Really confused now!!!

[modistee]

Well yesterday morning was my two month visit with sleep Doctor to see how things were going and if I was doing what I was supposed to be doing. Well after visiting with him I am more confused than ever. He made a comment about my sleep apnea being very mild and most of the time it doesnt bother people when its that mild and that he thought my thyroid level being too low had more to do with my being that tired than sleep apnea. Wow I wish he had thought about that before I spent two nights in the sleep lab and bought close to $2000 worth of cpap equipment. I am sooo confused and somewhat upset about this. I have been trying to wear that dang cpap machine and have been doing quite well except when I have sinus trouble and can't breath. And now I find out I maybe wouldnt have had to have it at all????????? He said to use it for four more months and then we will try a trial without it. I am in one way glad we have insurance because most of the money didnt come out of our pockets but in another way ticked off because they got possibly ripped off and us too. *sigh* Now I am wondering if I could just not do the cpap at all and save time and not wait the four months. But I am so afraid of being that horrible tired again. I guess since I have it now I might as well stick it out for the next four months. sorry but I just had to vent

Modistee

[OutaSync]

Your doctor sounds like an idiot. If you had two nights in a sleep lab, you should know how "mild" your sleep apnea is. How many times a minute did you stop breathing? How long did each apnea last? How low did your oxygen levels go? Is this the same doctor that prescribed the CPAP? Testing for thyroid levels doesn't have anything to do with sleep apnea.

[bearded_two]

Hypothyroidism can have some of the same symptoms of sleep apnea.

[Hawthorne]

Are you saying that you are not feeling as tired now that you are using cpap? If that's the case, you probably have at least mild sleep apnea and maybe some thryroid issues as well.

You seem to say that cpap is helping some. If that's the case I won't stop using it until I had been having my thyroid treated properly for a reasonable period of time, if that turns out to be a problem. It may just be an additional problem.

I would certainly want to have another sleep study after thyroid treatment kicks in and is stablized (if that turns out to be a probelm for you) to determine whether or not I still did in fact have even mild sleep apnea. If, at that point, my apnea was even mild, I think I would still use cpap.

That's what I would do anyway.

[OutaSync]

Hypothyroidism can have some of the same symptoms of sleep apnea.

Yes, it can, but I'm not aware that it causes sleep apnea. She had a sleep study, so presumably they found a reason to put her on CPAP. I think that Hawthorn's advise is good. She may have concurrent conditions.

[rested gal]

But I am so afraid of being that horrible tired again.

Modistee, this sentence you wrote jumped out at me. If that sentence means you've seen some improvement (even if not as much improvement as you might wish) in feeling a little less "tired", I would say that you do need CPAP.

Or to put it another way, if you still feel tired, but not as "horrible tired" as you did before CPAP, I would say that you do need CPAP -- that it is doing you good.

I do believe other health issues can leave a person feeling tired, perhaps to the point of not realizing the good that CPAP is doing. Low thyroid is one of those things. But that doesn't mean the person doesn't need CPAP to handle sleep disordered breathing, even if the person received a diagnosis of "mild" sleep apnea.

"Mild" doesn't mean, "doesn't realllllllllly need treating."

Even if CPAP is doing its part of the job like a champ -- keeping the airway open for good breathing during sleep -- there can be any number of other health or sleep hygiene issues that can cause a person to still feel tired, worn out, lousy. But what that means, to me, is that the other health issues need to be discovered and taken care of.

To me, it wouldn't mean that CPAP for sleep disordered breathing should be discontinued in favor of pursuing treating the other health issues, if a person has already received a PSG study showing even "mild" sleep apnea. I think the doctor, "sleep doctor" though he may be, is doing you a disservice in suggesting that. I agree with OutaSync that if your sleep study indicated sleep apnea, you've got it, and it needs to be treated, even if "mild." Just because another health issue also need treating doesn't mean treating sleep apnea should be tossed out. Just my non-medical opinion.

We wouldn't stop taking meds for diagnosed anemia or for diagnosed diabetes, simply because another health problem like low thyroid was diagnosed... all disorders that could make us feel tired.

As for the word "mild" -- my overall AHI indicated very mild OSA. However, if you looked at the AHI just for when I was in REM, I have moderate OSA in REM, not "mild." I think there's much more to looking at a sleep study than just looking at the overall AHI. Your doctor may have done that kind of looking at your study. Or perhaps hasn't, and is relying just on your overall AHI.

