Frustration - Doctor's Blowoff?
 

Ok, I realize this is long, but it's a long story.

For the past 6 months and longer, I've been struggling with feeling constantly tired and falling asleep any time I sit still (in meetings, on the bus, at the bench, etc). I started tracking my sleep habits and making sure I slept 8+ hours, going to bed and getting up at the same times, etc. No help. I started to look into it back in November, starting with a whole series of blood tests to rule out some of the most obvious stuff (thyroid, glucose, hematocrit, CBC, and about a dozen others). Nothing suspicious, so the next step was an appointment with the sleep clinic to see if there's something directly disturbing my sleep which would cause this.

In January I went in and was wired up with all sorts of electrodes and such for a night and continued for a nap test the next day. Mainly looking for obstructive sleep apnea (OSA), which wouldn't have surprised me since my father has it, and narcolepsy (with the daytime nap test). I've been waiting since - finally called the clinic yesterday since it'd been more than 2 months and I hadn't heard anything, and of course I came home to find the report in my mailbox last night.

Observations - pretty darn good overall. No signs of sleep apnea, my oxygen saturation never fell below 96%, recorded "apnic events" was 0.1/hour (so I paused MAYBE once in the entire night), and a pretty even time spent in each stage of sleep (just short of 20% REM). The daytime test was also considered within the normal range.

What would the logical conclusion to this be? And recommendation? I would expect something along the lines of "no signs of sleep disorder - look elsewhere for cause of symptoms" perhaps. As in, we've ruled out this problem, let's move on.

Instead, the recommendations were 1) Lose weight, through diet and low-level exercise. If symptoms continue, return in 6 months for a repeat test for OSA. 2) Good sleep practices. 3) Return in 6 months for a follow-up appointment.


OK, I realize I'm fat. I'm medically obese. I get it. And I realize I need to lose weight to ward off future health issues, to keep myself in good standing, etc. Losing weight might give me more energy and help me feel less sleepy. However, I'm showing no signs of OSA at all, so why the heck would losing weight and follow-up to confirm that I have something for which I have no evidence do any good? And why does this doctor assume there's nothing else to be done?

Am I being overly touchy to assume that advice to lose weight to solve my sleep problem is just assuming I'm fat and lazy? I feel like I'm being blown off... "obesity causes OSA, so since she's obese, she must have OSA so let's treat accordingly" - despite the lack of evidence in the sleep study. The problem is, I'm sick of being exhausted all the time, and I'm tired of waiting for an answer. I feel like there's got to be a good reason and some way to help me feel like a normal person, but it seems I'm not going to get a whole lot of help from this set of doctors.

I'm just really bugged by the fact that the only advice I'm given is to lose weight, and with "low level exercise" (since apparently they didn't take notes of anything I said about my tri training?) It just feels like such a pat response and a total blow-off, and I don't really know where to go from here. I ALREADY have a good exercise routine; if anything it's too intense (I usually average 80-90 minutes of cardio 6 days/week - and I've tried tweaking/cutting back/etc with no major effect on my sleep issues.) I ALREADY am careful to follow good sleep habits to try to get the best of this situation. And I don't find "lose some weight" to be an appropriate response, especially combined with a lack of further options.

Any thoughts? Anyone else been through a similar "you're fat, suck it up" response from doctors? I'm just so frustrated right now!

It may not be related to any sleep disorder still. I'd start by thinking back 6 or so months to see if anything changed (diet, exercise, stress, etc.) that may have triggered this problem.

I'm not sure what your tiredness issue might be stemming from (and I hope you get an answer soon!!!). I definitely think there's a tendency for doctors to blame medical problems on weight - whether or not that's actually the problem. I would recommend being persistent, and insisting on more testing and not allowing them to dismiss you because of your weight. Good luck!

For me I see it like the weight is just ANOTHER symtom of my poor habits. So when someone tells you to lose weight what they really are saying is to start taking care of yourself and everything else should fall into place. You will start losing weight/having more energy/etc...I have certain issues. I know that before I started losing I was depressed and wanted to sleep all the time. Now I have much more energy. I have days that i'm tired but it's so much better. I've lost 20 pounds so far and I still have around 50 more to go but it's already much better. Our goals are quite similar so just get yourself on a good program and focus on the daily goals. Don't be so hard on the Dr. It's a good thing he didn't find anything more serious. :) You can do this!

