Other Causes for Tiredness

sybert1ger · Post by **sybert1ger** » Sun Aug 26, 2007 8:46 pm

After almost 8 months on CPAP, I still don't feel any improvement in my daytime fatigue. My AHI is under 2.0. I brought printouts to my Sleep Doc and and he agreed that I should be feeling better by now. He's scheduled another sleep study to see if there's something else that could be going o now.

So here's my questions. What else could still be going on? Have any of you been diagnosed with other problems that contribute to daytime sleepiness? Have you been diagnosed with Sleep Apnea and something else at the same time?

I looked at the Apnea diagnosis as a godsend but I'm still tired from the moment I wake up in the morning until the moment I go back to sleep.

lawdognellie · Post by **lawdognellie** » Sun Aug 26, 2007 9:09 pm

I feel for you as I have/had the same problem- I've been on xPAP for 1.5 years and I've still got excessive daytime drowsiness. My sleep doc (who was actually just a neurologist) wouldn't bother to find out why. I just got a new doc who is really on top of it. She ran some blood work and discovered that I have really low vitamin B-12 levels, which apparently can cause fatigue. Apparently my body can't absorb B-12 the way it should. but I started injections . Thursday and I already feel 30% better. I have no idea why no one else has bothered to check B-12 before. Have you had yours checked?

Of course there are also other forms of sleep disorders - restless leg, etc. can can also be at fault. My sleep doc is redoing my PSG so she can go through the data with a fine tooth comb to look for other problems. (My old doc never put the raw data in my chart, only her "opinions" about what is wrong).

Hope this may give you some help.

Sarah

Wulfman... · Post by **Wulfman...** » Sun Aug 26, 2007 9:14 pm

My guess is that you're leaking air out your mouth.

Den

sharon1965 · Post by **sharon1965** » Sun Aug 26, 2007 10:06 pm

After almost 8 months on CPAP, I still don't feel any improvement in my daytime fatigue. My AHI is under 2.0. I brought printouts to my Sleep Doc and and he agreed that I should be feeling better by now.

den,
isn't an AHI of under 2 a good result? would you be able to achieve such a good number if you were leaking/mouth breathing? i don't really know much about this aspect...

as far as other issues causing tiredness go, sybert1ger, i was diagnosed years ago with fibromyalgia, which causes crushing fatigue and sleep fragmentation...i also have periodic limb movement disorder, with the limb movements causing frequent arousals...so even if my cpap is doing it's job, the leg movement is now the culprit...i also have extremely low iron (don't know if you're a man or a woman, so this may or may not apply to you)...my sleep doc checked my ferritin level (ferritin is a protein which stores iron)...the normal range for a woman is 10-250, mine was 6...so, on top of causing tiredness, such a low iron level could be the reason for the plmd, as plmd and restless leg syndrome can be caused by low iron...i'm hoping that's the reason, as we're working on increasing my levels through prescription iron supps, and have so far raised my value to 30...but, to address the plmd and rls, the value needs to be around 60...if we can achieve that, it may eliminate the plmd, but for now i'm medicated for it--it is helping though, so i don't mind the meds for now...i also had many spontaneous arousals on my psg, which had unknown causes...so, all in all, getting me into any kind of decent shape is a pretty complex challenge, which is why i still kind of feel like poop after 7 months on cpap
so, these are a couple of avenues you could explore, though i'm sure others will weigh in with many more! good luck figuring it out
sharon1965

dllfo · Post by **dllfo** » Sun Aug 26, 2007 10:13 pm

PULSE OX??

I was so tired they put me Provigil. It helped, but getting my heart fixed really did the trick.

Check your pulse ox...at home too. I could hit a low 90 in a doctor's office,
but sitting around the house I was tired, sleepy, fatigued....

If your oxygen levels are up, there are a lot of other reasons for your symptoms. Smarter people than myself visit here, ask them.

Best wishes......

Highnote · Post by **Highnote** » Sun Aug 26, 2007 11:44 pm

Fatigue is a nonspecific symptom unfortunately....a full checkup with blood work is a good thing to do, which is not the sleep doc's bailiwick. Never know what might pop up, like the B-12 absorption problem (a/k/a pernicious anemia) or iron deficiency anemia people have mentioned.

echo · Post by **echo** » Mon Aug 27, 2007 1:05 am

Thyroid (hypothryodism) is also something else to check for.
Normally they check just for TSH, but the full panel -to get the full story- is TSH, Free T4, Free T3, T4, T3 Uptake and T7.

Note that the recommended ranges for TSH "normal" were changed from .5-5 to 0.3-3, so some doctors/labs might still consider anything above 5 'normal'.

