Excessive daytime sleepiness post surgery

I had the sleep apnea surgery last July 29. I had insomnia afterwards. I went from sleeping 12 hours each night and taking two or three naps per day to not sleeping but two or three hours per night and no naps during the day. Over the course of this past year, my psych doctor has tried me on several different sleeping pills. Just two months ago, I finally started taking Lunesta 2 mg and am finally sleeping at night now. But, it hasn't affected my excessive daytime sleepiness. The alertness I got after my sleep apnea surgery only lasted about two or three months. Then the tiredness kicked in again. It is so bad now that within two hours of being up, I have to lay back down for a nap because I cannot keep my eyes open. I'm sleeping 8-9 hours each night now, without waking up. My surgery doctor put me through a overnight sleep study after the surgery and it showed that I do not have sleep apnea anymore. He just sent me for another one, where I had to stay over the next day and take naps. He said that it showed I was just above normal limits, no narcalepsy. According to the report, I go into REM sleep a little fast. My bloodwork shows up fine, or whatever is normal for a CBC. Has anyone else had this problem or heard of anyone else with this problem and what did you do about it? My sleep surgery doctor has washed his hands of me stating that he has "fixed" me and that the EDS (excessive daytime sleepiness) must be from a combination of my meds. My family doctor and psych doctor won't change any of my meds, they act like they don't even hear me when I tell them that I cannot function on a daily basis. Oh, I did also meet with my pharmacist and we went over each of my current medicines. He recommended that I take most of them before bed (only once a days) to see if they were causing sleepiness, that way they would help me sleep. It is helping me sleep (with the Lunesta), but the EDS is unbearable. I have a horrible time working during the day. On my days off, I nap all day and don't get anything done.

Hi DazzlinDarlene69,

Welcome to the forum although I am sorry it is under these circumstances.

What the did the recent study show?

Also, what meds do you take besides Lunesta as I am wondering if they could be contributing to your problem?

49er

DazzlinDarlene69 wrote:I had the sleep apnea surgery last July 29. I had insomnia afterwards. I went from sleeping 12 hours each night and taking two or three naps per day to not sleeping but two or three hours per night and no naps during the day. Over the course of this past year, my psych doctor has tried me on several different sleeping pills. Just two months ago, I finally started taking Lunesta 2 mg and am finally sleeping at night now. But, it hasn't affected my excessive daytime sleepiness. The alertness I got after my sleep apnea surgery only lasted about two or three months. Then the tiredness kicked in again. It is so bad now that within two hours of being up, I have to lay back down for a nap because I cannot keep my eyes open. I'm sleeping 8-9 hours each night now, without waking up. My surgery doctor put me through a overnight sleep study after the surgery and it showed that I do not have sleep apnea anymore. He just sent me for another one, where I had to stay over the next day and take naps. He said that it showed I was just above normal limits, no narcalepsy. According to the report, I go into REM sleep a little fast. My bloodwork shows up fine, or whatever is normal for a CBC. Has anyone else had this problem or heard of anyone else with this problem and what did you do about it? My sleep surgery doctor has washed his hands of me stating that he has "fixed" me and that the EDS (excessive daytime sleepiness) must be from a combination of my meds. My family doctor and psych doctor won't change any of my meds, they act like they don't even hear me when I tell them that I cannot function on a daily basis. Oh, I did also meet with my pharmacist and we went over each of my current medicines. He recommended that I take most of them before bed (only once a days) to see if they were causing sleepiness, that way they would help me sleep. It is helping me sleep (with the Lunesta), but the EDS is unbearable. I have a horrible time working during the day. On my days off, I nap all day and don't get anything done.

I'm so sorry you're going through this, but I'm afraid I don't have an answer for you. I'm sure someone with more knowledge than I , or who has had the surgery will chime in.

It would help us help you if you could let us know what the sleep study results showed before and after the surgery. My question to you is, were you using cpap therapy prior to the surgery, and are you using it now?

