Anxiety 

Anxiety is an emotion characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events.[1][2][3] Anxiety is different from fear in that fear is defined as the emotional response to a present threat, whereas anxiety is the anticipation of a future one.[4] It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.[5]

Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing.[6] It is often accompanied by muscular tension,[7] restlessness, fatigue, inability to catch one’s breath, tightness in the abdominal region, nausea, and problems in concentration. Anxiety is closely related to fear,[3] which is a response to a real or perceived immediate threat (fight-or-flight response); anxiety involves the expectation of a future threat including dread.[7] People facing anxiety may withdraw from situations which have provoked anxiety in the past.[8]

The emotion of anxiety can persist beyond the developmentally appropriate time-periods in response to specific events, and thus turning into one of the multiple anxiety disorders (e.g., generalized anxiety disorderpanic disorder).[9][10] The difference between anxiety disorder and anxiety (as normal emotion), is that people with an anxiety disorder experience anxiety excessively or persistently during approximately 6 months, or even during shorter time-periods in children.[7] Anxiety disorders are among the most persistent mental problems and often last decades.[11] Anxiety can also be experienced within other mental disorders (e.g., obsessive–compulsive disorderpost-traumatic stress disorder).[12][13]

Anxiety vs. fear

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Anxiety is distinguished from fear, which is an appropriate cognitive and emotional response to a perceived threat.[14] Anxiety is related to the specific behaviors of fight-or-flight responses, defensive behavior or escape.[15] There is a false presumption that often circulates that anxiety only occurs in situations perceived as uncontrollable or unavoidable, but this is not always so.[16] David Barlow defines anxiety as “a future-oriented mood state in which one is not ready or prepared to attempt to cope with upcoming negative events,”[17] and that it is a distinction between future and present dangers which divides anxiety and fear. Another description of anxiety is agony, dread, terror, or even apprehension.[18] In positive psychology, anxiety is described as the mental state that results from a difficult challenge for which the subject has insufficient coping skills.[3][19]

Fear and anxiety can be differentiated into four domains: (1) duration of emotional experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction. Fear is short-lived, present-focused, geared towards a specific threat, and facilitating escape from threat. On the other hand, anxiety is long-acting, future-focused, broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat and interferes with constructive coping.[20]

Joseph E. LeDoux and Lisa Feldman Barrett have both sought to separate automatic threat responses from additional associated cognitive activity within anxiety.[21][22]

Evolutionary perspectives

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Evolutionary psychiatry and Evolutionary psychology interprets anxiety as an evolved defence that helps organisms avoid potential threats; by design, such defenses can produce “false alarms” when the cost of a missed danger would be high (sometimes described as a “smoke‑detector” principle). Contemporary reviews stress that this framing does not treat anxiety disorders as adaptive, but rather as dysregulations or context‑insensitive activation of otherwise useful systems; the perspective is used for explanation and psychoeducation, not as a specific therapy.[23]

Symptoms

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Anxiety can be experienced with long, drawn-out daily symptoms that reduce quality of life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful panic attacks, known as acute anxiety.[24] Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. However, most people do not suffer from chronic anxiety.[25]

Insomnia

Insomnia is trouble falling asleep, staying asleep (usually through the night), or waking up too early in the morning.

Episodes of insomnia may come and go or be long-lasting.

The quality of your sleep is as important as how much sleep you get.

Causes

Sleep habits we learned as children may affect our sleep behaviors as adults. Poor sleep or lifestyle habits that may cause insomnia or make it worse include:

  • Going to bed at a different time each night
  • Daytime napping
  • Poor sleeping environment, such as too much noise or light
  • Spending too much time in bed while awake
  • Working evenings or night shifts
  • Not getting enough exercise
  • Using the television, computer, or a mobile device in bed

The use of some medicines and substances may also affect sleep, including:

  • Alcohol or other substances
  • Heavy smoking
  • Too much caffeine throughout the day or consuming caffeine late in the day
  • Getting used to certain types of sleep medicines
  • Some cold medicines and diet pills
  • Other medicines, herbs, or supplements

Physical, social, and mental health issues can affect sleep patterns, including:

  • Bipolar disorder.
  • Feeling sad or depressed. (Often, insomnia is the symptom that causes people with depression to seek medical help.)
  • Stress and anxiety, whether it is short-term or long-term. For some people, the stress and anxiety caused by insomnia makes it even harder to fall asleep.

Health problems may also lead to problems sleeping and insomnia:

  • Pregnancy
  • Physical pain or discomfort.
  • Waking up at night to use the bathroom, common in men with enlarged prostate
  • Sleep apnea

With age, sleep patterns tend to change. Many people find that aging causes them to have a harder time falling asleep, and that they wake up more often.

