I have experienced extreme fatigue for years, but I thought it was normal.  I am 23 and have been out of college and working for a year.  At any time of the day I feel the urge to go to sleep, despite getting technically adequate amounts of sleep.  I am easily capable of dozing off in meeting even if I am on adderall, and even if adderall physically keeps me from sleeping I still feel tired.  After having worked for a year where I changed my sleep scheduled, increased my exercise levels, lost weight, cut down my alcohol consumption to nearly zero (and zero at times) and refrained from naps; did everything possible to enhance sleep hygiene, I have not seen adequate improvement.  I no longer feel like I am completely sleep deprived but I am very impaired and a bad night of sleep can lead to days or substandard wakefulness.  I now take provigil 200mgs of provigil (I took 800 for a couple weeks but the side effects outweighed the negligible additional benefit of the drug) and 10mg of adderall XR.  I still feel tired.  

I had a sleep study which indicated that that breathing shouldn't be the cause of my fatigue.  They actually said that I sleep fairly well.  I was convinced that it must be chemical or hormonal or that I have some other disease or syndrome.  I ahd innumerable doctor's appointments with an annoyingly thorough internist who sent me to see an infectious disease specialist even who said that I am more than healthy and that this must all be in my head.  

I went back to my doctor who suggested that this wasn't correct but my thyroid, etc. and other tests pan out to suggest that I am in robust health.

I had used breathe right strips to improve my sleep which made a difference the first couple of nights but now don't seem to do much.  I am at loss here.  I am desperate to figure this out.

Recently my doctor suggested that the sleep study metrics for oxygen depletion may be set too high or low (i.e. they require too extreme an abnormality to signal that intervention is necessary).

I suggested that it might be in my head, but he says thats unlikely, seeing as its been going on for so long.  I have also been told that it's not a result of depression as though I used to be depressed, I have had few depression symptoms for several years.

I am wondering if anyone else has had similar diagnosis difficulties?  

For a couple months I had moved away from sleep as an explanation for my ailments, but I am thinking that it is the only possible explanation.

My first sleep study found nothing at all, just "insomnia" (well, duh, that's why I was there, severe insomnia all night every night).  No apnea, no limb movements, no snoring, no respiratory distress, no nothing.

I believe, and it is only a belief based on my gut instincts and my observations, the lab staff were incompetent and accurate data was NOT collected at my first sleep study.  I believe the sleep doc may have been OK but with the data as collected he did not have a clue.  I did let him know what I thought happened, after I went on to have further sleep studies and a Dx of Severe OSA (AHI = 53.6) and UARS (total RDI = 83.6) from Stanford.

I have not been back to that doctor or lab so I don't know what he did with the information.  I did report it to my GP as well, he was the one that referred me to this lab and also to Stanford.  He is not using that lab and doc anymore because of my experience.

Blessings,
--pseudonym

I am thinking of getting a referral to an ENT specialist to see what he or she may have to say; perhaps they can ferret out the problem.  I am now convinced that this must be a respiratory/apnea thing because no other explanation seems to fit.

Hi ebitdamargin,

Have you seen a copy of your sleep study report?  It might be good to ask for a copy if you've not seen it, even if the results indicate no sleep apnea or borderline.  It might be that you have sleep apnea and the doc is interpreting mild for no sleep apnea.  Not likely, but at least the report would verify that.  

I work in the office of a sleep study center.  Part of my job is scheduling patients for sleep studies.  One lady described so many of the typical symptoms (although I don't know if there were witnessed breathing stoppages), but she had no sleep apnea, zilch.  I saw the report.  It was perplexing and I've not heard if another cause had been found.  Good luck with things.


Linda

If your insurance allows I'd be looking for the nearest teaching university hospital assuming they have a sleep clinic, possibly as part of their neurology department, or their pulmonology department. Yes, you might likely have to thru the entire gamut of tests again, from thyroid, nutritional levels, infectuous disease such as mono, etc, etc. maybe even the psychiatric department to again rule out depression w/a good thorough neuropsychological workup as well as another sleep evaluation, of course. What the hay, whatever it takes to determine what the devil is robbing you of sufficient REST and SLEEP!!! And more important, WHAT can be done to GET YOU RESTFUL SLEEP.


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