Struggling with FATIGUE. Please, any advice! I tried to make my thread detailed

[Dylanmatthew]

Hello! I am 30M. 5'11"(180cm) 155lbs(70kg). I have been suffering from fatigue since I believe 2018 when I started noticing feeling unwell and unrested.
https://imgur.com/a/63xYgTc

I went to several general doctors & had many blood tests taken. Last testing done late 2020. (Blood tests for anyone interested https://imgur.com/a/XR9ws6a).
My doctor says I am depressed and should try out various anti-depressants. I have tried a few with no luck. I asked him to refer me to an ENT/Sleep Specialist. They did a nasal endoscopy and noticed it was very difficult to go up my right nostril, left was cramped as well. Was only told to try Flonase. (I never did, afraid of side effects.)



Here is where I did my 1st home sleep study, the Resmed ApneaLink Air. (results: https://imgur.com/a/ac8s5TH.)
I didn't believe this test & believed I wasted my money as the ENT wouldn't let me do any more sleep studies after my perfect AHI 1 result. I decided to go online and find another home study. I found Lofta had the WatchPAT ONE home study so I tried it. Here are my results: https://imgur.com/a/63xYgTc. It would seem I do suffer from sleep apnea to an extent. I was then prescribed a CPAP machine, but insurance refused to help since I went with an online website.



My father who has sleep apnea and a CPAP machine but doesn't treat it said I can use his Philips Dreamstation along with his full face mask by Resmed. I was able to get some nights of sleep with the face mask and a random pressure setting. https://imgur.com/a/QoUHvtn

I then found out about the foam issue. I went on Amazon and found a chamber that didn't have any foam and replaced it with the original with the bad foam. Then I bought a Resmed P10 nasal pillow mask since I move around so often.



My current pressure settings are 8-15 using no humidifier. Size 15 basic hose. I can't seem to fall asleep anymore with either face mask on, it feels too stimulating and I feel like I have to MANUALLY BREATHE! Also, on the rare occasions I do fall asleep with the mask on I TAKE IT OFF IN MY SLEEP AN HOUR LATER!



My insurance is crap, and an in-lab would cost me $750, not counting appointments, all just to get a better picture of my issue.



my daily symptoms: I don't wake up refreshed, I have dull headaches, fatigue, malaise, depression, anxiety, dark circles under eyes, congested sinuses.



My questions are: What would be a better pressure setting?

Is my CPAP machine safe since I removed the foam chamber with a non-foam chamber?

Can I effectively use the humidity setting with my basic hose?

Why does the mask feel so stimulating and makes me feel like I am having trouble breathing?

Should I instead use my dad's NEW Philips Dreamstation 2?

Is it safe to assume sleep apnea is what is causing my unfreshing sleep and daily fatigue?

Any other advice you'd give to a man struggling with all this?

sleepyhead01.png (278.87 KiB) Viewed 864 times

[ChicagoGranny]

They did a nasal endoscopy and noticed it was very difficult to go up my right nostril, left was cramped as well.

That's not a professional diagnosis. A common diagnosis might be something like "enlarged turbinates and/or a deviated septum and/or nasal polyps and/or inflamed turbinates."

Was only told to try Flonase. (I never did, afraid of side effects.)

That's a mistake. The side effects profile of Flonase is very safe. It's so safe, it's OTC.

Did the ENT schedule a follow-up appointment? Often, they want to recheck after six weeks of Flonase treatment to see if it cleared up inflammation or if the problem is more structural.

Having a narrow nasal passage due to the conditions mentioned can make it difficult to use CPAP. As a priority, I would work on getting the nasal issue clearly identified and hopefully resolved.

My doctor says I am depressed and should try out various anti-depressants. I have tried a few with no luck.

This pisses me off when doctors overlook sleep-disordered breathing (A major cause of psych problems.) and jump straight to psych pills.

Going forward, keep your discussion to this single thread so that members helping you can more easily follow your history.

Welcome! You have come to a good (but sometimes cranky) place.

[Dylanmatthew]

They did a nasal endoscopy and noticed it was very difficult to go up my right nostril, left was cramped as well.

That's not a professional diagnosis. A common diagnosis might be something like "enlarged turbinates and/or a deviated septum and/or nasal polyps and/or inflamed turbinates."

