Date : 2021-01-28 10:56:26

Worst 5 Sleep Disorders - Symptoms, Side Effects and Its Prevention

As essential as sleep is, not everyone might have the luxury, environment, or health to sleep soundly. Sleep disorders affect more people today because of lifestyle issues, ever-increasing stress levels, and inadequate personal care. Moreover, sleep disorders are directly related to your physical and mental health. Since sleep is an essential aspect of our life, it affects our health and vice versa. This vicious circle of ignoring health and sleep can lead adversely impact the individual as a whole, not just when asleep but also when awake.

Sleep disorders like insomnia, restless leg syndrome, sleep apnea, snoring, and others are common. But there are more sleep and lifestyle issues that can be as disturbing to your overall health as they can be to your life expectancy. While most sleep disorders are treatable either medically or through lifestyle changes, some may need surgery, and others can be fatal if left unchecked. Additionally, in general, sleep disorders are any condition or health adversity diagnosis that impacts your sleep quality and timing.

So, if you see yourself waking up from repetitive nightmares (night terrors), sleepwalking, or even sleep paralysis, they're all cause for concern. Sleep disorders can affect your immune system, metabolic rate, mental and physical health and cause a cascade of other failures. These issues arise because our body repairs and rejuvenates itself from the mind to internal systems, and it needs time and quality sleep. Anything less, irregular disturbances around you can lead to you developing sleep disorders.

Lifestyle and Sleep Disorders:
Lifestyle issues are the leading cause of sleep disorders in the modern world. While most sleep disorders arise from sleep hygiene, sleep environment, and even genetic issues in some cases, lifestyle has the most prominent role. Directly or indirectly, sleep disorders are common in people with excess body weight, stress, posture problems, or poor sleeping habits. Moreover, depression, anxiety, insomnia are mental health issues that take time to heal and need more medication and care than lifestyle changes.

But before we delve into understanding sleep disorders further, it is essential to know more about specific cases. Being aware of how lifestyle, diet, stress, sleeping positions, and even sleep environment lead to sleep disorders is quintessential. The concept of sleep may be as simple as relaxing on the comfortable pillow, but just like any other aspect of our health, it has its complications and necessary practices to stay healthy.

Types of Sleep Disorders (#5 is the deadliest):
While sleep disorders vary in severity and can change depending on the individual, it is essential to understand the different types. Furthermore, the sleep disorders mentioned below also have subcategories to specify their symptoms. The best way to cure or get relief from any sleep disorder is to understand them better and look into causes and reversal tips if possible. Here are the most common sleep disorders:

  1. Insomnia: Insomnia is the inability to go to sleep or stay asleep, and there are different kinds of insomnia to classify further. Two main kinds of insomnia that can affect a person are:

    a. Short-term Insomnia: Short term insomnia can be the inability to go to sleep because of a major stressful event. Personal or professional front issues that cause insane stress to one's mind can trigger short-term insomnia. Personal loss, job loss, or any other hurtful and personally shocking life events lead to loss of sleep. This is because to go to sleep, one needs to be relaxed, and such a significant event can lead to issues relaxing or thinking of anything else.

    The brain doesn't secrete the sleep hormone-melatonin, and it is more of a short-term issue than a long-term. The increase in the stress hormone-cortisol is high and doesn't let your body and mind rest. Moreover, if one doesn't recover from the life event or healthily move on, this insomnia can become recurrent and even lead to long-term insomnia.

    b. Long-term Insomnia: Also known as chronic insomnia, long-term insomnia is much more severe. Long-term insomnia is also a result of a stressful event, as mentioned above, and can be recurrent short-term insomnia episodes. Long-term insomnia has more to do with lifestyle issues and neurological and mental health disorders, leading to loss of sleep. Ideally, long-term insomnia is when a patient cannot go to sleep for months or weeks with some gap in between. If a person cannot sleep/stay asleep for more than three nights sustained over weeks or months, it can be long-term insomnia. The leading causes of long-term insomnia are:
    Short term or chronic stress: Mental health is one major issue that can lead to long-term insomnia. It can be as simple as the daily stress of juggling work, stressful situations, and stressful personal events, which trigger more cortisol. Moreover, extraordinarily unfortunate or hurtful life events can also lead to permanent shock to one's mental health, triggering recurring insomnia episodes.
    Unhealthy lifestyle and medicines: While our body can recover from most body clock shifting issues, sometimes it can be too much to bear. That is why an irregular sleep schedule is one of the leading causes of sleep insomnia. People who rely on medicines excessively for severe and minor issues are more likely to see neurological issues arise. The imbalance of an unhealthy lifestyle and over-reliance on medicines can lead to chronic insomnia too.
    Poor sleep hygiene: Sleep hygiene refers to the things you do just before bed or around bedtime. If you find yourself exposing your body to unhealthy thoughts, media, or even food and beverages, it can lead to a sustained pattern of doing the same. In the long-term, you would be unable to go to sleep if these items aren't available. When they are available, they might have already caused too much internal damage to your body clock and health to go to sleep quickly. Poor hygiene with alcohol consumption, horror movies before sleep, night terrors, and other unhealthy issues can lead to chronic insomnia too.

