Tired, Tired, Tired... Does life ever get better?

[Swordz]

Guys, I've been gone for so long! I hope everyone is doing good!

Now, to the reason for my "visit". I just started my 1st real job, and it's killing me. It's been close to a year since my major surgery (Tonsils, modified-UP3, GA), and the transition from 55 apnea/hr to ~3 apnea/hr. I am still tired as crap though, and really want some thoughts from people that have "messed" up sleep stages.

My sleep study noted a high % of my sleep being stages 1 and 2, which we all know is the "useless" sleep which basically gets you to the good stuff (stages 3-4, REM). I'm thinking that my lack of stages 3-4 are the reason that I'm tired, but I'd still like to hear some thoughts from those hear.

The only other thing I can think of for my fatigue is my bed. I have minor scoliosis, but enough to cause pain/fatigue through the day. My bed isn't that bad, but I'm getting a tempurpedic soon to see if my scoliosis is the factor in my overwhelming fatigue.

Hope everyone is well, and feel free to email me. You got it already, if not just PM me!

[blarg]

When was your last sleep study?

I'm just thinking it would be better to make sure we're talking about current data, as your sleep may have changed since right after the surgery.

[tangents]

Hi Swordz!

What equipment are you using? Do you monitor your daily stats? Sorry you're so tired, but with more information, I'm sure the folks here can get you back on track.

Cathy

[rested gal]

Hi Coreeeeeeeee!

You're right...it's been a long time. Good to see you posting an update, but sorry to hear you're still so tired.

While stage 1 is more like a transition from wake to more restful sleep, I don't think stage 2 is considered "useless." On my sleep study (both the baseline night and the titration night) it showed I get just a little stage 3 and no stage 4. Normal amounts of 1, 2, and REM. So...for me, getting stage 2 and REM (and a smidgen of 3) is apparently fine since I always feel refreshed when I get up.

Of course, I'm a LOT older than you, Cory. As we get older we normally tend to get less stage 3/4 sleep, and I don't how much of that would be normal for you at your age... in your early twenties still, right?

I was looking back at one of your messages after the post-surgery PSG:
viewtopic.php?t=14521

"Phase 1" surgery on July 10th, 2006, consisting of modified UP3, further turbinate reduction, tonsellectomy, and genioglossus advancement (GA). Followup sleep study was Oct 10th, with results reported to me today.

Results:

AHI reduced from 52/hr to ~10/hr. Sa02 increased from 84% from previous studies, to no less than 93% during sleep. "There was 1 central event, 14 hypopneas. The apnea plus hypopnea index was within normal range at 3 per hour, and this is markedly improved compared with more than 50 per hour on the baseline study." Stage 1 sleep is 18%, and Stage 2 is 60%, Stage 3/4 14.7%, and REM was 5.9%. Dr. stated, "PLMD was present, with 127 PLM's averaging 25.7/hr, but very few of those caused arousals." "Sleep Efficiency poor for Unknown reasons" listed by Dr, but I'm skipping caffiene before bed, windows are darkened, no TV, etc.

The surgery was an overwhelming success in my opinion. The Dr. said my best results would be an AHI of around 20/hr, but I've eclipsed that with ~10/hr. My oxygen levels at night are much better too, and I've noticed that with less headaches and much less groginess in the morning. My numbers overall are much better, but I'm not feeling that much better. I believe that my sleep stages are still not where they should be, so I'm looking into medication to enhance Stage 3/4 time. I am starting Lexapro next week for anti-anxiety/depression, so that might give me a "lift" as well.

---

One question though, the study states there were 10.5 arousals an hour, but it says "apnea plus hypopnea index was within normal range at 3 per hour". Is the 10.5 AHI or 3/hr?


Still planning to go for the MMA eventually? I remember that insurance was the issue there...that you had to jump through the other surgery hoops first before your particular insurance would consider you qualified to MMA. I was always sorry their requirement made you have to go through UPPP first.

I guess you've not had another sleep study since the surgery followup study in Oct last year?

As always, hoping for the best for you Cory!

[kteague]

Cory,

It's great to hear from you again, but I was so hoping your absence was because you were doing so well and had gone on with your busy life.

