question: Why do cold/illness symptoms feel worse at night?
comment: When you go through the day, your body has energy, but as you keep pushing, your level of energy is used more quickly because your body is working in overdrive to fight the illness. As such, early evening comes and you feel like if it's much later
passages: Noman et al., in the UK in 2012, studied 2571 consecutive PCI-treated STEMI patients. There was no difference in mortality between weekday and weekend groups (OR = 1.09, 95% CI 0.82-1.46; p=0.57). Similarly, no increase in mortality was seen in patients who underwent PCI at night (22:00-06:00).
  
  Whereas, in 2015, Singh et al., in the US, carried out a much larger study of 401,571 PCI procedures. In a multivariate analysis, the weekend was a significant predictor of mortality.
   In 2016, Shin et al., in Taiwan, studied 398,043 patients with severe sepsis. Compared with patients admitted on weekends, patients admitted on weekdays had a lower 7-day mortality rate (OR = 0.89, 95% CI 0.87-0.91), 14-day mortality rate (OR = 0.92, 95% CI 0.90-0.93), and 28-day mortality rate (OR = 0.97, 95% CI 0.95-0.98).
   In 2008, Kruth et al. in Germany, analysed 11,516 patients with ST-elevation myocardial infarction (STEMI). On weekends the group found a significantly higher in-hospital mortality (11.1 vs 9.4%, p=0.01) and at night there was a trend to higher in-hospital mortality when compared with regular working hours (10.6 vs 9.4%, p=0.07).
   Dry eyes because of CVS can also be treated using moisture chamber glasses or humidifier machines. Office spaces with artificially dry air can worsen CVS syndromes, in which case, a desktop or a room humidifier can help the eyes keep a healthy moisture level.
  
  At night, CVS can become worse. It is recommended to use a dark user interface while working at night on the computer. Several browser and OS add-ons exist to darken the user interface.
   There have been four studies in COPD (one including pneumonia), three on PE and two on pneumonia alone. In 2011, in a study of 9,915 admissions in the UK with an acute exacerbation of COPD, Brims et al. found that the adjusted odds ratio for death on day 1 after winter weekend admission was 2.89 (95% CI 1.04-8.08). But after opening a Medical Admission Unit, the OR for death day 1 after weekend winter admission fell from 3.63 (95% CI 1.15-11.5) to 1.65 (95% CI 0.14-19.01).
   Similarly, in 2012, in a study of 4616 AMI patients in Middle Eastern Countries, Al-Lawati et al. found no significant differences in 1-month (OR = 0.88; 95% CI 0.68-1.14) and 1-year mortality (OR = 0.88; 95% CI 0.70-1.10), respectively, between weekday and weekend admissions.
   It has been suggested that, in Hodgkin lymphoma, fever and weight loss are much more prognostically significant than night sweats. In one series of patients with early-stage Hodgkin disease, the presence or absence of night sweats had no impact on cure rates and outcome. However, fever and weight loss had a pronounced negative impact on cure and survival rates, regardless of treatment modality.
  