    c. Specific insomnia categories: Insomnia also has different ways that it affects people. These categories define how insomnia can affect and be diagnosed in an individual as Sleep-onset insomnia, Sleep maintenance insomnia, and mixed insomnia.
     
  2. Narcolepsy: Narcolepsy is a relatively uncommon sleep disorder and affects people with a neurological issue. Narcolepsy causes sudden episodes of people falling asleep during the daytime. These episodes happen irrespective of the previous night giving sound sleep as it is more neurological than lifestyle issues. Feeling so exhausted and tired enough to sleep during the day is a form of narcolepsy, which is further divided into two categories:
    a. Narcolepsy Type 1: Narcolepsy type 1's main characteristic is cataplexy. Cataplexy refers to the way muscles can lose their tone leading to one collapsing in sleep. This form of narcolepsy is hazardous since severe cases can cause one to sleep without any warning. Although a patient may feel sleepy during the day because of narcolepsy, it can also happen in dangerous situations. One can fall asleep behind the wheel or even standing, leading to severe injuries for themselves and others around. Moreover, narcolepsy type 1 is more cause for concern as it renders one less self-dependable and can lead to mental health disorders, among other issues.
    b. Narcolepsy type 2: Narcolepsy type 2 doesn't have cataplexy or the sudden loss of muscle strength. In this case, one may feel excessively sleepy despite adequate rest and more likely to sleep gradually than have narcoleptic attacks.

    Cause of Narcolepsy: The leading cause of narcolepsy is the lack of the brain chemical hypocretin. Narcolepsy can usually surface in childhood or teen years and is a result of genetic disorders. The immune system attacks the part of the brain responsible for hypocretin production and causes narcolepsy. Since this is an immune disorder that is also a sleep disorder, narcolepsy is also an autoimmune disease. While a person can rest and have adequate REM sleep, the timing may be odd enough to leave one dysfunctional.
     
  3. Restless Leg Syndrome (RSL): In restless leg syndrome, your legs experience excessive movement, itching, and urges to move legs. While most cases of restless leg syndrome may be voluntary, restless leg syndrome can also be involuntary. RLS classifies as a sleep disorder because of the intensity or urge to move legs because the above mentioned uncomfortable activities trigger in the comfortable lying position. Also known as the Willis Ekbom disease, restless leg syndrome can also lead to other sleep disorders. Although it is more of an itchy or uncomfortable event condition, the urge to get rid of it can render one sleepless and lead to other sleep disorders.

    Cause of Restless Leg Syndrome: Although the leading cause of restless leg syndrome is unknown so far, there are events known to trigger it. Episodes of restless leg syndrome can be short-lived as well as long-term. Like other neurological or nervous issues, restless leg syndrome is also genetic to some extent.
    Moreover, internal diseases and conditions like iron-deficiency, Parkinson's neuropathy, or even kidney disease can lead to restless leg syndrome. Women are even more likely to have short-term restless leg syndrome episodes in the third trimester of pregnancy, and it can lead to trouble going to sleep. Substances like alcohol, caffeine, nicotine, and intense medicines can also trigger restless leg syndrome episodes.
     
