about Addison’s disease:
Hypothyroidism, sweating, and night sweats: What to know
Hypothyroidism is commonly associated with decreased sweating and feeling cold, according to doctors. Sweating is a symptom of hypothyroidism in some people. This could be due to the fact that thyroid hormones assist control body temperature, and a lack of them causes instability.
There are, however, other, more plausible reasons for similar symptoms.
For example, if someone takes more levothyroxine than they require, a hypothyroidism drug called levothyroxine might cause sweating as a side effect. Other variables, such as menopause, can cause sweating and may occur in conjunction with hypothyroidism.
In this article, the connection between hypothyroidism, sweating, and nite sweats is examined. It also looks into how people might live more comfortably when they are sweating profusely.
When to consult a physician
If a person has night sweats on a frequent basis, they should consult a doctor. If they already have hypothyroidism, the doctor may suggest changing their medication dosage or checking for other possible causes.
If someone does not have a diagnosis of hypothyroidism, consulting a doctor will allow them to run tests to confirm or rule out the condition.
Hypothyroidism and sweating
Although doctors connect hypothyroidism with feeling chilly and hyperthyroidism with feeling hot, low thyroid hormone levels may cause overall difficulties controlling body temperature. This could imply that some hypothyroid people suffer perspiration. There is, however, insufficient scientific evidence to back this claim.
Another possibility is that the individual is taking too much levothyroxine. Levothyroxine substitutes thyroid hormones that the body can not produce enough of. Taking more of this medication than is necessary may result in:
- difficulty sleeping
- chest pain
- nausea or vomiting
- a racing heartbeat
- anxiety or agitation
Hypothyroidism and night sweats
Night sweats can be caused by hypothyroidism, but clinicians rarely link the two. There could be other causes for this condition. For example, levothyroxine, a hypothyroidism drug, may cause a person to feel excessively hot in general, including at night.
Thyroid hormone levels influence other hormone levels in the body and vice versa. This is especially important for women, who are five to eight times more likely than men to have hypothyroidism.
In their mid-to-late 40s, most women experience the first signs of menopause. At this point, estrogen and progesterone levels begin to fall. This can cause in symptoms, the most prevalent of which are hot flashes and nocturnal sweats. Doctors believe that estrogen levels may have an effect on thyroid function as well.
Menopause and hypothyroidism have several symptoms, and each can aggravate the other. This could imply that some hypothyroid people suffer both thyroid and menopausal symptoms at the same time.
Estrogen influences how much triiodothyronine and thyroxine the thyroid produces, and the thyroid may struggle to meet the body’s needs during menopause. According to a 2011 study, estrogen has a direct influence on human thyroid cells.
An earlier 2007 study looked at females with hypothyroidism or hyperthyroidism and severe menopausal symptoms. The researchers discovered that treating thyroid dysfunction reduced patients menopausal symptoms, such as night sweats.
Other hypothyroidism symptoms
The symptoms of hypothyroidism might vary from person to person. However, some common symptoms are as follows:
- weight gain
- dry skin
- an inability to tolerate cold
- heavy or irregular periods
- fertility problems
- dry, thinning hair
- voice changes
- muscle pain
- joint pain
- a slowed heart rate
People who have frequent sweating and nocturnal sweats should consult a doctor about their symptoms. They may need to be tested for thyroid disease. Alternatively, if they already have a diagnosis, they may need to alter their prescription dosage.
To alleviate the discomfort caused by sweating, it may be beneficial to:
- Sleep in a cool bedroom: Turning down the thermostat and sleeping with less or lighter bedding might help minimize heat around the body during sleeping. Make an effort to use bedding composed of breathable, natural fibers such as cotton.
- Choose breathable clothing: Wherever feasible, use lightweight, flowy clothing made of natural fibers. This can assist in keeping the body cool and wicking away perspiration. Wearing light layers allows someone to remove or reapply garments as their body temperature changes.
- Reduce sweat triggers: Spicy meals, cigarettes, and alcohol can aggravate night sweats, therefore avoiding these can help to alleviate this condition.
- Use a cooling pillow or ice pack: Some pillows feature a gel filling that keeps you cool while you sleep. Alternatively, a cool pack can be placed under the pillow. When a person has night sweats, flipping the pillow to the cool side can help them chill down.
If levothyroxine and lifestyle adjustments do not alleviate sweating, it is possible that something else is causing this symptom. The following are some further explanations.
Perimenopause, or the earliest stage of menopause, is characterized by hot flashes and nocturnal sweats. These are known as vasomotor symptoms by doctors.
