Cause of chronic fatigue besides sleep apnea?

[weiss27md]

I have chronic fatigue. Started 7 years ago. I got an in lab sleep study 6 years ago that showed 0 AHI and 0 RERAs. Been to many doctors and blood work and all normal. Full thyroid, testosterone and even tested for autoimmune diseases. Took a food sensitivity, stool, sibo, and adrenal test. Did have some elevated sibo numbers but my adrenal test showed I had high cortisol all day. I've tried everything sleep hygiene wise and nothing seems to help. I even bought my own Resmed Aircurve 10 Vauto. Tried that for about 2 months with no improvement in fatigue. Skin allergy test done and was all negative despite nasal congestion due to swelling. I think the sinus issues was due to reflux. I took 2 at home sleep studies last year, 5.5 and 8.3 AHI with a nasal surgery in between. Nasal surgery opened up airway but still have fatigue. Was told by doctor and dentist that airway looks good. Trying to get another in lab sleep study done but still waiting. I started taking Wellbutrin. I'm 36, 5'11" 155lbs. Upper endoscopy done, nothing major, small hiatel hernia and some gastritis.

A couple years after the fatigue the tired eyes developed and then the dizziness. Fatigue, dizziness, heavy tired eyes and brain fog are the worse. My throat lymph nodes are also sore. I have a history of anxiety, reflux and headaches. Don't have headaches or reflux as often. It was hard but not drinking coffee got rid of most of the reflux issues. I've always had an eye sensitivity to bright lights like outside. I now have a sensitivity to smells like perfumes. The fatigue is so bad that I feel like I might have to quit my job soon.

[Julie]

Apnea is not a 'cause' of CF as such, but the real one(s) are not known either - not much help unfortunately.

Are you still on the Wellbutrin? Did you take it to quit smoking? Any other meds now?

Have you tried probiotics for the SIBO (don't know much about it actually, just a thought)?

Dizziness is not a 'symptom' of apnea - have you seen a neurologist, hopefully one trained in sleep problems?
Might also help with the 'tired eyes' and other problems... I'd definitely push for a referral.

Nasal surgery can only help with nasal problems - won't cure apnea of course as that's about blockage to your airway in your throat.

And please don't misunderstand this question, but have you had a psych. consult/therapy etc. recently? I only ask because you do seem to have some symptoms that might be addressed there, whether or not with meds and/or a better sorting out of symptoms.

You do need help, but whether apnea is involved is hard to say.

[weiss27md]

Thanks Julie,
I've tried pretty much every supplement related to helping with sleep, energy and fatigue. I've tried several probiotics with no improvement in fatigue. Not much GI issues since giving up caffeine.

I took the Wellbutrin and Lexapro for a week and got some ED symptoms so stopped the Lexapro. Continued the Wellbutrin for another week and noticed no improvements so stopped taking it. I just started taking it again 3 days ago and will give it 4 weeks try this time. I'm on no other meds. PA thinks maybe depression is causing my fatigue. But I have more anxiety symptoms over depression.

Maybe dizziness can occur with chronic sleep deprivation? Went to a neurologist a couple weeks ago and the best he could do was give me another at home sleep study, no thanks.
Seen another neurologist 7 years ago for headaches, got an MRI, all clear. Been to 2 ENTs, immunologist, rheumatologist, and several regular doctors.

My current plan it to try to get an in lab sleep study again, endocrinologist and psychiatrist.

[Julie]

Why the Wellbutrin?

But many side FX of Lexapro include some of your symptoms... I wonder if you need to rethink it.

Dizziness is not a symptom of fatigue.

[ChicagoGranny]

I got an in lab sleep study 6 years ago that showed 0 AHI and 0 RERAs.

How many spontaneous arousals?

[Miss Emerita]

Actually, when I was visiting a physical therapist for balance problems, she said that being sleep-deprived contributes to balance problems. Whether that's the same as what you're describing as dizziness, I'm not sure.

This is so difficult; I'm really sorry. One thing that can help doctors diagnoses and treat you when you have "subjective" symptoms like sleepiness or fatigue is to describe the functional limitations you experience and what it's like to feel the way you do. For example: "I have too much fatigue and brain fog to continue working" should get someone's attention! "I do/don't feel more tired with exertion/in the morning/in the evening," "It feels like I have the flu; I'm not sleepy but it takes a huge act of will to take a shower." You get the idea.

It can also be helpful for the doctor to hear from people who know you well about what they've observed.

Do you have any data from your use of the VAuto?

[raisedfist]

Anxiety/depression can cause fatigue. What helps me fix my sleep somewhat is avoiding stimulants, getting some exercise each day, staying out of bed until it's time to sleep, going to bed and waking up around the same time (no hitting snooze, no laying around in bed), avoiding screens an hour before bed.

Under supervision from a physician, perhaps attempt CBT-I and part of that can be sleep restriction therapy.