Tina

Well, you know, I hate to say this, but it's probably true--it's probably the weight. Since I've dropped 30 pounds, and even before that, I have stopped snoring completely (reported by my SO). I generally sleep like a rock.

Are you taking a multivitamin? It could be that you're lacking in something along those lines, if you're on a weight loss program.

And, maybe you ARE exercising too intensively. That will certainly tire you out, especially if you're restricting calories.

"Lose some weight" really might be the best answer, sorry to say... and if it's not, then once you've lost some, you can revisit the issue.

Jay

Have you noticed any pattern perhaps relating to hormones or TOM? I am very sleepy 1 - 2 first days of TOM and will fall asleep anywhere. Ive also noticed that mid-cycle, ill hit a day that im just exhausted....and im not overweight. If you havnt been tested for low iron...consider it. I also have issues with mild anemeia.

I agree - I think you've been blown off a bit. If it was purely due to your weight, I think it would have been an issue before 6 months ago. After all, you didn't weigh 140 6 months ago, did you? What was your own doctor's response to the sleep clinic report? I don't see a problem with the clinic's recommendations - they're simply healthy lifestyle practices. But I'd want your doc. to continue to dig a little deeper. Then again, I'm a hypochondriac, so my advice should maybe be taken with a grain of salt!

Just my 2 cents here -- I thinks doctors who don't have an immediate answer will never tell you they don't know. They want us "regular" people to think they are the medical Gods of all time. I also find that they treat the "symptoms" but don't want to spend the time figuring out what the "source" of the problem is. Sorry if this offends anyone, but my opinions are based on years of crappy, uncaring doctor's experience.

I would continue to research, look into, problem solve the sleep problems on your own. You know your body better than anyone else. I'm not saying don't go back to the sleep clinic in the future for further testing; just don't count on them having the answers.

My brother is going through a similar situation that started about 3 yrs. ago. A one day occurance of feeling like he was sick w/a fever -- sweating, clammy, hot, etc. - but his body temp dropped a degree instead of rising. He felt completely sick but it only lasted for one day. Over the next three years, these exact same symptoms have returned at more and more frequent intervals and have continued for longer and longer periods of time. The last 8 months have been really bad. NO ONE will listen to him. They have done test after test and every single one of them is coming back fine. Therefore, nothing is wrong (doc's conclusion). They all tell him to go see a shrink (he finally did and is). His anxiety over this (aside from feeling completely awful) is through the roof. He went 4 days straight about a month ago w/no sleep whatsoever. Checked himself into the hospital, again test after test (many repeats of previous tests). Normal. He finally consulted w/a doctor who is at an alternative/holistic center. The doctor was with him for an hour and listened to him, and ordered these tests; they did a heavy metals test for mercury and an intestinal yeast test. Why didn't any of the other numerous doc's he saw suggest these tests? Why didn't they listen to what his symptoms were? How is my brother suppose to know that his symptoms warrant these tests? He's not the freakin' doctor!! He won't have the results back for a few weeks. It may not be mercury overload or intestinal yeast overgrowth at all. But he is at a place and has found doctors who actually listen to what he is saying and do not dismiss him because the anwers are not obvious.

My point is, and from my own personal exeperience, that doctors do not listen. If it is not a quick fix - strep? here's some keflex; appendix burst? - take it out, etc - then they pat you on the head and send you away. They don't really, truly care. I have found that I have to be my own researcher, doctor, problem solver because I cannot count on the doctors. I cannot tell you the number of times I've gone to the doctors trying to get a dx on my son only to have them sit there reading the information I had sent to them (tests, etc) months in advance while I'm sitting there talking to them. They can't possibly be giving 100% of their attention to either the paperwork or me. I've had doctors dismiss me because they were done.