Wulfman... · Post by **Wulfman...** » Mon Aug 27, 2007 5:42 am

sharon1965 wrote:
After almost 8 months on CPAP, I still don't feel any improvement in my daytime fatigue. My AHI is under 2.0. I brought printouts to my Sleep Doc and and he agreed that I should be feeling better by now.
den,
isn't an AHI of under 2 a good result? would you be able to achieve such a good number if you were leaking/mouth breathing? i don't really know much about this aspect...

as far as other issues causing tiredness go, sybert1ger, i was diagnosed years ago with fibromyalgia, which causes crushing fatigue and sleep fragmentation...i also have periodic limb movement disorder, with the limb movements causing frequent arousals...so even if my cpap is doing it's job, the leg movement is now the culprit...i also have extremely low iron (don't know if you're a man or a woman, so this may or may not apply to you)...my sleep doc checked my ferritin level (ferritin is a protein which stores iron)...the normal range for a woman is 10-250, mine was 6...so, on top of causing tiredness, such a low iron level could be the reason for the plmd, as plmd and restless leg syndrome can be caused by low iron...i'm hoping that's the reason, as we're working on increasing my levels through prescription iron supps, and have so far raised my value to 30...but, to address the plmd and rls, the value needs to be around 60...if we can achieve that, it may eliminate the plmd, but for now i'm medicated for it--it is helping though, so i don't mind the meds for now...i also had many spontaneous arousals on my psg, which had unknown causes...so, all in all, getting me into any kind of decent shape is a pretty complex challenge, which is why i still kind of feel like poop after 7 months on cpap
so, these are a couple of avenues you could explore, though i'm sure others will weigh in with many more! good luck figuring it out
sharon1965

Sharon,

It could be one or more of a lot of things. The nasal mask in the profile is what caught my eye.
If there's a lot of leaking (and large leaks in particular), the machine will not record events during that time.....hence, dropping the number of events.

On the other hand, if I had an average of around 2.0, I'd be dragging.

Another of the "unknowns" is how MUCH sleep is this person getting. If you have a combination of mouth leaking AND too little sleep, you'll have the same results on a larger scale.

Den

Wulfman... · Post by **Wulfman...** » Mon Aug 27, 2007 5:45 am

I meant to say: "....hence dropping the AHI".

Den

Nodzy · Post by **Nodzy** » Mon Aug 27, 2007 6:41 am

As mentioned above by others, full blood work-up is essential but may not be definitive.

Nutrients, whether you get the right mix, and whether your body can properly process all of them, is a major consideration. Caffeine intake, alcohol, smoking, exposure to chemicals, even hidden chemicals in home products like carpeting, paneling and furniture can play into it.

Mouth breathing and / or mouth venting are likely causes.

Stress overload and excessive worry are hugely detrimental to quality sleep, overall health and the "good" energy levels. Not nervous energy, but the good energy.

The amount of exercise you get, how regularly, and at what times toward evening hours you do it can also affect the quality and benefit of sleep.

Go through your life and lifestyle and look at all the factors. You may find one or more things, in addition to OSA and its complications, that are contributing to the lack of what should feel like beneficial treatment.

Nodzy

sharon1965 · Post by **sharon1965** » Mon Aug 27, 2007 8:08 am

thanks den, for the explanation!

tillymarigold · Post by **tillymarigold** » Mon Aug 27, 2007 11:59 am

For me, when I'm tired it's usually one of three things:

1. Mask was leaking the night before and waking me up (I mean, actually fully waking me up with the noise).

2. I didn't sleep long enough the night before; I need at least 7 hours of actual sleep but 7½ to 8 is better.

3. My Vitamin B-12 levels are low; my body can't absorb it through the digestive tract so I have to take sublingual supplements. Sometimes I forget to take them as often as I should (I'm supposed to take them twice a week).

Vader · Post by **Vader** » Mon Aug 27, 2007 12:51 pm

lawdognellie wrote: Apparently my body can't absorb B-12 the way it should. but I started injections . Thursday and I already feel 30% better.

As we age, many of us lose the ability to properly absorb B-12, because we can no longer produce the enzyme necessary for breaking down and absorbing the vitamin.Once absorbed, it is stored in the muscle tissue of the body.
There are also many who cannot absorb it due to a hereditary defect. (usually for those of mediterranean ancestry).

You probably already know how extremely important it is to get your injections, so make sure you keep a regular schedule of getting the shots, as prescribed by your doctor.

RosemaryB · Post by **RosemaryB** » Mon Aug 27, 2007 6:24 pm

I had a lot of spontaneous arousals that weren't taken care of during titration. They titrated me at 5 (lazy or incompetent tech), but luckily I got an auto and with the help of the good folks on this forum and the software printouts, 8.5 was the best single pressure for me. If I have minimal leaks and an AHI below 1.0, I feel great. One theory I have about this is that those spontaneous arousals were caused by "subclinical apneas, UAR-like phenonmena" and are taken care of when everything works right. This is just my own little theory, but it seems logical to me. The only way to know for sure would be to get a good titration study done at the proper pressures and see if the SA's go away.

I agree with others here who have said that the fatigue could be any number of things. Finding a good GP who like detective work and knows how to refer to other compentent specialists is the way to go. (Warning, this ideal doc may not exist in real life).

amandalee · Post by **amandalee** » Mon Aug 27, 2007 6:36 pm

RosemaryB wrote:Finding a good GP who like detective work and knows how to refer to other compentent specialists is the way to go. (Warning, this ideal doc may not exist in real life).

I still haven't found one...

As Highnote said, fatigue is one of those vague, non-specific symptoms. Countless things can cause it.
Unfortunately, the medical system is pretty screwed up; doctors are over-worked and under-educated, and if your blood tests come back normal, they're likely to suggest anti-depressants to "cure" your fatigue...not that my experiences have made me bitter at all...

Anyway, I guess what I'm saying is insist on further testing, if you feel that the basic bloodwork or whatever wasn't enough.
Also, I second what Nodzy said about examining your lifestyle to see if anything else you're doing might be contributing to your tiredness; I should do that myself!