I had not been wearing the cpap because I kept taking it off during my sleep. My last sleep study results stated: "The patient was monitored for a total of 409.5 minutes and slept for 354 minutes resultilng in a sleep efficiency of 86.3%. Latency to sleep onset was 7.3 minutes, REM latency from sleep onset was 42.0 minutes. Sleep staging: N1: 16.5 min - 4.7%, N2: 204.5 min. - 57.9%, N3 0 min - 0%, REM 132.5 min - 37.5%. Sleep effiicency was mildly decreased. Sleep onset was normal. REM onset was early. Respiratory Data: A total of 7 respiratory events were observed during the analysis period as follows: 0 obstructive apneas, 2 central apneas, 0 mixed apneas and 5 hypopneas, for an apnea/hypopnea index of 1.2 and 0.9 during REM. The lowest oxygen saturation recorded was 86%. However, it should be noted that this was a single desaturation accompanying a central apnea in REM sleep. Cardiac data: There were no significant EKG findings. Average heart rate was 74.2 bpm. No significant limb movements were observed during the analysis period. Patient shows no evidence of sleep apnea. An MSLT will follow this PSG.

PSG: The patient was monitored for a total of 443 minutes and slept for 425.5 minutes resulting in a sleep efficiency of 96.1%. Latency to sleep onset was 7.4 minutes, REM latency from sleep onset was 103.5 minutes. Sleep staging: N1: 6 min - 1.4%, N2: 344 min - 80.8%, N3: 0 min - 0%, REM: 75.5 min - 17.7%. Sleep efficiency was increased. Sleep onset was normal. REM onset was delayed. Respiratory data: There was 2 hypopneas and no apnea noted during the entire recording. The AHI was 0.3. The lowest SaO2 was 91%. This compares very favourably to her pre-surgical respiratory parameters. There was residual UARS noted. No significant positional effect was noted. Cardiac data: There were no significant EKG findings. Average heart rate was 77.9 bpm. There were no significant limb movements observed.

That's both of the reports.

Did they say how many residual UARS were noted? If not, you might want to find out. Who knows whether that is significant or not but it is good to cover all bases since UARS can definitely cause excess daytime sleepiness.

49er

DazzlinDarlene69 wrote:I had not been wearing the cpap because I kept taking it off during my sleep. My last sleep study results stated: "The patient was monitored for a total of 409.5 minutes and slept for 354 minutes resultilng in a sleep efficiency of 86.3%. Latency to sleep onset was 7.3 minutes, REM latency from sleep onset was 42.0 minutes. Sleep staging: N1: 16.5 min - 4.7%, N2: 204.5 min. - 57.9%, N3 0 min - 0%, REM 132.5 min - 37.5%. Sleep effiicency was mildly decreased. Sleep onset was normal. REM onset was early. Respiratory Data: A total of 7 respiratory events were observed during the analysis period as follows: 0 obstructive apneas, 2 central apneas, 0 mixed apneas and 5 hypopneas, for an apnea/hypopnea index of 1.2 and 0.9 during REM. The lowest oxygen saturation recorded was 86%. However, it should be noted that this was a single desaturation accompanying a central apnea in REM sleep. Cardiac data: There were no significant EKG findings. Average heart rate was 74.2 bpm. No significant limb movements were observed during the analysis period. Patient shows no evidence of sleep apnea. An MSLT will follow this PSG.

PSG: The patient was monitored for a total of 443 minutes and slept for 425.5 minutes resulting in a sleep efficiency of 96.1%. Latency to sleep onset was 7.4 minutes, REM latency from sleep onset was 103.5 minutes. Sleep staging: N1: 6 min - 1.4%, N2: 344 min - 80.8%, N3: 0 min - 0%, REM: 75.5 min - 17.7%. Sleep efficiency was increased. Sleep onset was normal. REM onset was delayed. Respiratory data: There was 2 hypopneas and no apnea noted during the entire recording. The AHI was 0.3. The lowest SaO2 was 91%. This compares very favourably to her pre-surgical respiratory parameters. There was residual UARS noted. No significant positional effect was noted. Cardiac data: There were no significant EKG findings. Average heart rate was 77.9 bpm. There were no significant limb movements observed.

That's both of the reports.

Hi Darlene - what machine (full name + model #) do you use? And what kind of mask? What are your pressure settings?

Without that info, it's hard to advise...