Randomly falling asleep throughout the day isn't normal. I don't know much but I do know that. Maybe it is your weight I don't know. Have you been this weight for a long time and all of a sudden this sleeping problem started happening? Then I would think there is something else contributing to the sleep problem. And what is it about making you wait 2 months for the test results?? That is ridiculous. In the mean time, you are suffering and they do nothing. I would continue to dig into your problem. Continue to have tests done. Don't accept the blow-off that doctors may give you. Continue to lose weight; maybe the problem will resolve itself. I have no idea. I just know that you should count on yourself before anyone else.

Again, this is just my experience and opinion. Please do not jump all over me if you are a medical person, being insulted and all. If you were in my shoes you'd feel the same way.

Jo

Is that really me - I'm sorry you've had such frustrating experiences with the medical establishment - but know that not all doctors are like that. I had an amazing doctor in my teens who spent well over 2 years trying to get to the bottom of my chronic knee pain (which could have easily just been blamed on my weight, i was a heavy kid and knee problems are notorious in the overweight) - MRI, x-rays, extensive physical exams of the knee - and finally found what was essentially a birth defect in the way my knee was formed that could be surgically prevented from causing me additional damage.

So know that while there are lots of docs out there who don't care, and perhaps they are even in the majority, there are some genuinely caring doctors who listen as well.

I understand (at least, I understand from interviews with the guy who wrote "How Doctors Think") that sort of logical fallacy is actually somewhat common among doctors, especially when they aren't presented with any other compelling diagnostic evidence. If most obese people who come in with sleep problems have OSA, it's natural to start with that assumption...and doctors, like most humans, often don't like to let their assumptions go just because the evidence doesn't support them. Granted, some of that is just because medicine is hard, and doctors are under pressure to come up with some reason, any reason, even if they don't know one...and to complicate matters, it really could just be a psychological or lifestyle problem.

You can try looking for a second-opinion, and you might be able to dodge the assumptions not meeting evidence problem if you say upfront that you've done sleep testing and your numbers did not indicate OSA. Otherwise, I might suggest taking the exercise down a notch, but you've got kind of a Catch-22 there...losing weight can make you tired, but so can being fat, and without anymore medical evidence it's hard to know what will make the situation better. (Granted, I keep hearing about research that suggests too little sleep can cause obesity, so who can say which is cause and which is effect? Dr. House, where are you?)

From a different angle...have you tried sleeping more at night? I know they say eight hours is standard, but some people need more...I know I can function pretty well at six hours a night if not too much is going on, but if I get under stress I really need seven or eight to keep myself together. Maybe eight hours was great for you a year ago, but under stress you need nine or ten? And being tired all the time can be pretty stressful, so you could still be deprived even after your stress stimulus is gone.

Well, that's my creative non-medical opinion for today. Good luck!

Tough experience, I agree!

I don't know if this is relevant to you or not, but starting in HS I used to fall asleep and nap nearly every afternoon, usually sometime between 3-7. In grad school, if I was in a late afternoon class I would nearly always fall asleep. It even happened sometimes in the morning. Very frustrating, but I just assumed that it was my "biorhythms" or that my mind just had trouble when I was sitting (I had fewer problems if I was moving around).

This continued until I started changing my eating habits nearly 2 years ago -- it seems that better nutrition, especially a healthy late afternoon snack -- especially something with protein and/or fiber -- helps to stave off sleepiness, especially if I do get enough sleep. It's made a world of difference, and started well before I'd lost a substantive amount of weight.

So, you might want to add nutrition to your "list of things to consider"

Know what? Although I think the doctor's response doesn't tell me enough about sleeping disorders, it DOES tell me that you DON'T have sleep apnea....i guess thats the usefulness of the report...