  Section::::"B symptoms" in other diseases.
   But not all ICU studies show an effect. For example, in the following year, Ensminger et al.(2004) published a similar study in the US, looking at a significantly smaller population (of 29,084 patients). In multivariable analyses - controlling for the factors associated with mortality such as APACHE (acute physiology and chronic health evaluation) III predicted mortality rate, ICU admission source, and intensity of treatment - no statistically significant difference in hospital mortality was found between weekend and weekday admissions in the study population (OR = 1.06; 95% CI 0.95-1.17)
   Three first studies in Pulmonary Embolus (PE) have been carried out. The first was published by Aujesky in 2009, concerning 15,531 patients with PE in Switzerland. Patients admitted on weekends had a higher unadjusted 30-day mortality rate (11.1% vs 8.8%) than patients admitted on weekdays, with no difference in length of stay. Patients admitted on weekends had significantly greater adjusted odds of dying (OR = 1.17, 95% CI 1.03-1.34) than patients admitted on weekdays. Then Gallerani et al. in 2011, studied 26,560 Italian patients with PE. Weekend admissions were associated with significantly higher rates of in-hospital mortality than weekday admissions (28% vs. 24.8%) (p0.001). The third study, by Nanchal et al. was carried out a year later, in the US, and was a huge one (of 1,143,707 patients). The authors found unadjusted mortality was higher for weekend admissions than weekday admissions (OR = 1.19; 95% CI 1.13-1.24). This increase in mortality remained statistically significant after controlling for potential confounding variables (OR = 1.17; 95% CI 1.11-1.22).
   In the following year, in a much larger study (of 289,077 COPD patients), in Spain, Barba et al. discovered weekend admissions were associated with a significantly higher in-hospital mortality (12.9%) than weekday admissions (12.1%) (OR = 1.07; 95% CI 1.04-1.10). In 2014, in Canada, Suissa et al. published another very large study (of 323,895 patients) with COPD and pneumonia. They found mortality was higher for weekend (OR = 1.06; 95% CI 1.03-1.09) but not Friday admissions (OR = 0.97; 95% CI 0.95-1.00), relative to Monday-Thursday admissions.
   Section::::Published research: Non-disease specific (unselected) patients.
  
  Section::::Published research: Non-disease specific (unselected) patients.:Medical patients.
  
  Schmulewitz et al., in the UK in 2005, studied 3,244 patients with chronic obstructive pulmonary disease, cerebrovascular accidents, pulmonary embolism, pneumonia, collapse and upper gastrointestinal bleed. They found "Weekend admission was not associated with significantly higher in-hospital mortality, readmission rates or increased length of stay compared to the weekday equivalent for any of the six conditions".
   In another similar US study, by Dorn et al., in 2010, 98,975 patients with UGIB were studied, and a similar weekend effect found. Compared to patients admitted on a weekday, for those admitted on a weekend, in-hospital mortality was higher (unadjusted mortality 3.76 vs 3.33%; p = 0.003; adjusted OR = 1.09, 95% CI 1.00-1.18). Whereas, in a much smaller 2011 UK study (of 6749 patients), Jaraith et al., no weekend effect was found in UGIB. After adjustment for confounders, there was no evidence of a difference between weekend and weekday mortality (OR = 0.93; 95% CI 0.75-1.16).
   In another huge US study, also in 2016, 3,625,271 NSTEMI admissions were identified by Agrawal et al. Admission on a weekend vs weekday was independently associated with a lower rate of coronary angiography (OR = 0.88; 95% CI 0.89-0.90; p0.001). And adjusted in-hospital mortality was significantly higher for the cohort of patients admitted on weekends (OR = 1.02; 95% CI 1.01-1.04; p0.001).
  
  PCI
   While night sweats might be relatively harmless, it can also be a sign of a serious underlying disease. It is important to distinguish night sweats due to medical causes from those that occur simply because the sleep environment is too warm, either because the bedroom is unusually hot or because there are too many covers on the bed. Night sweats caused by a medical condition or infection can be described as "severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to the environment". Some of the underlying medical conditions and infections that cause these severe night sweats can be life-threatening and should promptly be investigated by a medical practitioner.
   When suffering from sleep deprivation, active immunizations may have a diminished effect and may result in lower antibody production, and a lower immune response, than would be noted in a well-rested individual. Additionally, proteins such as NFIL3, which have been shown to be closely intertwined with both T-cell differentiation and our circadian rhythms, can be affected through the disturbance of natural light and dark cycles through instances of sleep deprivation, shift work, etc. As a result, these disruptions can lead to an increase in chronic conditions such as heart disease, chronic pain, and asthma.
   In another study on major trauma in 2016, in all 22 UK major trauma centres (MTC), Metcalfe et al., investigated 49,070 patients. Using multivariable logistic regression models, odds of secondary transfer into an MTC were higher at night (OR = 2.05, 95% CI 1.93-2.19) but not during the day at weekends (OR = 1.09; CI 0.99-1.19). Neither admission at night nor at the weekend was associated with increased length of stay, or higher odds of in-hospital death.
  