I regret going to that ENT/Sleep Specialist. My insurance isn't great either, so the Endoscopy alone cost me $160 plus the $180 appointment plus the $173 home study. UGH! When she saw the results and how defeated I looked all she said was she was sorry but it's not sleep apnea and sent me on my way. Never wanted to see me again, it seemed.

Was only told to try Flonase. (I never did, afraid of side effects.)

That's a mistake. The side effects profile of Flonase is very safe. It's so safe, it's OTC.

Did the ENT schedule a follow-up appointment? Often, they want to recheck after six weeks of Flonase treatment to see if it cleared up inflammation or if the problem is more structural.

Having a narrow nasal passage due to the conditions mentioned can make it difficult to use CPAP. As a priority, I would work on getting the nasal issue clearly identified and hopefully resolved.

I suppose I should go buy some flonase this weekend and give it a shot. I have anxiety and always worry about side effects of anything so I rarely try new drugs. I use Xclear nasal spray and a nasal rinse. I wonder if my narrow sinuses are causing all of this fatigue, I mean, I can still breathe through my nose. I don't mouth breathe during the day, maybe I do at night.

My doctor says I am depressed and should try out various anti-depressants. I have tried a few with no luck.

This pisses me off when doctors overlook sleep-disordered breathing (A major cause of psych problems.) and jump straight to psych pills.

Going forward, keep your discussion to this single thread so that members helping you can more easily follow your history.

Welcome! You have come to a good (but sometimes cranky) place.

I feel like every Dr. I have seen, including an endocrinologist, has overlooked me and just assumes I am feeling this way due to depression and loneliness....

Thank you for your reply. I suppose my next goal is to try Flonase.

SORRY I DON'T KNOW HOW TO USE THE QUOTE FEATURE WELL

[ChicagoGranny]

SORRY I DON'T KNOW HOW TO USE THE QUOTE FEATURE WELL

Click POST REPLY, highlight section to be quoted, click "

The section you are quoting will appear where your cursor is in the REPLY BOX, so make sure the cursor is where you want the section to appear.

Multiple quotes can be used in one reply.

[lazarus]

I, too, will not use Flonase, a corticosteroid, which buffers down a part of my immune system, during an active pandemic, unless I have no other choice. It isn't for everyone, and it isn't meant for constant longterm use, anyway. But as Granny said, ENTs will sometimes have you use it or some other nasal medication awhile to see if doing the same thing as the medication but more 'permanently' with surgery might solve an issue. I personally would cooperate with that diagnostic process.

Improving sleep can often help deal with fatigue. But diet and activity level and social support and getting help for coping mentally and emotionally also often come into play. Be methodical as you keep looking for things that help you.

Self-treaters with PAP generally experiment a bit to find the best pressures that keep AHI low and that are comfortable.

Many docs have seen the wonders that sustained, sweaty, physical activity early in the morning has done (1) for clearing someone's mind to take on the challenges of the day and (2) for making someone physically tired enough in late evening to get good restorative sleep overnight. Not always a miracle cure, of course. But sometimes. Always worth a shot if doc approves.

Your mileage may vary.

[ChicagoGranny]

I, too, will not use Flonase, a corticosteroid, which buffers down a part of my immune system, during an active pandemic, unless I have no other choice.

I don't know your personal medical condition. You may be scaring people away from Flonase unnecessarily or worse.

A recent Cleveland Clinic study found that patients who regularly use steroid nasal sprays are less likely to develop severe COVID-19-related disease, including a 20 to 25% lower risk of hospitalization, ICU admission and mortality. The study was published in Journal of Allergy and Clinical Immunology: In Practice.

https://newsroom.clevelandclinic.org/20 ... %20Disease

Steroid-based nasal sprays have come under particular scrutiny because the active ingredient—corticosteroids—can reduce the strength of the body’s immune system, which is concerning during a pandemic. Fortunately, nasal spray users need not worry. Anthony Del Signore, MD, PharmD, Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square, explains why allergy sufferers should keep using their medications.

Should I stop using my steroid-based nasal spray?

If patients are getting the relief that they usually receive from taking these medications, I typically say to continue using them. Often, symptoms of nasal drainage, nasal obstruction, or sinus infections will increase if you come off of the medications.

It is also important to remember that with topical intranasal sprays, as well as topical nasal rinses with steroids in them, the absorption of the steroid is quite low. And, there is conflicting evidence as to whether or not steroids taken this way will actually cause any decreased defense against the virus.