According to research, more than 80% of females experience hot flashes throughout menopause. These often cause in a sudden feeling of heat, perspiration, flushing, anxiousness, and chills. This can persist 1–5 minutes before dissipating.
Many drugs might cause night sweats. Night sweats, for example, are reported by up to 22% of people who take antidepressants.
Among the other drugs that may have this effect are:
- hormone therapy drugs
- medications that decrease blood sugar
A doctor may propose alternatives if a person is taking a medicine that can cause perspiration. Do not change the dosage or discontinue a medicine without first consulting a medical expert.
Diabetes can cause havoc on the body’s natural capacity to regulate its internal temperature. This frequently leads to less sweating than is desirable, putting people at higher risk of heat-related diseases including heat stroke.
People who have low blood sugar, or hypoglycemia, may also have excessive sweating. A condition known as gustatory sweating is also a known consequence of diabetes. This causes excessive sweating during or immediately following meals.
Other causes for sweating or night sweats include:
- excessive alcohol consumption
- autoimmune conditions
- gastroesophageal reflux disease
- Parkinson’s disease and other neurological conditions
- cancer, such as pheochromocytoma, leukemia, and lymphoma
Hypothyroidism is a condition in which the thyroid produces insufficient thyroid hormone. Although sweating is more frequently associated with hyperthyroidism, or an overactive thyroid, it is possible that low levels of thyroid hormone may cause sweating in some hypothyroid patients.
There are, however, numerous other causes that can cause perspiration. Menopause, medication side effects, diabetes, and other conditions could all be factors. As a cause, anyone who sweats during the day or night for no apparent reason should consult a doctor.
Insomnia and hypothyroidism: Is there a link?
Rather than an underactive thyroid, doctors usually connect difficulties sleeping with an overactive thyroid. However, there is little evidence that hypothyroidism may be linked to sleep issues.
This article examines whether hypothyroidism is associated to insomnia, as well as the reasons for such a link. It also looks into how people can manage their symptoms.
Hypothyroidism and insomnia
Hypothyroidism and insomnia may be linked. A 2019 study looked at hypothyroidism and sleep quality.
For a full-blown diagnosis of hypothyroidism, a condition must have subclinical hypothyroidism.
The scientists discovered several associations between sleep of 2,224 people with subclinical hypothyroidism and 12,622 people with normal thyroid hormone levels. Subclinical hypothyroidism was associated with:
- lower satisfaction with sleep quality
- longer sleep latency, which is the amount of time it takes to go to sleep
- shorter sleep duration
The researchers also discovered that people with both subclinical hypothyroidism and poor sleep quality were more likely to be female, younger, and underweight.
A 2014 study looked into the possibility of a link between subclinical hypothyroidism and poor sleep quality, however the sample size was smaller and less diversified. There were 682 men in the study, 38 of whom had hypothyroidism.
There was no link between thyroid hormone levels and poor sleep quality, according to the findings. However, due to the study’s limitations, it may not be accurate.
Is there a link?
Thyroid-stimulating hormone levels are high in subclinical hypothyroidism (TSH). The hypothalamus, a component of the brain, causes the pituitary gland to release more TSH when thyroid levels in the body are low.
TSH stimulates the thyroid gland to produce more of the hormone known as free thyroxine when it reaches the gland (T4).
Subclinical hypothyroidism is defined by normal T4 levels in the blood and increased TSH levels, which can indicate that hypothyroidism symptoms are nonexistent or moderate.
Researchers don’t entirely understand how elevated TSH levels can lead to poor sleep, but they do have an idea.
The hypothalamic-pituitary-thyroid (HPT) axis connects the hypothalamus, pituitary gland, and thyroid gland. The HPT axis gets increasingly active as a person falls asleep.
This stimulates the thyroid gland by increasing the secretion of TSH. Thyroid stimulation may cause sleep disturbances under specific physiological situations.
Other ways hypothyroidism can affect sleep
While it is unknown if hypothyroidism can cause insomnia directly, it is plausible that it can affect sleep indirectly. Hypothyroidism can cause the following symptoms:
Hypothyroidism’s physical effects can sometimes make it difficult to sleep. For example, if a person has joint or muscular pain, is sensitive to the cold, or is anxious, sleeping may be difficult.
According to an older 2011 study, insomnia is more common in people who have a higher number of medical issues. With this in mind, the vast range of symptoms caused by hypothyroidism might have a severe impact on sleep quality.
