How to fatigue

July 2, 2018 6:06 AM

Have made multiple attempts to address fatigue which has lasted over a year. So far nothing is helping. What do I do next?

Last spring i started experiencing fatigue. My doc at the time thought it might be mono, so I took a big step back from my social/volunteering life and waited. In the fall I began to think it might not be mono since I wasn’t feeling better, so I began to explore the possibility that I could have sleep apnea. (Expensive) sleep studies found that I had mild apnea, so I got a c-pap. After weeks of consistent usage I still felt fatigued. I started strength training regularly, hydrating more, and quit multiple meditations that could have side effects of fatigue. I have ups and downs but I still don’t feel like myself.

Current doc and I discussed this a couple of weeks ago and while we discussed my med adjustments we also discussed me going back to visit the sleep specialist. He has a $30 co-pay and seems really focused on how the results from the cpap - I didn’t bother telling him at my last visit that the fatigue I was hoping to address with the cpap was still present. But I probably should have.

I just slept 7 hours and 37 minutes, and according to the cpap machine I had only .6 events per hour. I feel completely exhausted.

I’ve also decided that if this is the new status quo then I need to re-engage with life again - be more social, volunteer, etc. Any tips on finding a balance with this would be good (3 out of the last 4 nights in a row I’ve been either entertaining guests or out with friends - while being isolated makes me depressed, doing too much seems to contribute to the exhaustion).

Questions:
What else could I explore/attempt/bring up with my doc?

Any good strategies for maintaining an effective, productive, social existence in a balanced way? Creating and sticking to routines and boundaries are probably my weak points here.

I'm early 30s and female if that helps.

posted by bunderful to Health & Fitness (21 answers total)

Response by poster: Crap. That's early 40s, not 30s.
posted by bunderful at 6:07 AM on July 2, 2018

What else could I explore/attempt/bring up with my doc?

Get tested for lyme disease.
posted by PhoBWanKenobi at 6:12 AM on July 2, 2018 [6 favorites]

Fatigue can be caused by so many things. Thyroid issues, low blood iron, disease, sleep issues...I would definitely keep up with the doctor to see if you can get to the underlying issue.

As I got into and through my 40s, I discovered the power of the nap. Don't be afraid to take some time out for yourself every day (if you can) and take a nap. Use a timer/alarm to keep them brief (longer naps, oddly, seem to make people more tired), but they can be transformative.
posted by xingcat at 6:22 AM on July 2, 2018 [2 favorites]

This was me when my low thyroid got diagnosed, but surely that's the first thing they checked, right? And your iron levels? And your vitamin D levels? Can you update us briefly with anything else that's been checked so we don't duplicate what's already been looked at?

Fatigue sucks and I hope you get to the bottom of it.
posted by joycehealy at 6:26 AM on July 2, 2018 [8 favorites]

What is the fatigue like? Is it mental fatigue -- feeling sleepy or fuzzy headed? Or physical -- muscles feel drained or ache, etc.?
posted by duoshao at 6:26 AM on July 2, 2018 [1 favorite]

Please get a new doctor. "You're tired? Oh it could be mono. Or hey maybe apnea" is throwing darts at a dart board, not diagnostic medicine.

Did your doctor start with a basic blood test? Has he or she tested your B12, Vitamin D, folate and thyroid? Those are literally the first line screenings for fatigue. If you have not had screening for B12 deficiency / pernicious anemia, Vitamin D deficiency, iron deficiency, and thyroid, your doctor is incompetent. Get a new one and get screened.
posted by DarlingBri at 6:29 AM on July 2, 2018 [13 favorites]

Test thyroid levels
Test hemoglobin and ferritin levels
posted by pseudostrabismus at 6:38 AM on July 2, 2018 [3 favorites]

Find an MD that practices functional medicine. Don't accept this as normal for another minute. I went through this and you can feel better, maybe better than in your 30's.
posted by jbenben at 6:51 AM on July 2, 2018

Explore the world of autoimmune related diseases.