Warning: LONG & rambling. I guess I'm going to "weigh in" (omigawd, TERRIBLE pun!) on the side of whoever's saying that doctors IN GENERAL don't like to go out of their way to figure anything out, and TYPICALLY blame anything quick, easy (for them) and obvious. That's one of the reasons why so many people end up with the wrong medications, or very scary side effects - because doctors often don't even read up on what they're prescribing, and don't have a clue themselves what the side effects can be.
I have high blood pressure. It runs in my family. My sister, who is a tiny woman - about 5'2 and 100 pounds - has high blood pressure. My old (you'll see why I no longer go to him) doctor maintained that mine was because I needed to lose (at that time) about 20 pounds, and my blood pressure would *miraculously* drop, right? Um, no. NOT right at all. Beyond, that, he prescribed a medication with a dosage of 100 MG a day first time out. I was so tired and lethargic all the time, I could barely get myself dressed (although I had to, because I had to go to work) and by mid-afternoon, I was almost afraid to drive myself home because my eyes kept closing on me. I started thinking there was something SERIOUSLY wrong with me - like maybe cancer, or something - and that I was just going to get progressively worse. I didn't want to say anything to anybody. I'm the type who prefers to "suffer in silence". THEN, I was at a cookout with some friends, and they got to talking about blood pressure medicines for some reason. They brought up mine, and somebody said, "OMIGAWD! That stuff is TERRIBLE!!!" It seems her sister was on 50 Mg a day and could barely function. I WAS ON 100!!!!! I stopped taking it immediately, and felt a thousand percent better. I had to literally DEMAND that he put me on something else.
Now it's interesting, because I smoked for many years (Just quit three months ago. Gained 12 pounds, and now I'm making the NEXT lifestyle change with healthy eating and losing 30-40 pounds). But when I was SMOKING, my doctor blamed everything on THAT! I swear, if I sprained my ankle, it was because I smoked!
Which is what I mean by their diagnosing the easiest and most obvious thing so they don't have to work too hard finding answers. You smoke? Any problems are caused by that. You're overweight? Oh, then anything wrong is because you're overweight. Stop smoking and lose weight. I SWEAR they'd prescribe that if you fell out of a plane.
OF COURSE there are some good, caring doctors out there. But even the ones who care are getting forced to give their patients less and less of their time because of the HMO's. The system is corrupt and it's about making huge profits for the HMO's, the drug manufacturers....okay, I'll stop.
The holistic practitioners - who typically DO take more time and ARE more interested in discovering what's really wrong - aren't covered by the HMO's. What does that tell us?
Believe it or not, a sleeping problem like you describe COULD be related to allergies, and a holistic practitioner would be the one to find out for you - if you can afford to pay them.
Okay, rant over.
TTFN,

Ella :tape:

Ella's right. You really shouldvisit a doctor who specializes in medical diagnostics, or as she called them, hollistic practicioners. Somebody who is willing to dig into the problem, and find the source.

I know some people have had some pretty bad experiences with doctors, and maybe even quit trusting them, and in a way, I don't blame you. Keep this in mind though, doctors, whether they seem to care or not, they don't always have the answers. They are not miracle workers. Medicine is an ever-changing science, and every day they are discovering new things and new cures for this or that. Maybe they honestly don't know what's wrong, and it may take years to find out what the problem is.

And, for those of you who try to doctor yourself, that's not always wise. My grandmother used to do that. She had a whole medical library,and if she had symptoms of whatever, she would look it up in these books and go running to the doctor, telling him what she though she had, and he would hand her prescriptions for god knows what every time, just to shut her up.

There is a saying that goes something like "A person who is his own doctor, has a fool for a patient." No offense, but it kinda holds some truth, don't ya think? We do not have the same education that these doctor's have. Even if some of them are idiots, they are still more educated than we.

I could tell you stories of my own horrible experiences with doctors. Suffice it to say, you're better off trying to investigate your own symptoms throught the library, Internet, and then when you think you've hit upon the solution, bring the papers in to PROVE it and get the testing done that you need.

In response to that whole, "doctors are more educated than we are" bit, I beg to differ. I have met quite a few that while they may have gone to medical school for lord knows how long, I usually feel like I know more than they do. Simply put, know what's wrong with you, or at least have an idea, and talk it over with the doctor. It's a helluva lot better than walking in there with no clue, and a doctor who's just happy he's getting more money out of you for showing up.