  4. Shift-Work disorder: Shift work disorder is the misalignment of the body clock and related issues resulting from improper work-life balance. Night-shift workers and people with rotating day and night shifts are prone/targets of the shift-work disorder. The shift work disorder can take many forms, but people may take them for granted as it might be too late to detect or too short of taking seriously. However, the shift-work disorder is nothing to take lightly as it can upset our body clock and impact all internal systems of our body. Here are the symptoms of what happens to people with shift work disorder:
    - Mental health issues: People in jobs that require them to change their job and work balance every week, fortnightly, or even monthly are prone to the shift work disorder. While most people prefer a lifestyle where they can do things that allow them to lead their lives healthily, this frequent change can severely impact mental health.
    Loss of morale, substance abuse, food or other addiction and unhealthy lifestyle patterns become the way to deal with things. Moreover, since the body clock has little time to adjust, the individual is more prone to other sleep disorders. In such cases, people can experience more mental and physical health issues that are both side-effects and directly impact a person's mental health.
    - Low testosterone: Low testosterone is one of the main consequences which can affect a person's productivity. Issues like low alertness, slower reaction times, and even low libido are symptoms of the shift work disorder. Moreover, people are more prone to vehicle accidents because of the impact of such a chaotic lifestyle and their bodies not being able to cope with changes.
    - Low attention span: People feel most productive at certain times of the day, and if one sees random shift timings, it can cause one to fall asleep easier. Moreover, people with shift work disorder resulting from the above lifestyle issues can also feel physically weaker and mentally drained, and burned out.

    These issues directly impact the physical strength and mental attention span, which leads to low productivity and overall lower mental health. Moreover, shift work disorder can also lead to serious mental health issues like depression, anxiety, ADHD, and other issues than people with a fixed lifestyle. The issue is more common with people who are awake during the day for one or more weeks and awake during the night for others.
     
  5. Sleep Apnea: Sleep Apnea is the deadliest sleep disorder since it has to do with a sleeping person's ability to breathe. Sleep apnea is also much more common and cautious to stay away from since it can equally impact children and adults. This deadly condition can impact the way one breathes during sleep and is often characterized by longer durations when a person cannot breathe.

    While most cases are physiological in a way that the windpipe or the throat is physically blocked. Either the way from the throat to the windpipe may be blocked, or the windpipe itself could be deformed or anatomically collapsed/differently oriented. Based on the way sleep apnea affects, it is further categorized into two types:

    Obstructive Sleep Apnea (OSA): Obstructive sleep apnea refers to the kind where the throat or intake of oxygen may be blocked because of physical obstructions. In obstructive sleep apnea, a patient can face sudden pauses of breathing or obstruction. A person who has obstructive sleep apnea may even stop breathing for a minute, and further pauses or sustained pauses in sleep can lead to less blood oxygen. All these issues affect your internal systems and lead to high blood pressure, heart attacks, stroke, and cardiovascular diseases. Obstructive sleep apnea is strictly related to how the breathing mechanism may pause or face difficulty because of physically diagnosable issues.
    Central Sleep Apnea (CSA):  Central sleep apnea is not common and affects fewer people but is much more severe than obstructive sleep apnea. Central sleep apnea is the diagnosis in people where the brain stops sending signals or sends wrong signals regulating the breathing mechanisms. It is a strictly neurological issue and can be a side effect of medicines, nervous infections, severe obesity, and other issues.
    Mixed sleep apnea: If someone has central sleep apnea and is diagnosed with obstructive sleep apnea, it is known as mixed sleep apnea. Moreover, this would be a much more complex issue as one would have to consider severe medical therapy to address. In mixed sleep apnea, medical care is quintessential, and the consequences can be complicated and much more fatal.

    Causes of obstructive sleep apnea:
    - Anatomical deformations/irregularities:
    The leading cause of obstructive sleep apnea is any disfigurement, injury, or natural deformity of the muscles or tissue surrounding the windpipe. Moreover, this issue is genetic, so the child can have obstructive sleep apnea if the parent has it. The size of the jaw, tongue tissue, and tonsils also come under this category. As long as any deformity, inflammation, or irregularity in the way you breathe through the nose or the mouth exists, it is OSA.
    - Obesity: Obesity leads to excessive fat tissue stored around the neck or throat in general. In cases of morbid obesity, there is even more cause for concern since the chances of developing obstructive sleep apnea go significantly higher. Obesity also contributes to the above mentioned anatomical deformations cause since it is more likely to deposit fat, leading to collapse of the windpipe or surrounding areas.
    - Alcohol consumption: Alcohol or any form of alcoholic beverages impacts the brain, sending signals to orient the throat and air passageways for breathing correctly. Increased and sustained alcohol use can lead to obstructive sleep apnea by offering the passageways more room to relax. Moreover, in some cases, alcohol consumption with an unhealthy pattern can also lead to central sleep apnea if one already has other health concerns.
    - Hormonal issues: Hypothyroidism or thyroidal issues in general that cause inflammation can also lead to obstructive sleep apnea. Swelling or inflammation of tonsils, thyroid, or other issues can lead to obstructive sleep apnea too.
    - Sleeping orientation: If one has all the areas as mentioned above as potential causes for concern, they're also more likely to develop OSA in the back sleeping position. Sleeping on the back makes it easier for your windpipe to collapse or tongue to roll back. Moreover, the back sleeping position also makes the snoring louder and enhances obstructive sleep apnea's risk and severity.