Symptoms

The most common complaints or symptoms in people with insomnia are:

  • Trouble falling asleep on most nights
  • Feeling tired during the day or falling asleep during the day
  • Not feeling refreshed when you wake up
  • Waking up several times during sleep

People who have insomnia are sometimes consumed by the thought of getting enough sleep. But the more they try to sleep, the more frustrated and upset they get, and the harder sleep becomes.

Lack of restful sleep can:

  • Make you tired and unfocused, so it is hard to do daily activities.
  • Put you at risk for auto accidents. If you are driving and feel sleepy, pull over and take a break.

Exams and Tests

Your health care provider will do a physical exam and ask about your current medicines, drug and substance use, and medical history. Usually, these are the only methods needed to diagnose insomnia.

Treatment

Different people have different sleep needs. Some people do fine on 6 hours of sleep a night. Others only do well if they get 10 to 11 hours of sleep a night. Research indicates that adults should get 7 to 9 hours sleep per night.

Treatment often begins by reviewing any medicines or health problems that may be causing or worsen insomnia, such as:

  • Enlarged prostate gland or any other medical condition, causing men to wake up at night to urinate
  • Pain or discomfort from muscle, joint, or nerve disorders, such as arthritis and Parkinson disease
  • Other medical conditions, such as acid reflux, allergies, and thyroid problems
  • Mental health disorders, such as depression and anxiety

You should also think about lifestyle and sleep habits that may affect your sleep. This is called sleep hygiene. Making some changes in your sleep habits may improve or solve your insomnia.

Some people may need medicines to help with sleep for a short period of time. But in the long run, making changes in your lifestyle and sleep habits is the best treatment for problems with falling and staying asleep.

  • Most over-the-counter (OTC) sleeping pills contain antihistamines. These medicines are commonly used to treat allergies. Your body quickly becomes used to them.
  • Sleep medicines called hypnotics can be prescribed by your provider to help reduce the time it takes you to fall asleep. Most of these can become habit-forming.
  • Medicines used to treat anxiety or depression can also help with sleep

Different methods of talk therapy, such as cognitive behavioral therapy for insomnia (CBT-I), may help you gain control over anxiety or depression.

painkiers

Painkillers, also known as analgesics, are medications used to relieve various types of pain. The main types include non-opioids (like paracetamol and NSAIDs), and stronger opioids, which work in different ways and are suitable for different pain levels. 

Types of Painkillers

Painkillers are broadly classified by how they work and their strength: 

  • Paracetamol (Acetaminophen): Often the first choice for mild-to-moderate pain and fever, it works in the brain and spinal cord to block pain signals. It does not reduce inflammation.
    • Common Brands: Tylenol, Panadol
  • Non-steroidal Anti-inflammatory Drugs (NSAIDs): These reduce pain, fever, and inflammation (swelling) by blocking specific enzymes (COX enzymes) at the site of injury. They are effective for conditions like arthritis, muscle aches, and sprains.
    • Common Brands: Ibuprofen (Advil, Motrin), Naproxen (Aleve), Aspirin, Diclofenac (Voltaren)
  • Opioids: Used for moderate to severe pain, such as after surgery or a serious injury. They work by binding to receptors in the central nervous system to change the brain’s perception of pain.
    • Common Examples: Codeine, tramadol (weaker), morphine, oxycodone, and fentanyl (stronger)
  • Adjuvants: These are medicines initially developed for other conditions (e.g., antidepressants, anticonvulsants) but are also effective for certain types of pain, especially nerve pain (neuropathic pain). 

Important Considerations

  • Over-the-Counter (OTC) vs. Prescription: Paracetamol and some NSAIDs are available over the counter, while most opioids and higher-dose NSAIDs require a prescription.
  • Dosage and Safety: Always follow the dosage instructions on the packet or as advised by your healthcare provider.
    • Taking too much paracetamol can cause liver damage.
    • Long-term use of NSAIDs can lead to stomach, kidney, or heart problems.
    • Opioids carry a risk of side effects, dependence, and addiction, and should be used for the shortest possible time under medical supervision.
  • Interactions: Painkillers can interact with other medicines, supplements, and alcohol. Consult a doctor or pharmacist about potential interactions, especially if you have existing health conditions like liver, kidney, or heart disease. 

For personalized advice on the best painkiller for your specific condition, always talk to a doctor or a pharmacist. You can also use online resources like the MedlinePlus Pain Relievers page for more information. 

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