I thought I would start a new topic, since I don't like to overtake anyone else's posts. Try to keep this one "on topic" too, since I think this conversation would be helpful to everyone.

Susan (Desert Flower) defined the areas as three: Tired (lacking energy), Fatigued (weak due to overexertion) and Weak (lacking physical strength). In my opinion, and after researching, I honestly think there are only two categories: Tired (sleepy tired) and Muscle Weakness (due to overexertion or lack of physical muscle strength).

1. Sleepy tired Being tired is all about needing to sleep. Whatever got you there, you need to sleep. There are a lot of causes other than MG, such as a B12 deficiency, thyroid issues, sleep apnea, cortisol deficiency, jet lag (which IS a cortisol issue) and not getting enough sleep. Yawning can be a signal that you need sleep . . . or oxygen. Sleeping more may or may not help you get better and less sleepy. That's why defining what is making you want to sleep is so important. It's not always the MG that does it.

2. Muscle Weakness The more we do, the more our muscles get weak. Whether that is due to repetitive activity, overexertion as Susan described it, our acetylcholine not getting to our muscles or many other variables of MG weakness.

Doctors call muscle weakness "muscle fatigue." That does not mean our muscles are "sleepy." They are not getting enough acetylcholine and simply don't work well or at all. It's semantics but what it all means is muscle weakness. Fatigue is often used interchangeably as "fatigable" by doctors because MG is all about muscles that can get weaker the more you do. When a neurologist says, "Your muscles are fatigued" they mean your muscles are weak.

To confuse the issue even more, when our muscles are too weak, our mind can become "tired." In "normal" people, physical exhaustion "signals" our mind to put our bodies to sleep. We have these inborn mechanisms like that to help us. Like when you are dehydrated and your body sends out a signal to make you thirsty. So when enough of your muscles become weak due to a lack of acetylcholine, your body thinks you need to sleep, thereby making you sleepy tired.

Take cortisol, for example. If you burn the candle at both ends, whether you have MG or not, your body's cortisol may get maxed out. Then the body will try to put you to sleep by a reduction in cortisol. Sleep is essential to keep our bodies working well.

There are a good number of articles on MG and fatigue (tiredness or weakness) in PubMed. Here are a couple.

http://www.ncbi.nlm.nih.gov/pubmed/20656621
"Antibodies to the postsynaptic acetylcholine receptor at the myoneural junction cause diminution of the force of muscle contractions. This leads to a feeling of fatigue."

http://www.ncbi.nlm.nih.gov/pubmed/19813207

Muscle strength and fatigue in patients with generalized myasthenia gravis.
Symonette CJ, Watson BV, Koopman WJ, Nicolle MW, Doherty TJ.

School of Kinesiology, University of Western Ontario, London, Ontario, Canada.

Abstract

Since autoimmune diseases do tend to group together, any new symptoms like increased muscle weakness or increased need to sleep should be brought to your primary doctor's and/or neurologist's attention. Sometimes it's best to start with your primary doctor because they can do some basic testing to rule out anything new. For instance, if you are on immunosuppressants, it may be that you have anemia, B12 deficiency or other deficiencies or you could have cancer. Neurologists can't be bothered with any of that. Their specialty is neurology. Specialists only want to deal with their own little specialties.

Simply the act of drinking coffee every day can cause you to be tired when it runs out. So many things can make you want to sleep, like reading a post about weakness and sleepiness that is too long.

The important thing is to see those two things as signals to you to either slow the heck down, get more drugs or get more sleep. Or stay out of the heat or so many other things that tick MG off.

This is how I wish my mind and body felt on a daily basis, neither sleepy nor weak:

There are so many other variables in the body that fatigue us, such as tryptophan (like in turkeys) but I thought we better keep this brief and as it relates to MG. However, if it helps you to talk about other issues such as amino acids, go for it!

Any comments, thoughts or ideas would be great. And if a doctor uses words like "fatigue" or "tired" and does not define them well enough, you can help them clarify what they are trying to say.

Annie