    Side effects of Sleep Apnea:
    As a deadly sleep disorder, sleep apnea requires special treatment and active medical care. However, there are other causes of concern that can lead to adverse health issues. These symptoms and side effects can give some idea for a sleep apnea diagnosis:
    Abnormal breathing: While obstructive or any sleep apnea generally affects your breathing in the back sleeping position, it can also lead to breathing issues during the day. So, if you see any signs of having difficulty breathing in a relaxed position, be it day or night, it can be a sign of sleep apnea.
    Headaches in the morning: Since sleep apnea causes oxygen intake issues, it can lead to headaches in the morning.
    Snoring and a dry mouth: Snoring is a side effect or a significant reason for sleep apnea. If your partner often complains of excessive snoring, it is a reason to worry about sleep apnea. Moreover, snoring is a sign of an improper breathing mechanism that relaxes during sleep. The same can lead to sleep apnea, snoring, and a dry mouth in the morning. This factor is also more likely to wake you up with headaches and suddenly to wake up gasping for air.


Categories of sleep disorder symptoms and sleep disorder consequences:
There is not one single way that sleep disorders affect us. While diagnosing one can take time, it is even harder to assess the side effects, consequences, and steps to recovery unless we know the specifics. While sleep disorders mentioned above have their own categories, it is also the way they impact a patient that matters. Here are some categories to deal with sleep disorders:

Insomnia Types and Prevention:
Even though insomnia is the general inability to sleep, it can be categorized into different types:

  1. Sleep-onset insomnia: Sleep onset insomnia is the inability to sleep when you try to relax in bed. It can be both short-term and chronic and generally refers to how one cannot go to sleep despite in a relaxed mood.
  2. Sleep maintenance insomnia: Insomniacs often also have trouble staying asleep, and it can be as hard staying in REM sleep as waking up early. Sleep maintenance insomnia makes it possible for a patient to fall asleep, yet staying asleep can be problematic. Sleep maintenance insomnia leads to sleep debt and can also lead to mental health issues and depression, anxiety, and other conditions. Once a person wakes up early, it can be challenging to go back to sleep, which can become a vicious cycle.

    Side effects/consequences of sleep insomnia:
    Apart from issues like sleep debt, laziness, mental health, and lethargy in general, insomnia also leads to other issues one may not notice:
    Sleepwalking: Specifically, in sleep maintenance insomnia, sleepwalking is a common phenomenon. Sleepwalking episodes are frequent in people who have insomnia and can lead to fatigue, improper sleep, headaches, and other issues resulting from improper sleep. While people may stay safe in their room, monitoring sleepwalking in combination with insomnia is essential as it leads to other complications as well.
    Night terrors: People who have insomnia or sleepwalking, or both also exhibit frequent night terrors. Some medications, obstructive sleep apnea, or other conditions can lead to night terrors too. Night terrors result in a person being very afraid of a nightmare or feeling as if they're real and scream, move aggressively in bed, as well as cold sweats. If they're common, night terrors need treatment as they may make one afraid of going to sleep, which leads to an array of other issues.
    - Confusion: In sleep maintenance insomnia, one can also experience confusion on waking up. One can wake up feeling confused about their surroundings and might not remember anything that happens in the daze.