Side effects of medications
Hypothyroidism is treated with thyroxine, a hormone that increases low thyroid hormone levels and relieves hypothyroidism symptoms. It is an effective medication for many people when given at the proper dose.
If someone takes more than they require, they may encounter side effects such as:
- feeling hot
- racing heartbeat
- inability to sleep
- anxiety or nervousness
- increased appetite
Other health conditions
Hypothyroidism is linked to other sleep-disrupting conditions, such as obstructive sleep apnea (OSA), a condition in which breathing stops and causes periodically during the night.
Daytime tiredness, frequent waking, and difficulty sleeping can all be symptoms of OSA. If someone has OSA, others sleeping in the same room may hear excessive snoring, choking, or gasping noises.
Restless legs syndrome, which causes unpleasant crawling or tingling feelings in the legs while someone is sleeping, is linked to hypothyroidism.
What relieves insomnia depends on the source of the problem. If you have hypothyroidism, your doctor may recommend:
- lowering the dose of someone’s thyroxine to a more comfortable level if they are having side effects
- beginning thyroxine treatment to relieve physical discomfort
- testing for other conditions that may be causing insomnia
It is important not to change the dose of thyroxine without first consulting with a doctor.
If taking or altering thyroid medication does not help, a doctor may investigate other possible causes. They may inquire as to when their insomnia began, how frequently it occurs, and any changes that occurred in their life around that time.
If a doctor detects a sleep issue, such as OSA, he or she may refer the patient for a sleep study to confirm the diagnosis. Alternatively, if the insomnia is caused by another medical or mental health condition, the individual may begin treatment for it as well.
Is there anything else that can increase thyroid hormone levels?
Although there is no cure for hypothyroidism, it may nearly always be managed with medicine, which restores thyroid hormone levels to normal.
There is evidence that there are additional strategies for people to support their thyroid hormone levels, such as:
An older study from 2015 looked at the effect of a regular physical activity program on 20 people who were being treated for hypothyroidism. Thyroid hormone levels were measured in blood before and after three months of daily one-hour exercise sessions, according to the authors.
They determined that exercise can improve thyroid function after comparing the results to people who did not engage in any physical activity at all.
Iodine is a nutrient used by the thyroid gland to produce thyroid hormones. The majority of people in the United States obtain enough iodine.
Iodine deficiency, on the other hand, can cause hypothyroidism in rare situations. People who are deficient in iodine can supplement their diet with foods like seaweed or take pills.
Taking iodine pills will not help if iodine insufficiency is not the cause.
Furthermore, people with autoimmune thyroid disease, such as Hashimoto’s disease, may discover that iodine in food or supplements aggravates their condition. A doctor or dietician can advise on the best course of action for each individual.
A diet that reduces inflammation is something that practically everyone can benefit from. Inflammation has been associated to a number of chronic illnesses, including autoimmune thyroiditis, according to the United States Department of Veterans Affairs. Thyroiditis can result in hypothyroidism.
An anti-inflammatory diet may help people with autoimmune hypothyroidism. This entails eating:
- foods that contain omega-3 fatty acids, such as wild salmon
- plenty of fresh fruits, vegetables, and whole grains
- monounsaturated or “healthy” fats, such as olive oil, rather than saturated fat
- at least 30 grams of fiber per day
Can people with hypothyroidism take melatonin?
Melatonin is a hormone that the body makes naturally as part of the sleep-wake cycle. Its production increases in the evening darkness, promoting healthy sleep, and decreases when a person is exposed to light, assisting them in waking up.
As a result, the sleep-wake cycle is synchronized with the rhythms of night and day.
Some people use extra melatonin to help them sleep. Short-term use of melatonin supplements appears to be safe, according to the National Institutes of Health, but there is limited evidence on long-term consequences.
A small study published in 2001 examined the effect of melatonin on females with hypothyroidism, 36 of whom were perimenopausal and 18 of whom were postmenopausal. The individuals were divided into two groups at random by the researchers. At bedtime, one group received a placebo, while the other received melatonin.
After 3–6 months, the scientists discovered that the melatonin group had significantly greater levels of thyroid hormones than the placebo group.
They hypothesized that low levels of melatonin due to aging were linked to low levels of thyroid hormones, which explains why taking a melatonin pill increased TSH levels as well.
To confirm that melatonin is safe and effective for people with hypothyroidism, large-scale investigations are required. People who want to use a melatonin supplement should see a doctor about appropriate amounts and keep in mind that the quality of supplements might vary greatly.