Secondly, like others say, try going with the losing weight, but also take some vitamins since it also sounds like you're not getting enough there.

Sorry to hear that...
 

Hey there! I do know exactly what you are talking about with Drs blaming weight for everything (I would assume it is just as bad if you smoke) Unfortunately, I don't have any insight into your own problem...I would just have to say do as much research as you can on your own of what the possible causes are and maybe check out some medical forums from people who are having the same symptoms as you and keep trying to find a Dr who will listen to you.

I know this because I had a similar problem a little over a year ago with Drs I have my cholesterol, blood sugar, thyroid, etc tested every year when I go in for my pap. I had a perfectly normal test the year before...then in Aug of that year I was put on birth control pills for fibroid/period problems... I was still exercising and watching my diet like always...nothing had changed...but when I went in for my test after being on the pill for about 7 mos my numbers were through the roof! Triglycerides were scary! I had them re test me several times...each worse than before...I went to a cholesterol class (which I could have taught) They wanted to put me on cholesterol lowering drugs!!! I was resistant to that and started thinking...the pill was the only factor that had changed in my life...then I went out to some forums asking the question if birth control pills had raised anyone elses levels...there were quite a few people that had noticed their levels were raised after starting on the pills... And if you read the pamphlets with your pills they recommend not taking them or talking to your Dr if you have high cholesterol or blood pressure etc etc...hmmmm wonder why? Could it be that it *might affect those levels!!!* Anyway, I talked to my Dr about it and he was resistant to the idea but was openminded enough to entertain the notion...I went off the pills and was tested after 6 weeks...my cholesterol had dropped significantly (still slightly high) but my triglycerides had went COMPLETELY back to normal!!! I am not saying that they effect everyone like this but it is at least something people should be aware of if they are trying to put you on CHOLESTEROL LOWERING DRUGS, don't you think!!! Anyway, I am off the pills...still dealing with the other issues but I am definitely aware that I need to be my own health advocate and I think everyone else should be too!

I hope you find the answer to your own problem very soon...hugs!!!

Raven!!!!!!!!!!! YESSSSSSSS!!!!! My point, exactly! They don't even BOTHER to look up the side effects, and when you experience them, they just want to give you MORE MEDS instead of taking the time to figure out what's going on. Sorry, but I don't know how to include quotes in my posts (computer-challenged, here...) but whoever it was (and other than this observation, I'm sure you're a very intelligent woman...after all, you're hanging out with US...
:dizzy: ) but WHOEVER said that drs are, after all, more educated than WE are....well, m'dear, how do you know they didn't sleep through all their classes, for pity's sake? Just because someone has their license to PRACTICE medicine (keep in mind that the key word here is *practice*) doesn't neccessarily mean that they know more than WE do about our bodies, nor do they neccessarily know any more than someone who actually does some research for themselves. And when you think about the way most of them went through their residencies - working 20 hours out of 24, exhausted, making mistakes, mistreating, never even having the time to think straight, never mind LEARN ....well, all I can say is that most of us who are educated in other disciplines don't learn - or attempt to learn - under such adverse conditions. Is it any wonder that when they finish up their residencies and start *practicing* they feel entitled to make as much money as they can with as little effort as possible? NO...I KNOW they're not ALL like that. NO profession has 100% slouches in it...but I would really have to say that with the way medicine is practiced today, there are a disproportionate number of hacks in it. I DON'T blame them entirely. There may have been some idealism in the beginning...MAY have been....but the system really does discourage it. Doctors today are like assembly line workers...get 'em in, throw some pills at 'em, collect your money and get 'em out. (Or tell 'em to quit smoking and lose weight...and the ones who do that are actually doing LESS harm than the ones who throw you a pill not knowing what it may do to you).
Tsk.
More educated.
Tsk, tsk.
Ella the opinionated :D

Narcolepsy?
 

I see a lot of older people who just do whatever the dr. tells them, without question. They don't bother to find out anything on their own. The dr. just must know. These people are usually put on medications--statins for cholesterol, anti-GERD medication, Lasix, beta-blockers, and of course Prozac.