Parasomnia: Although parasomnia isn't a category of insomnia, it refers to the disorders that affect one in sleep. They can be commonplace things one ignores, but the frequent occurrence is cause for concern. Moreover, parasomnia can be as common as the above sleepwalking, night terrors, and confusion episodes to rare conditions. Here are some cases of parasomnia that can affect a person:

  1. Sexual abnormal behavior: In sleep, the mind is not conscious, and parasomnias, in general, can activate aggressive or improper behavior. Since the subconscious mind is more active in a sleep state, sleep disorders can manifest differently. Sexual abnormal behavior in sleep can see a person resorting to sudden inappropriate sexual behavior. Additionally, the person wouldn't remember any of it after waking up and barely remember if they can recall.
  2. Sleep Paralysis: Sleep paralysis refers to the way one can feel stuck or unable to wake up. Yet, the mind is awake, and muscles unable to move throughout the body. Sleep paralysis occurs when the mind fails to wake up the body and often wake up feeling 'stuck in your body.' Moreover, people report waking up to 'see' horrible images, figures, and nightmarish characters often standing or sitting near them.
    Sleep paralysis may or may not be accompanied by such episodes, but it depends on the person's mental health on what happens in a state of sleep paralysis. Episodes may last or be frequent enough to be afraid of going to sleep. The best way to address sleep paralysis is to consider clean sleep hygiene. A calming sleep environment before sleep often leads to fewer parasomnia disorders affecting oneself. The primary cause of sleep deprivation can be sleep debt deprivation, among other things.
  3. Nightmare occurrences: Although everyone goes through nightmares enough to consider it a natural part of life, a disorder is different. In a nightmare disorder, one can expect nightmares too frequently for comfort, and it even leads to a person waking up. Moreover, once awake, one may not feel like going back to sleep, which further leads to sleep deprivation and mental health issues. Sleep maintenance insomnia can be a side effect if not treated properly. The disturbing thing about nightmare disorder is that they only intensify with time and can render one afraid to sleep. People may feel afraid, confused, and anxious for long periods even when fully conscious.
  4. Exploding head syndrome: The exploding head syndrome makes one see or hear loud explosions in their sleep. Although there is no headache, people may feel like there is a real explosion. This disorder can cause people to react violently or aggressively as if to escape a real explosion. Although harmless, it can be disturbing for the patient and their partner.
  5. Sleep hallucinations: The period between going to sleep and actually falling asleep is known as sleep onset. Once the person is almost asleep in the sleep onset period, the subconscious brain can activate, resulting in hallucinations. Sometimes this can lead to confusion, fear, and even loss of sleep. If the patient starts getting a fear response, the need or will to sleep may be gone. Although the condition itself is not as harmful, a person's fear response may lead to sleep deprivation, mental health disorders, and increased anxiety.
  6. Sleep Enuresis: Sleep enuresis or bedwetting is common for toddlers and children in general. However, if it happens in children over five years or adults, it is a sleep disorder that needs to be looked at. Involuntary urination may be a result of kidney or other infection as well as alcohol influence. Additionally, sleep enuresis may also be a symptom of infections or cancer related to the prostate or bladder. A urinary tract infection may also be possible for causing sleep enuresis, and it is more common in women or people with kidney infections. If left untreated, it can become recurrent and chronic.


Types of issues sleep disorders cause:

  1. Breathing related disorders: Sleep disorders affect the mind and airways often lead to breathing issues while asleep. The deadliest of these is sleep apnea, yet there are different categories of breathing-related disorders:
    Obstructive sleep apnea: Obstructive sleep apnea is primarily a breathing disorder that results in the air passageway collapsing or facing blockage in sleep.
    Central or mixed sleep apnea: Central sleep apnea refers to the brain failing to send proper signals to muscles or your respiratory system to work appropriately in sleep. A case in which a person may experience both obstructive and central sleep apnea is called mixed sleep apnea.
    Hypoventilation: Hypoventilation refers to the lack of breathable oxygen in the surroundings. This may happen in poorly ventilated rooms and tight or damp spaces where a person doesn't have as much access to fresh air as is essential. The lack of blood oxygen as a result of this in sleep is known as hypoventilation.
    Hypoxemia: Hypoxemia or low blood oxygen levels can be a consequence of various sleep disorders, especially sleep apnea. Moreover, people that are prone to cardiovascular or neuromuscular issues, including central sleep apnea, are more prone to hypoxemia. Sleep apnea can cause multiple episodes of waking up and hypoxemia, which means sleep deprivation and headaches.
     