Other causes of insomnia
Insomnia can be caused by a variety of conditions, including:
- shift work
- hormone changes, such as during pregnancy or menopause
- lifestyle factors, such as:
- using electronic devices close to bedtime
- exercising too little
- using caffeine, nicotine, illegal drugs, or alcohol
- taking long naps in the day
- having an irregular sleep schedule
- environmental factors, such as:
- noise or light
- frequent travel to different time zones
- a temperature that is too hot or cool in the bedroom
People who are having trouble sleeping may benefit from minimizing any of the probable risk factors for insomnia that they have control over. It can, for example, aid in:
- quit smoking
- get regular exercise, while avoiding exercise in the evening before sleep
- manage stress or practice relaxation techniques
- create a cool, dark, and comfortable sleep environment
- wake up and go to bed at the same time every day
- reduce or stop caffeine and alcohol consumption
In conclusion, hypothyroidism may be connected to insomnia, however evidence to date has been inconsistent.
People with hypothyroidism, on the other hand, frequently have difficulty tolerating low temperatures at night, as well as joint and muscular pain that can interfere with sleep. If the dose is too high, the side effects of thyroxine might also cause trouble sleeping.
Even if thyroid hormone shortage isn’t directly causing insomnia, the vast variety of symptoms associated with thyroid dysfunction can easily exacerbate sleeping problems and limit a person’s capacity to attain quality, deep sleep.
Consult a doctor if insomnia becomes a persistent issue. Treating the underlying issue and implementing sleep-promoting lifestyle modifications may be beneficial.
What exactly is the difference between narcolepsy and sleep apnea?
Narcolepsy and sleep apnea are two diseases that can cause you weary during the day. Their symptoms, causes, and therapies, on the other hand, are vastly different.
Narcolepsy is an uncommon condition that causes episodes of extreme tiredness that can occur at any time. Cataplexy is a condition in which some people experience an abrupt loss of muscular tone.
The differences between narcolepsy and sleep apnea, as well as the link between the two sleep disorders and how doctors diagnose them, are discussed in this article.
What is narcolepsy?
Narcolepsy is a neurological condition that impairs the brain’s capacity to regulate its sleep-wake cycle. This can cause people to fall asleep spontaneously and unexpectedly during the day, even when performing tasks that need focus, such as driving.
Narcolepsy patients frequently have disrupted sleep owing to intense dreams, hallucinations, or sleep paralysis.
Narcolepsy is classified into two types: type 1 and type 2. Cataplexy, or a decrease of muscular tone, is a symptom of type 1. Cataplexy causes a section of or the entire body to become limp. Type 2 occurs in the absence of cataplexy.
Narcolepsy symptoms often appear in childhood or early adulthood, but they can appear at any age. Many studies believe that the condition is frequently misdiagnosed or underdiagnosed.
What is sleep apnea?
Sleep apnea is a frequent condition in which a person’s breathing temporarily stop or becomes very shallow during sleep. These are known as “breathing pauses” by doctors, and they can last anywhere from a few seconds to a few minutes.
People who suffer from sleep apnea experience frequent breathing pauses, which can occur 30 times or more per hour. Sleep apnea can be classified into numerous categories, including:
- OSA (obstructive sleep apnea): This is the most frequent type of sleep apnea, and it is caused by an obstruction in the upper airways.
- Central sleep apnea: This condition happens when the brain fails to provide the necessary impulses for breathing.
- Complex sleep apnea syndrome: This is a combination of obstructive and central sleep apnea.
The symptoms of sleep apnea and narcolepsy are compared in the table below:
|excessive daytime sleepiness||excessive daytime sleepiness that may occur suddenly|
|gasping or choking noises during sleep||cataplexy, which strong emotions such as fear, laughter, stress, anger, or excitement often trigger|
|loud snoring||vivid dreams, sleep paralysis, or hallucinations|
|dry mouth when waking||acting out dreams|
|frequent waking during sleep||difficulty sleeping at night|
|difficulty focusing or remembering||automatic behaviors, which occur when a person briefly falls asleep but carries on with their activity|
Can sleep apnea progress to narcolepsy?
According to research, OSA is widespread in people who have narcolepsy. An earlier 2010 study discovered that 33 people with narcolepsy — nearly 25 percent — also had sleep apnea symptoms.
Sleep apnea, on the other hand, does not cause narcolepsy. Narcolepsy is a neurological condition in which the brain is unable to control its sleep-wake cycle.
Sleep apnea is common in people with narcolepsy, although it may be related to the other sleep abnormalities that people with narcolepsy frequently encounter, according to doctors.