For an interesting take (that I agree with) on not relying completely on "AHI" to decide whether a person should be on CPAP or not -- from the inventor of CPAP, Dr. Colin Sullivan:
http://www.pulmonaryreviews.com/sep02/p ... Index.html

Have you felt any "less tired" since starting CPAP, Modistee, even if not feeling as good as you'd like? Or have you felt just as tired as ever?

[DreamOn]

I can understand your confusion over your doctor's comments, modistee! You either have sleep apnea, or you don't -- and the tests showed you do! It is odd that he would have suggested CPAP if your sleep studies didn't indicate that your apnea was at such a level that it was treatable. I also have mild apnea, but I have seen tremendous benefits from CPAP during the short time I've used it. What was your pre-CPAP AHI, and what has it been lately on CPAP? Do you feel it's made a difference in how you feel? If so, I'd stick with it.

Hypothyroidism can have some of the same symptoms of sleep apnea.

Yes, it can, but I'm not aware that it causes sleep apnea. She had a sleep study, so presumably they found a reason to put her on CPAP. I think that Hawthorn's advise is good. She may have concurrent conditions.

Actually, there may be a direct connection between the two conditions -- thyroid problems and sleep apnea! I have suspected that my thyroid may be wacky for a while. I have low basal body temperature and other symptoms. I was just tested this week, and my TSH, T3 and T4 are all normal. I'm going to request testing for thyroid antibodies next, to rule out Hashimoto's thyroiditis.

I've been doing lots of research on both hypothyroidism and sleep apnea recently. I came across this at http://www.medicalonly.com/2007/09/03/s ... er_thyroid:

"The fatigue linked with hypothyroidism is often worsened by the fact that patients with this disorder often have difficulty sleeping due to thyroid-related sleep disorders. One of the most common sleep disorders reported by thyroid patients is obstructive sleep apnea. This sleeping disorder can disrupt rest and, in some cases, pose a serious health threat.

"Patients with obstructive sleep apnea do not breathe in a regular, consistent pattern while sleeping, leading to heavy snoring, restless sleep, and a near-constant sense of feeling tired during the day. Although researchers are still exploring the exact ways in which hypothyroidism causes or increases the risk of obstructive sleep apnea, they are fairly convinced that there is a causal connection."

~ DreamOn

[modistee]

Thank you all for the input. I was so confused after I left that Doctors office. I kept thinking all the problems I had with the machine and getting used to it and trying to wear it every night were for naught. That is interesting that thyroid is tied in with sleep apnea. Wonder if I will ever know what is going on for sure. One thing I know is I have an innate distrust of Doctors. And I dont think it will ever go away.
*HUGS* to you all and thanks for being here.

Modistee

[Gerryk]

Have any of your doctors had your thyroid levels tested? You could have low levels and not show all the signs but still be tired. Not saying you don't have sleep apnea, you could have both. I had marginal thyroid levels and went on meds. Overall the meds and cpap were elements of my treatment not the whole treatment.
I am sure I am not the only one who could have marginally low or low thyroid levels and sleep apnea. It won't hurt to be tested.

Gerry

[modistee]

My thyroid has been off kilter for a couple years now. The Drs lowered my med twice and then had to raise it three times. Not sure what is going on with that.... HOpefully it will settle down soon. This kind of fatigue is not fun as you all well know.

Modistee

[peppi]

Modistee:
If the CPAP is helping with your being tired I would discount what the doctor said about your having a "mild" case.
My doctor told me the same thing, I was having just enough apnea events (7) an hour for him to prescribe a machine.
Then he told me to keep the machine on 4 -8. 4 is the lowest setting and I was sucking for air. So much for the doctors advice.

After I was coached here, I played with my own settings and I feel better the second day on the APAP machine than I have in two years.
I was so tired that I felt continuously depressed and I couldn't watch TV for more than 10 minutes without falling asleep and I was a grump all the time.
My grandkids call me GrumpPa. LOL , it was funny at first but then I realized I wasn't that fun to be around due to my being tired and cranky all the time.

If it works for you. Stay with it and get coached here. There are a lot of people on this board I trust more than my doctor at this point.

