Chronic fatigue, I need some help.

[weiss27md]

My chronic fatigue started in 2014.  In 2015 I had an in lab sleep study and it showed 0 AHI and nothing was really found.  I have been to many doctors with no diagnosis.  Vit D, B12, full thyroid panel all normal.  All blood work normal.  Tried different diets.  Thought maybe it was my sinus congestion (swelling).  Bought my own ResMed BiPAP AirCurve 10 and tried that making adjustments with help on here for 2 months with no improvement in fatigue.  Got nasal surgery which opened up my nasal airway.  Got 2 at home sleep studies (Alice one) that showed 5 AHI before surgery and 8 AHI after.  Was told my airway looks good.  I want to get another in lab sleep study but it's taking forever.  Tried many supplements and sleep hygiene tips.  The fatigue just keeps getting worse and worse every year.  Doctor thinks maybe depression so taking Wellbutrin to see if that helps but nothing yet.  Nothing I do seems to help.  I'm 36 yo, 5'11", 150 lbs, M.  Not sure how much longer I can keep my job.

Things I've tried: supplements, diets, exercise, new mattress, CBD, bipap, etc.

Symptoms:
chronic fatigue
brain fog
tired eyes (look tired and feel heavy)
vertigo / dizziness (last year or two)
slight shortness of breath, mostly in morning (last couple months)

[staceyburke]

Sometimes flow limits can cause loss of sleep and are not reported in many sleep studies. Flow limits are small apnea and are not timed. Your ResMed does report these.  To see if that might be a problem we need to se OSCAR charts. 

You need a SD card in your machine while you sleep. Download OSCAR (free at the top of the site) and post a night or 2 and we can see if there are problems.

[weiss27md]

Thank you.  I got these from last year.

[sheepless]

I looked briefly through some of your other threads. ca is dominant in every screenshot I looked at. vauto isn't the machine for you unless you can tolerate high or very high trigger and that setting has the desired effect in your case. otherwise, while it may look like you won't qualify for asv, that's the machine you need for the ca (although that may or may not be the source of your fatigue). you can buy used without doctors and insurers or you can take your screenshots of all your ca and a long laundry list of your complaints and all the things you've tried to no avail to your doctor and ask them to justify asv as medically necessary for you. I did not see any zoomed screenshots and the night-long ones don't suggest it but you might want to rule out periodic limb movement which can be as exhausting as apnea. idk if ca is why you're fatigued but if you want to address them, find a sympathetic doc and deluge them with your complaints and machine data. overnight video might help identify whether or not sleep is the root of your problem.

[StevesSp]

You and I share remarkably similar experiences. I have suffered the same malaise for many years and treating my apnea successfully hasn't helped the fatigue at all, nor the widespread pain in joints and muscles.

I was diagnosed with depression back in 2011 or so, and I know that depression could cause both problems, but I diligently followed the therapy provided by several mental health practitioners, including trialing many anti-depressants, with no improvement in my fatigue and pain. I gave all that up some years ago when the contintual visits to psyches began to make me feel worse, not better.

I have also been diagnosed with fibromyalgia, which neatly encompasses all the symptoms, but there is no definitive test for that and the few 'indicators' that are used didn't apply to me, such as the pressure point pain. So once again, who knows?

A couple of docs suggested it could be post-viral syndrome, and these issues did indeed start soon after I had a bout of flu-like illness in 2010. I have also been told I have osteoarthritis but, again, the accepted tests don't confirm that.

I finally got to the point where I gave up trying to get a definitive diagnosis. I now believe that my fatigue and pain are not caused by a single problem, but the combined effect of several, i.e. post-viral syndrome, a dicky heart and the fact (IMO) that CPAP-sleep, even with a low AHI, isn't good sleep in the sense that it is refreshing.

My focus now is in adapting to these problems and trying to live with the limitations that they impose, to the best extent that I can. This included taking early retirement (which wasn't in my financial interests) in the expectation that the fatigue etc will only get worse, so I have to make the most of the next few years. I would say that this 'acceptance' is working better than any of the medical treatments I have tried.

[weiss27md]

Thanks, looks like the best bet would be to get another in lab sleep study done. Maybe I could try my CPAP but with that EPR mod?

[sheepless]

since I'm not sure what epr mod you're referring to, you're probably not replying to me, but here's my 2 cents anyway: while I doubt cpap/apap will be any better than what you can do with the vauto, anything and everything is worth a try. at minimum, what you learn will be additional information to take to your doc. even at the sleep lab, it's all trial and error and they'll do nowhere near as much of that as you've probably already done and probably will do on your own. many/most titrations end when oa is reduced as much as they can manage so imo titration in a lab is pretty much a waste of time & money unless they specifically address your ca and if they look for sleep issues beyond apnea as well.

[weiss27md]

Thanks Sheepless, I was responding to you. I just saw about a mod that can be done on non-ASV machines that can reduce CAs. Something about it moving the exhaust further away so you get more CO2 which can initiate a breath. Still wondering if those small amount of CAs are even causing my chronic fatigue. Think my best best is another in lab sleep study, neurologist and maybe an endocrinologist. I know my thyroid is good but maybe it's hormone related. I thought maybe stress but stress reducing activities have not seemed to make any difference. It can't be anything too common like GI issues because this fatigue is pretty bad. Must be something wrong in my head.

[sheepless]

that would be EERS. there are others that can tell you more about that. to the limited extent I understand, I believe it's useful for ca caused by over ventilation or reaching the apneic threshold we often see reference to on this site. idk if it's useful with asv but I don't see why it can't be tried on any machine, including your vauto (again, I don't know much about this so...).

[weiss27md]

I don't know if it means anything or not but I remember my first night on bipap I woke up refreshed even though I only slept like 4-5 hours. But nothing the next month or two on therapy.