Hypocretin, a hormone, is deficient in people with type 1 narcolepsy. Hypocretin awakens people and regulates rapid eye movement (REM) sleep. Excessive tiredness during waking hours and irregular sleep cycles cause in symptoms such as vivid nightmares when this hormone is deficient.
Doctors aren’t clear why certain people have low hypocretin levels, although various variables could be at play:
- Autoimmune disease: Autoimmune disorders, in which the immune system assaults healthy cells, are common in people with type 1 narcolepsy. The immune system may also assault the cells that produce hypocretin, resulting in a deficit, according to researchers.
- History of the family: Most cases of narcolepsy do not have a familial history of the condition. However, approximately 10% of people indicate they have a family relative who likewise suffers with narcolepsy symptoms. This shows that in some circumstances, there may be a hereditary component.
- Injuries or diseases to the brain: In rare cases, narcolepsy develops as a result of an injury to a brain area that regulates sleep or as a result of another condition that affects the brain, such as a tumor.
Hypocretin levels in people with type 2 narcolepsy are frequently normal. Researchers are still trying to figure out what causes this condition.
There are numerous reasons why a person may feel excessively fatigued during the day. Other things that may contribute to this symptom are as follows:
- insufficient sleep
- certain medications, such as antihistamines, antidepressants, and beta-blockers
- other sleep disorders, such as circadian rhythm disorder
- traumatic brain injuries
Some more serious illnesses, such as Parkinson’s disease, multiple sclerosis, and muscular dystrophy, can also cause extreme sleepiness. However, these are generally accompanied by additional symptoms.
A doctor can determine the cause of extreme tiredness, frequent awakening during the night, and other symptoms that may indicate sleep apnea or narcolepsy. They will start the diagnostic procedure by:
- asking the person to keep a sleep journal to record their symptoms
- taking a medical history
- performing a physical examination
Sleep studies, on the other hand, are the major tool used by doctors to identify sleep apnea. A person will spend the night at a health center, where doctors will monitor them and count the number of breathing pauses in an hour. Doctors will also look to see if the blood oxygen levels change.
If a doctor suspects narcolepsy, he or she may order a polysomnography (PSG) and a multiple sleep latency test (MSLT).
A PSG is a form of sleep study that monitors breathing, eye movements, brain activity, and muscle movements while the patient is sleeping. It can detect narcolepsy and other sleep-related problems, such as sleep apnea.
An MSLT is usually performed the morning after a PSG. The individual will take a nap every two hours until they have had five naps in total. This test allows doctors to detect how quickly a person falls asleep and whether they enter REM sleep.
A lumbar puncture is sometimes performed to assess the hypocretin levels in a person’s cerebrospinal fluid.
To treat these sleeping disorders, doctors employ a variety of treatments.
Treatment for sleep apnea
The following are some of the possible therapies for OSA:
- surgery, if OSA is due to enlarged tonsils or adenoids
- breathing devices
- lifestyle changes, such as quitting smoking or maintaining a moderate weight
A continuous positive air pressure (CPAP) machine is the most commonly recommended breathing equipment by doctors. To keep the airway from collapsing, these devices blast pressurized air into the individual’s neck.
Sleep apnea mouthpieces move the lower jaw forward sufficiently to keep the airway open. If OSA treatment is ineffective, it could be a symptom that the person has another kind of sleep apnea, another sleep disorder, or a condition such as narcolepsy.
Treatment for Narcolepsy
There is no cure for narcolepsy, however medication can help most people regulate their extreme sleepiness and cataplexy. A doctor may order:
- tricyclic antidepressants
- selective serotonin reuptake inhibitors
- modafinil (Provigil)
- amphetamine-like stimulants
- noradrenergic reuptake inhibitors
To help control their symptoms, an individual may need to make lifestyle changes like as avoiding coffee before bed, taking short naps, exercising everyday, and maintaining a regular sleep pattern.
Both sleep apnea and narcolepsy cause daytime tiredness. Sleep apnea, on the other hand, causes weariness as a result of sleep disturbances caused by frequent pauses in breathing. People with the condition frequently snore, produce gasping or choking noises while sleeping, or wake up with a dry mouth.
Narcolepsy is a neurological condition that causes excessive sleepiness, causing people to fall asleep unexpectedly throughout normal tasks. Insomnia, vivid dreams, sleep paralysis, and hallucinations are also possible. It is conceivable to have both sleep apnea and narcolepsy, but sleep apnea is significantly more prevalent on its own.
People who are concerned about their symptoms should seek medical attention, especially if their tiredness is interfering with their mental health or activities that could be risky, such as driving.