Why am I so tired?

November 16, 2013 8:02 PM

For the last several weeks, I've been very tired and prone to napping during the day. This doesn't seem to affect my ability to fall asleep at night. Before you suggest sleep apnea: yep, I have it. I use my CPAP as directed - I breathe so much better with it on that it's no hassle for me to use it (even during my frequent naps). More details below:

I used to nap a lot before I got my CPAP, so I made sure it's working correctly. I went to see the respiratory therapists at my medical supply company maybe 3 weeks ago. They looked over the data recorded by my machine and it looks like everything is good. My corrected AHI is where they want it to be, leakage is minimal, etc.

That seemed to be the most likely cause, so I've been trying to go through a process of elimination to try to identify other causes:

- Allergies? I do suffer from seasonal allergies. However, I do take 25mg hydroxyzine every night for another chronic health issue. I also use Flonase, usually before bed, though I have been less consistent in using it when compared to my oral medications (which I rarely forget).

- No change in eating or drinking habits recently. (I don't drink - thought that might be worth mentioning since I know alcohol can affect the quality of one's sleep.)

- I'm overweight, but haven't gained or lost a significant amount of weight in a few years.

- Depressed? Yes, but that's nothing new. (I'm also in therapy & taking an anti-depressant...have been doing both for some time.)

- Vitamin D deficiency? A possible contender. I was somewhat low (24 ng/mL, I think) when tested in May of this year. At the time, I was taking 2000 IU of vitamin D3 daily; since then, I started taking 4000 IU daily. Could I be feeling more tired lately because of the seasonal changes?

- Iron deficiency? I don't think I've had my blood iron levels tested recently. However, when I was giving blood regularly, several years ago, I was sometimes turned away for low hemoglobin.

- I think it's probably NOT a magnesium deficiency; I take 500mg daily (mostly for good measure - I have high blood pressure & diabetes, and though I'm on prescription medication for both, I figured magnesium would be a good thing to add to my arsenal).

As it happens, I do have a doctor's appointment on Friday. I am planning to call her office on Monday to make sure she's submitted the requisition for the blood work. I assume she'll be retesting my vitamin D levels, and I know she'll want a standard metabolic panel to check on my diabetes.

Do any of my theories sound more reasonable than others? Am I missing anything? Should I ask for any additional blood work?

posted by rikhei to Health & Fitness (13 answers total)

Could you just be run down? How's work? Are you running around a lot? Maybe getting a cold? Could be a lot of things, and I think your doctor is probably the best bet to rule out or diagnose anything medical.
posted by xingcat at 8:13 PM on November 16, 2013

You said no change to eating habits, but how are your carb intake levels? I find when I am eating too many carbs and not enough protein and fat midday I can hardly keep my eyes open.
posted by cecic at 8:23 PM on November 16, 2013 [1 favorite]

Best answer: You could be fighting off a bug but not actually sick/symptomatic. When I'm beat up for no apparent reason that's the usual cause.
posted by phearlez at 8:27 PM on November 16, 2013

Perhaps you are affected by there being less daylight?

A full spectrum lamp could help.
posted by cat_link at 8:30 PM on November 16, 2013 [1 favorite]

Response by poster: This has been going on for...probably about two months or so, maybe? I've been sleeping as much as I can on weekends, so I feel that if it were just a cold or other virus, it likely would have passed by now.

cecic: that's a possibility; I'll try to adjust my meals accordingly!

cat_link: I think that could be a possibility, too (and maybe related to the vitamin D thing). I do have a lamp, thanks for reminding me that it's time to start using it. :)
posted by rikhei at 8:38 PM on November 16, 2013

Try to get in for your blood draw before you see your doctor. Tuesday should be fine for a Friday appointment. I say this, because the results may point your doctor toward ordering further blood tests. But knowing it is or isn't Vitamin D or Iron can change the discussion you have during your exam.

Not all doctors will order labs before the appointment, but for a yearly physical, many will. In many cases, you can go to the office, and an MA will draw the blood. Additionally, you can have the doctor fax the orders to a lab (Lab Corp, Quest, etc) and you can get the draw done someplace convenient to you, with results sent to your doctor as soon as they're processed. Check with your insurance carrier if they have a lab that gives you a better price. Fees for blood work can vary...widely.
posted by bilabial at 8:38 PM on November 16, 2013

Ask for a thyroid panel when they do bloodwork; an underactive thyroid can present as fatigue, among other things.
posted by stellaluna at 8:44 PM on November 16, 2013

Just throwing this out there - could you be pregnant?
posted by MexicanYenta at 9:20 PM on November 16, 2013

Response by poster: bilabial: I'm definitely planning to get the blood draw before my appointment; my doctor actually asked me (back in May) to make sure I do that so we can check my metabolic panel numbers at the appointment. I know which lab to go to already, so I'm all set on that count.

stellaluna: Will do.

MexicanYenta: Nope. (Sorry, maybe should have mentioned that in my initial question details.)
posted by rikhei at 9:42 PM on November 16, 2013

Best answer: You're in the northern hemisphere? This is in the last few weeks? All else being equal and your bloodwork being fine, I'd guess daylight savings time. I've been sleepier since the time change and have had several conversations with people who have been experiencing this too.
posted by lunasol at 9:53 PM on November 16, 2013 [2 favorites]

You may be able to use software like Sleepyhead to watch for changes in your CPAP stats outside of your doctor's office, so you can watch for changes yourself. That way you can watch for AHI stat changes if you do any mask-tinkering, minor machine adjustments (either of the patient's prerogative, like changing the pressure ramp-up, or the doctor's, like altering the APAP pressure range). Sleepyhead lets you look at the graphs yourself so you can spot your rhythms and changes. I'm not sure what your doctor shows you from the CPAP data, but what mine shows me is generally summary numbers, which is interesting, but not good for spotting changes in detail.

Also, it's winter. I don't know what Michigan's climate is like, but is some seasonal-affective sluggishness a possibility? Have you tried getting more lights on as it gets darker?
posted by Sunburnt at 9:53 AM on November 17, 2013 [2 favorites]

Response by poster: Sunburnt: Alas! I actually downloaded Sleepyhead a few weeks ago, but it didn't work. Apparently there's a known issue with my particular CPAP machine. :(

Also? Points to the folks who thought I might just be run down. I think the seasonal change is probably the cause for the long-term sleepiness, but I seem to have developed mild bronchitis since posting this, so...yeah.

Thanks for all the advice, folks...going to go ahead and close this question.
posted by rikhei at 10:57 AM on November 18, 2013

Sorry to read Sleepyhead didn't work. You can also check the Apnea Board Forums and see if they have the official software for reading your machine. You'll need to sign up (free) to download, but you can search around without signing up.

Good luck.
posted by Sunburnt at 12:58 PM on November 18, 2013