You know, I've heard others discuss alpha wave intrusion, but I guess you'd have been told if that was happening with you. As you probably remember, there are some on here who are sharp at looking at downloaded data and making astute observations. Maybe that would be worth a try for you.

While it may not be an issue with you, it has taken me nearly a year for my brain to learn better sleeping patterns. It was so used to disruption it was like it didn't know how to do otherwise. Still far from perfect due to some leg movements, But I'm closer to my old "normal" than I've been in many years. Now that you're out of college, hopefully it will be easier to practice good sleep hygiene and retrain yourself to have regular sleep patterns. But of course, if the quality of that sleep stinks, you still won't be any better off.

Did you ever do anything about your PLMD? Don't laugh, especially since you are now a college educated man, but you should read the threads about Ivory soap in the bed helping the legs. And have you had a Ferritin level done just in case it plays a role?

Gosh, just so sorry you are not feeling a lot better. Best wishes at further narrowing down and resolving more contributing factors. You've been through a lot to make it this far.

Kathy

[Mile High Sleeper]

Good to hear from you again, Swordz; and that your surgery helped tremendously in reducing your AHI.

I think you may be right about changing your mattress. In my experience, once the worst sleep apnea symptoms get fixed, the body gets more sensitive to other health problems. It's like peeling an onion; another thing needs attention in your body's quest for healing.

With me, it was unknown food intolerances which were causing insomnia.

Caffeine stays in the body for 24 hours. I had to eliminate all caffeine, even decaf drinks which have a trace.

My doctor says that after the sleep deprivation she experienced during her medical training, it took 3 years to completely feel better.

I wish you long nights of blissful sleep and as many naps as you need.

[Snoredog]

I was looking back at one of your messages after the post-surgery PSG:
viewtopic.php?t=14521

"Phase 1" surgery on July 10th, 2006, consisting of modified UP3, further turbinate reduction, tonsellectomy, and genioglossus advancement (GA). Followup sleep study was Oct 10th, with results reported to me today.

Results:

AHI reduced from 52/hr to ~10/hr. Sa02 increased from 84% from previous studies, to no less than 93% during sleep. "There was 1 central event, 14 hypopneas. The apnea plus hypopnea index was within normal range at 3 per hour, and this is markedly improved compared with more than 50 per hour on the baseline study." Stage 1 sleep is 18%, and Stage 2 is 60%, Stage 3/4 14.7%, and REM was 5.9%. Dr. stated, "PLMD was present, with 127 PLM's averaging 25.7/hr, but very few of those caused arousals." "Sleep Efficiency poor for Unknown reasons" listed by Dr, but I'm skipping caffiene before bed, windows are darkened, no TV, etc.

The surgery was an overwhelming success in my opinion. The Dr. said my best results would be an AHI of around 20/hr, but I've eclipsed that with ~10/hr. My oxygen levels at night are much better too, and I've noticed that with less headaches and much less groginess in the morning. My numbers overall are much better, but I'm not feeling that much better. I believe that my sleep stages are still not where they should be, so I'm looking into medication to enhance Stage 3/4 time. I am starting Lexapro next week for anti-anxiety/depression, so that might give me a "lift" as well....

I think the continuing cause of his daytime fatigue can be found right in those results above. Until his doctor bites the bullet and addresses that PLMD problem he is will continue to spin his wheels with daytime fatigue issue.

OSA is only 1 disorder found to interrupt ones sleep, PLMD and Spontaneous Arousals are just a couple others. Once his OSA events are under control with either cpap, dental or surgery his doctor needs to get off his duff and address those other disorders seen on the PSG instead of labeling them "insignificant". I don't see PLMD's of 25 per hour being insignificant as his doctor suggests.

...what was SAG's famous last quote? "Assuming all the obstructive events are being properly addressed..."

So far for Swordz, he has

tried CPAP no luck
tried Dental no luck
tried Surgery no luck
and is still tired and back again.

At some point you have to come to the logical conclusion that OSA is NOT what is causing his daytime fatigue. I would go back to square one and pull out the PSG and look for all the disorders most likely seen there that his genius doctors have failed to address so far. My guess those PLM's and spontaneous events seen on his first report would be of interest.

[neverbetter]

Hows your thyroid levels ?
Simple blood test will tell.