A lot of the data and recommendations that we’re getting is for systemic steroids, which are steroids taken by mouth or administered intravenously. That’s where we are seeing the decrease in the immune system.

As a result, I am staying away from prescribing oral steroids for the time being. But topical nasal sprays, as well as topical rinses, I’m okay with.

https://health.mountsinai.org/blog/will ... d-19-risk/

[ChicagoGranny]

it isn't meant for constant longterm use

------------------------->

Intranasal steroid sprays are safe for long-term use, and there is little evidence to indicate they cause significant systemic side effects. However, patients with chronic rhinitis who might use them for long periods should be advised to use them only intermittently and at the lowest dose that controls their symptoms.

Patients who regularly use steroid sprays should undergo examination of the nasal cavity at least annually to check for damage to the septum.

https://www.clevelandclinicmeded.com/me ... 5/pien.htm

[lazarus]

use them only intermittently . . . check for damage to the septum. . . . there is conflicting evidence

Thanks, Granny. Your quotes contain phrases that explain my position quite well. I appreciate it.

[Architect]

I feel like every Dr. I have seen, including an endocrinologist, has overlooked me and just assumes I am feeling this way due to depression and loneliness....

Hi friend, I certainly can relate, to your struggle/journey. I know for a fact that hypo/hyper thyroid can cause mild to deliberating fatigue. Your TSH was tested, was in normal range. TSH fluctuates through out the day. You will need Endo to perform full thyroid labs TSH, FT3, FT4,. FT3 is active hormone that correlates with symptoms.

As for nasal congestion, allergies/sinuses can cause fatigue. Flonase works very well, but in my case, caused fatigue so I stopped using. Actually, all allergy meds causes me fatigue, I stopped using. What works for my sinuses is saline rinse, saline nasal spray, heat compress over sinuses, when really congested Vicks personal steam inhaler, alittle expensive, but works.

Upsets me, when physicians/specialist diagnose lonliness/depression for cure all, when they have no clue. Do not take any psych meds, until a diagnoses of your symptom(s) is diagnosed and confirmed.

Wish you well....

[ChicagoGranny]

use them only intermittently . . . check for damage to the septum. . . . there is conflicting evidence

Thanks, Granny. Your quotes contain phrases that explain my position quite well. I appreciate it.

This thread is not about you. It's about Dylanmatthew and a very reasonable and common treatment that his ENT prescribed.

[lazarus]

Forgot that only your opinions matter. Sorry. Outie. Have fun.

[Dylanmatthew]

Forgot that only your opinions matter. Sorry. Outie. Have fun.

I have an innie.

I will heed your warning on the usage of these nasal sprays. It could be worth the risk for the short term. I am more concerned about it giving me side effects like anxiety or worsening depression. I am not worried about getting covid or it weakening my immune system.
Thank you.

[lazarus]

Forgot that only your opinions matter. Sorry. Outie. Have fun.

I have an innie.

I will heed your warning on the usage of these nasal sprays. It could be worth the risk for the short term. I am more concerned about it giving me side effects like anxiety or worsening depression. I am not worried about getting covid or it weakening my immune system.
Thank you.

Not meant to be a warning. I have comorbidities myself that put me at high risk of COVID complications, so I was just stating my take for now. I would use it before agreeing to surgery. I have it in my medicine cabinet for "emergencies." I often recommend it to others for its intended uses and mention that if paying out of pocket, Sam's Club and Costco have generic versions dirt cheap.

I wish you the best. You deserve to feel better. Keep at it. Keeping up the fight against anxiety and depression is a victory in and of itself, and ultimately, may the battles never distract from the overall war.

[Dylanmatthew]

use them only intermittently . . . check for damage to the septum. . . . there is conflicting evidence

Thanks, Granny. Your quotes contain phrases that explain my position quite well. I appreciate it.

This thread is not about you. It's about Dylanmatthew and a very reasonable and common treatment that his ENT prescribed.

Thank you for all that info about the nasal sprays. I read it all. I bought the Flonase and will be giving it a trial run tomorrow! Tonight, I will give my CPAP another chance, but this time I will use the humidifier option.

[ChicagoGranny]

I would use it before agreeing to surgery. I have it in my medicine cabinet for "emergencies." I often recommend it to others for its intended uses and mention that if paying out of pocket, Sam's Club and Costco have generic versions dirt cheap.

Thanks for finally coming around to what should have been addressed to Dylanmatthew from the beginning. Better late than never!