  Section::::Published research: Disease-specific (selected) patients: Specialist surgery.:Vascular surgery.
   BULLET::::- Aspirin has been found to reduce the response probably through an action upon ACTH.
  
  Section::::Individual factors.
  
  BULLET::::- Morning types show a larger cortisol awakening response than evening types.
  
  BULLET::::- Those suffering fatigue show a low rise and flat plateau.
  
  BULLET::::- Those in pain: the response is reduced the more people are in pain.
  
  BULLET::::- The lower a person's socioeconomic status, the higher their response. This might link to the material hardship that occurs with low socioeconomic status.
  
  Section::::Stress.
  
  Cortisol awakening response is larger for those:
  
  BULLET::::- Waking up to a working day compared to work-free weekend day.
   Negative air ionization, which involves releasing charged particles into the sleep environment, has been found effective with a 47.9% improvement if the negative ions are in sufficient density (quantity).
   In summary, there is strong evidence of a weekend effect when large non-disease specific groups of unselected patients are studied; both medical, surgical (both elective and non-elective patients) and ED. Patients who have had a cardiac arrest, or are palliative, also show the effect. There is variable evidence of an effect in ICU patients, adult and paediatric; also with variable evidence in psychiatry admissions.
  
  Section::::Published research: Disease-specific (selected) patients: Cardiorespiratory medicine.
  
  Section::::Published research: Disease-specific (selected) patients: Cardiorespiratory medicine.:Cardiology.
  
  AMI
   Due to lack of studies, it is not known whether increased fluid intake improves symptoms or shortens respiratory illness. As of 2017 heated and humidified air, such as via RhinoTherm, is of unclear benefit. One study has found chest vapor rub to provide some relief of nocturnal cough, congestion, and sleep difficulty.
   Many people, especially the weak or infirm, avoided breathing night air by going indoors and keeping windows and doors shut. In addition to ideas associated with zymotic theory, there was also a general fear that cold or cool air spread disease. The fear of night air gradually disappeared as understanding about disease increased as well as with improvements in home heating and ventilation. Particularly important was the understanding that the agent spreading malaria was the mosquitoes (active at night) rather than miasmata.
  
  Section::::Developments from 19th century onwards.:Contagionism versus miasmatism.
   In a small study of 422 patients in 2010 with Acute Myeloid Leukaemia, also in the US, Bejanyan et al. did not see a difference in mortality based on day of admission. Similarly, in a much larger US study (of 12,043 patients with acute leukaemia), in 2014, Goodman et al. found that those admitted on the weekend did not have an increased mortality (OR = 1.0; 95% CI 0.8-1.6).
   I sure don't go out much at this time of year. You takes a chance just walkin' on the streets. Them Needle Mens is everywhere. They always comes 'round in the fall, and they's 'round to about March. You see, them Needle Mens is medical students from the Charity Hospital tryin' to git your body to work on. That's 'cause stiffs is very scarce at this time of the year.
   These case reports suggest that the observed cases of the morning pseudoneutropenia did not proceed to become agranulocytosis which is a significant and dangerous side effect of some of antipsychotics. Hence it was suggested that although the morning neutrophil count may appear low, if the antipsychotic medication were considered efficacious then white cell counts may be repeated in the afternoon prior to making a decision based only on the morning counts.
   "Ma nishtana ha lyla ha zeh mikkol hallaylot?"br
  
  Why is this night different from all other nights?
  
  BULLET::::1. "Shebb'khol hallelot anu okh’lin ḥamets umatsa, vehallayla hazze kullo matsa."brWhy is it that on all other nights during the year we eat either leavened bread or matza, but on this night we eat only matza?
  
  BULLET::::2. "Shebb'khol hallelot anu okh’lin sh’ar y'rakot, vehallayla hazze maror."brWhy is it that on all other nights we eat all kinds of vegetables, but on this night we eat bitter herbs?
  