She has this machine, posted for sale on another thread:
viewtopic/t99641/Fisher-amp-Paykel-ICON ... -sale.html

Julie wrote:Hi Darlene - what machine (full name + model #) do you use? And what kind of mask? What are your pressure settings?

Without that info, it's hard to advise...

none, I believe.

You may have missed it in my original post since it was so long, but I had the sleep apnea surgery and do NOT sleep with a cpap anymore as my sleep doctor told me that I no longer have sleep apnea. I have my cpap machine for sale on another post because I do not use it anymore. As for my UARS, there were none in my PSG and only residual in my MSLT. My sleep doctor actually got mad when my primary care and psych doctors told me to go back to him for answers. "I "fixed" your sleep apnea, that's not what's causing your EDS". He wasn't even very nice about it. I am on different meds which my pharmacist went over with me. Most medicines can cause drowsiness, that's why he had me switch them from taking most of them in the morning to taking them before bed. He said any drowsiness should be wore off before I wake up in the morning.

DazzlinDarlene69 wrote:You may have missed it in my original post since it was so long, but I had the sleep apnea surgery and do NOT sleep with a cpap anymore as my sleep doctor told me that I no longer have sleep apnea. I have my cpap machine for sale on another post because I do not use it anymore. As for my UARS, there were none in my PSG and only residual in my MSLT. My sleep doctor actually got mad when my primary care and psych doctors told me to go back to him for answers. "I "fixed" your sleep apnea, that's not what's causing your EDS". He wasn't even very nice about it. I am on different meds which my pharmacist went over with me. Most medicines can cause drowsiness, that's why he had me switch them from taking most of them in the morning to taking them before bed. He said any drowsiness should be wore off before I wake up in the morning.

I am not a medical professional so take my advice for what it is worth but I disagree that meds taken at night can't cause sleepiness the next day, particularly if you are taking more than 1 med. Since your current doctors won't review your meds, would it be possible to get a second opinion on them?

49er

DazzlinDarlene69 wrote:You may have missed it in my original post since it was so long, but I had the sleep apnea surgery and do NOT sleep with a cpap anymore as my sleep doctor told me that I no longer have sleep apnea. I have my cpap machine for sale on another post because I do not use it anymore. As for my UARS, there were none in my PSG and only residual in my MSLT. My sleep doctor actually got mad when my primary care and psych doctors told me to go back to him for answers. "I "fixed" your sleep apnea, that's not what's causing your EDS". He wasn't even very nice about it. I am on different meds which my pharmacist went over with me. Most medicines can cause drowsiness, that's why he had me switch them from taking most of them in the morning to taking them before bed. He said any drowsiness should be wore off before I wake up in the morning.

Then dig the machine out, get a new mask and start using it.

This is why people here never push surgery.

As for a second opinion, yes, I've already looked into that. I live in a pretty small town and there are only so many psych doctors. So, I've been on a waiting list for a second opinion. I finally just got my second opinion (dr. appt.) scheduled for Oct. 15. That's the quickest appt. with any psych dr. And as for using the cpap without having sleep apnea, that's not recommended by my doctor. I asked him about using it, but again, if you read my original post, I wasn't sleeping successfully with it anyway, I was taking it off every night.

DazzlinDarlene69 wrote:As for a second opinion, yes, I've already looked into that. I live in a pretty small town and there are only so many psych doctors. So, I've been on a waiting list for a second opinion. I finally just got my second opinion (dr. appt.) scheduled for Oct. 15. That's the quickest appt. with any psych dr. And as for using the cpap without having sleep apnea, that's not recommended by my doctor. I asked him about using it, but again, if you read my original post, I wasn't sleeping successfully with it anyway, I was taking it off every night.

Sorry to hear that. I am sure you have thought of this already but I would keep calling the office to see if there are any cancellations.

49er

BlackSpinner wrote: Then dig the machine out, get a new mask and start using it.

This is why people here never push surgery.

why? if the last two sleep studies don't show any apnea?

You had 0% deep sleep (N3) in both studies above, normal is 20%. Some sleep labs dose not check for UARS or score it, look in your sleep study for RERA, arousal or RDI.