As annoying as it can be to overly research symptoms and present them to a doctor, do that. Fight the assumption that you have sleep apnea (did they do a sleep study? Everyone I've known with sleep apnea related fatigue bounced back after using the cpap.) Go in with your list of possible illnesses and start asking the doctor to eliminate them from the list. Not using the "try this and wait weeks" method either. Make them run labs, check your white blood count, check your thyroid, etc.
posted by toomanycurls at 6:52 AM on July 2, 2018 [1 favorite]

Response by poster: I’ve had several blood tests including thyroid and iron - can’t remember the others off the top of my head but I can check later. As mentioned in the question I had sleep studies which led to the apnea diagnosis, and I have a new doc. (Actually liked former doc - she did run multiple tests - but my company made some changes to the health care plan).
posted by bunderful at 7:18 AM on July 2, 2018

With iron, make sure they check your ferritin levels, not just your hemoglobin count. Low ferritin can really impact your energy levels and sometimes all docs check is your hemoglobin.

Nthing getting tested for lyme disease. Also get tested for celiac, even if your digestion seems fine. I agree that autoimmune diseases often have mysterious fatigue as a component. If you've had any joint pain (even stuff you think of as normal aging) bring that up with your doctor too.
posted by purple_bird at 7:24 AM on July 2, 2018 [6 favorites]

You don't mention diet at all. Sometimes as you get older, your body becomes less tolerant of things it used to put up with. I radically changed my diet, and my energy levels improved immensely. I no longer have afternoon energy slumps at all. In my own case, I went vegan and cut out junk. I made an extreme change because I wanted extreme results.
posted by FencingGal at 8:05 AM on July 2, 2018 [1 favorite]

BTW, I don't mean to imply that there's nothing going on that needs medical treatment. But if something else is compromising your health, it can still be helpful to eat as well as you can. (And I know that you might already be doing that - just mentioning it because you didn't).
posted by FencingGal at 8:08 AM on July 2, 2018 [2 favorites]

I also experienced long lasting fatigue. My doctor ran many tests, X-rays even. Nothing. Because this fatigue was recurring and I noticed antibiotics helped in the past ,but my doctor declined to prescribe, I turned to natural antibiotics as found on the internet. Olive leaf extract worked for me in a matter of days. It might be worth a try. Good luck.
posted by JohnR at 8:33 AM on July 2, 2018 [1 favorite]

Be aware that there's a range of "normal" TSH for thyroid function, but some people do better on the low end. I would get your exact blood test results and see if that's a possibility.
posted by valeries at 9:16 AM on July 2, 2018 [3 favorites]

Autoimmune? Many of the autoimmune conditions have fatigue as a component. They can test for ANA, Rheumatoid factor, etc.
posted by crunchy potato at 9:40 AM on July 2, 2018 [1 favorite]

You might also look into chronic fatigue syndrome.
posted by bryon at 1:54 PM on July 2, 2018 [1 favorite]

Not just CFS, but also fibromyalgia.
posted by dust.wind.dude at 3:39 PM on July 2, 2018 [2 favorites]

Try going to an internal medicine doctor if you’re currently seeing a general practitioner. They should recheck t4, ferritin, vitamin d, hemoglobin, sed rate, glucose, etc. Either see the sleep specialist or look at your own c-pap’s data to see if the setting are optimized. A slight change in pressure can make a big difference in sleep quality. Try to get in a little exercise at least everyday and eat few prepared foods.
posted by Kalatraz at 4:58 PM on July 2, 2018

Did they just check your TSH or a full thyroid panel? TSH can be normal but T3 and T4 can be off. I've had difficulty getting those tests run, so they may not be automatic.

How has your blood oxygen been? If there's a problem the cpap would generally go a long way with that, but worth mentioning just in case.
posted by mermaidcafe at 8:03 PM on July 2, 2018 [1 favorite]

Go back to your sleep specialist and let them know that you are still very tired every day and that it's affecting your quality of life. That your CPAP hasn't done the trick. Tell them you have looked for other medical causes without luck. There are other sleep disorders (neurological in origin) that can be treated. Sleep specialists are often pulmonologists or other specialists who see things through an apnea lens. Neurologists who are also board certified in sleep medicine are better prepared for the neurological sleep disorders.
posted by Stewriffic at 5:09 AM on July 4, 2018 [1 favorite]