  2. Body clock disorders: Messing up sleep or the timing of sleep regularly can lead to sleep disorders. The type of sleep disorders that affect one because or poor lifestyle or work-life balance are known as body block sleep disorders. As mentioned earlier, lack of sleep or frequent and sudden changes in how one goes to sleep can affect everything from metabolism to neurological issues. Things that are supposed to happen in our bodies at night don't happen when we're awake and vice versa. These issues lead to sleep disorders that affect our body clock, such as:
    Sleep-Wake phase disorder: While in everyday life, people may choose to wake up and go to sleep at a particular time, disorders take out the option of choice. That is, in people with sleep-wake phase disorder, it becomes a habit or disorder to sleep and wake up at a particular time. Moreover, it may cause people to go to sleep late and wake up early as a recurring instance, which makes sleep deprivation and anxiety a high probability.
    Jet-lag and shift work disorder: Most of us are familiar with jet lag as it lands us in a different time zone with different daylight when flying. As our body sees us spend time moving from a day setting to another place's day setting it can be hard to fall asleep. Seeing daylight continuously can make people tired, cranky, and hard to sleep. A similar instance happens in the shift-work disorder, except it is much more extreme in that case.
    People doing night shifts, especially rotational night shifts at work, can face a sudden change in their lifestyle. This may seem easy for someone that has a habit of changing lifestyle, but the short and long term effect lead to poor lifestyle, time management, and lower productivity in general. Moreover, where in jet-lag, this is a short-lived issue, people with rotational shift work may face more long-lasting effects because the body clock has to see the consequences as a sustained unhealthy lifestyle.
     
  3. Non-24 hour sleep disorder: Because of unhealthy lifestyle issues that leave one hanging for some stability, some cases of shift work disorder or generally unstable lifestyle may lead to permanent damage. In such a case, a person may not have a 24-hour circadian rhythm or body clock and might see themselves falling asleep earlier or going to sleep at odd times. Moreover, this case happens mostly in vision-impaired people as the body doesn't recognize signs of day and night time shifting.
     
  4. Movement disorders: Some sleep disorders can cause involuntary movement. In such cases, a person isn't likely to remember anything, but if woken up from the state of movement in sleep, can exhibit aggressive behaviors.
    Restless leg syndrome: In restless leg syndrome, a patient may feel the itch or uncontrollable urge to move their legs in sleep. Mostly, restless leg syndrome makes one want to move legs voluntarily after discomfort, but it is involuntary in some cases.
    Sleep-related bruxism: Facing sleep issues and it resulting in one losing their dental health is discomforting. But in sleep-related bruxism, one may end up grinding their teeth. The untreated sleep-related bruxism condition leads to wear and tear of teeth, pain in the mouth, and severe dental issues. Moreover, sleep-related bruxism can lead to headaches and disturbance for the partner too.
     
  5. Fatigue disorders: The most common and direct way a sleep disorder affects a patient is by taking away the time they want to sleep. This leads to accumulated sleep debt, sleep deprivation, depression, anxiety, and other issues. Also known as hypersomnolence, fatigue from sleep deprivation or despite adequate time can have a devastating impact on the patient.
    Narcolepsy: Narcolepsy refers to the voluntary or sudden and involuntary action of falling asleep in the day despite adequate sleep. If it affects someone for over three months, it is chronic narcolepsy and needs treatment.
    Kevin-Levin syndrome: While some people may enjoy sleeping unhealthy or long hours on the weekends because of sleep debt or other issues, it has a disorder associated too. The Kevin-Levin syndrome makes one have episodes of sleep as long as up to 20 hours and can lead to devastating mental and physical inhibitive effects.


Conclusion: Sleep is a necessity, and people who do not have any sleep disorders might take it for granted. However, it can be a luxury for people with sleep disorders, and taking care of one's sleep becomes another aspect of health they need to take care of. Since we do not have any control over the way we behave, move or do anything in or around sleep, most of these issues might require medical care. However, some issues may even be as simple as getting rid of a lifestyle change and simple exercises. If you have a sleep disorder, it can be hard to tell which because most people do not remember what happened in their sleep moments after they wake up. So, if you want sweet dreams and a night of healthy sleep, taking care of your sleep hygiene, sleep environment, and general lifestyle are quintessential for overall health.

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