Best of luck!
Phil

[kteague]

Yes, having symptoms that can be attributed to more than one diagnosis can get confusing. I'm with the prior posters who feel the treatments for the diagnoses of sleep apnea and thyroid dysfunction should be both/and rather than either/or. That's not saying there's no correlation between the two. I too am surprised that a doctor would suggest that ignoring any diagnosed apnea could be acceptable. It's not just about your tiredness, it's about the criteria you met to get that diagnosis.

A couple years ago a thyroid/apnea connection was discussed on here. One thing I remember is that an enlarged tongue is sometimes seen with hypothyroid. With the tongue being a major player in OSA, one has to wonder. I remember before my OSA was being treated, I had developed major tongue problems. It had become too big for my mouth, and it pushed my teeth slightly apart bulging through and causing lots of biting and bruising. My thyroid screening tests have always been normal, but I'm wondering if that particular symptom is one that shows up when the dysfunction is at a level not routinely tested. The tongue problem lasted maybe a year or two, but subsided as mysteriously and gradually as it had evolved. However, there was no parallel decrease in the severity of my OSA.

Modistee, if you continue to see improvement as your thyroid treatment stabilizes, I would take that to mean you would then be successfully treating both causes of your excessive tiredness. If you have copies of your sleep study, it may help to review the specifics of your diagnosis. But there's nothing wrong with getting reevaluated at a later date if you think there's a chance you would get different results.

Kathy
who is comfortable with mild only in weather

[montana]

I have been hypothyroid ( hashimoto's ) for many many years. I was diagnosed way before cpap.
Even after I was put on thyroid medication that i take daily I still noticed trouble sleeping and finally went in for a sleep study after going to a lecture on sleep disorders.
Even though I have 'mild' sleep apnea cpap has done wonders for me. By the way on my last visit to sleep DR ...she LOWERED my thyroid dose after getting my thyroid blood checkup ! In the same week I had my eyes checked too and that prescription went down too...CPAP must be the miracle cure.. lol

I have a great DR. She is always helpful and listens to me if I have any issues . If you need her name let me know.

[DreamOn]

I remember before my OSA was being treated, I had developed major tongue problems. It had become too big for my mouth, and it pushed my teeth slightly apart bulging through and causing lots of biting and bruising. My thyroid screening tests have always been normal, but I'm wondering if that particular symptom is one that shows up when the dysfunction is at a level not routinely tested.

Kathy,

I have thought that my tongue has felt a bit enlarged for quite some time (years?), but then I convince myself that it's just my imagination. That is associated with hypothyroidism and Hashimoto's. As I mentioned in my earlier post on this thread, my recent TSH, T3 and T4 thyroid tests came back normal this week (smack-dab in the middle of each range, so nothing there appears even 'borderline').

I'm going to request testing for the thyroid peroxidase (TPO) and thyroglobulin (TG) antibodies next. Maybe you should consider having those tests, just to make sure there isn't anything going on? I want to rule out Hashimoto's, which can eventually destroy the thyroid gland. Once the thyroid function is decreased enough or stops working, then hypothyroidism will show up in the TSH/T3/T4 tests, but I don't want it to get to that point if I can help it.

I'm dragging my feet going to my primary care doctor for other reasons, but one of these days I'll get those tests done. When I mentioned to her several months ago that I was concerned at how low my body temperature is she just said, "Well, some people just have a low body temperature." (It hasn't always been low, so I know something has changed!) I wish I had a doctor like yours, Montana! Another doctor was the one who recently tested for TSH, T3 and T4, and that was only because I was recently diagnosed with another autoimmune disease so she wanted to make sure I didn't have an autoimmune thyroid problem too. I asked her to order the thyroid antibody tests, but she wasn't willing to do that.

I also have 'mild' sleep apnea, but CPAP has made a remarkable difference in the way I feel! I'm sure I've had it for at least 15 years, so now I'm hoping I can undo most of the damage it's done to my body. That's my goal anyway. First goal is to get my blood pressure down and get off the darn medication for that!

I'm glad this subject came up. One of these days we'll have to start another thyroid/sleep apnea thread. I'll go read some of the older threads again too. I think I looked at some of those older threads last week, but the old memory bank doesn't hold information as well as it once did. I'm hoping for further improvement in that regard as well.

~ DreamOn

[modistee]

Now that you guys mention big thick tongue hmmmm I have that feeling also and seems like I have not been able to swallow well for the last three years when this all started the downhill slide.

Modistee