The pharmaceutical companies teach in medical schools. What do people expect?

Then there is another group of people who want to MAKE the dr. DO THE RIGHT THING and FIND OUT WHAT'S WRONG and FIX IT. This can be a fool's quest. Once a dr. tells me there's "nothing wrong" from the tests, I start looking around on my own. I agree with other posters that one really does have to do some investigation this way. "Buyer beware" applies to everything.

That said, Rock Chalk Chick, I noticed that you mentioned narcolepsy. In my family we have a "mild" version of that. I, too, can easily fall asleep in a meeting. One thing that makes it worse is sugar or refined carbohydrates. I used to have a long commute, and I would have to stop halfway home and take a quick nap in my car or risk falling asleep at the wheel. But if I did not add sugar to the cup of coffee I drank before I left work, I did not have to stop.

Cheers!
Jay

Hmmmm... I'm starting to wonder if that was my problem lo those many years.

here's my recommendations...first try to eliminate a lot of extra carbs...some ppl have allergies to wheat, gluten etc. Second...get another opinion. See if you doc could referr you to an internal medicine specailist...not just a GP or sleep disorder clinic. It appears according to the results..you don't have a sleep disorder. An internist goes into more detail. Also i do think an holistic doctor may be in order. Maybe see both the internist and the holistic doc. Obviously what you have IS NOT NORMAL. Don't give up until you find an answer. Start doing some internet research (but realize not everything out there is good info). Start looking for ppl who have similar signs/symptoms. But get a referral. Obviously you need it. It sounds like what you have is a bit more advance that your gp (general practicnor) depth of knowledge or the sleep clinic's knowledge. So now its time to see someone more advance. If your doc won't do it...go see another gp with all your labs/test etc. Get opinions until your blue in the face...and for pet's sake..don't stop until you find an answer. If you are eating properly and doing moderate exercise..then you should feel energized not crashing every few mintues. Good luck!

I can definitely feel for your situation. I call it the TDF or (too darn fat)diagnosis. I've had it many times myself. This TDF diagnosis was given to me for Congestive Heart Failure, Hypertension, Gout, Asthma, Liver Disease, Tachycardia, Irritable Bowel Syndrome, Prolapsed Uterus, Gallbladder Disease, Broken Ankle, Diabetes, Repeated Abdominal Hernias and Bowel Obstruction. As you can see, most EVERYTHING was TDF. Granted wt. loss did help most all of my medical problems. I got sick of hearing TDF.

Being tired all the time and falling asleep frequently can be symptomatic of many different medical problems. Ex. with my liver disease, the number one symptom is severe exhaustion. This is true for other medical issues as well. Keep looking and try to get to the bottom of what is the Real Issue. In the meantime, I would advise the healthy eating and exercise. It certainly can't hurt and most likely will help no matter what the problem is.

Lilybelle is right, you should definitely do your best to rule out any medical issues, but I also wanted to second the person who said that you might be over-training. There was a period about two years ago when I was working out intensly and under-estimating my activity level (I was on WW at the time). I was so tired that I didn't know what to do with myself, and it got to the point that I couldn't stop yawning and falling asleep during my workouts. Make sure you're eating enough calories to fuel yourself, and make sure that they're as clean as possible.

That's all assuming you were working out when this problem started. Do you mind if I ask what a typical day is for you eating and activity-wise?

I tend to think that "regular" doctors are really good with emergency situations, but they aren't very good with the non-life-threatening ones. I would try to seek out another Dr. Perhaps an ND (Naturopath) or maybe a DO (regular doc with chiropractic schooling added) as they tend to be more apt to look for the problem and not just treat the symptoms.

Personally, I used to have a big problem with my energy level. In fact, my old roommate used to always ask if I was pregnant because I was always sleeping. It turns out that I had a vitamin deficiency. I did not find this out through a doctor, but on my own. I can't take hard vitamins because they come right back up, so I had never bothered to take them. Once I found a liquid vitamin that I liked my energy level soared! Currently I'm taking an adult chewable that I found and my energy is great.

I also agree that 8 hours of sleep may not be enough. I don't feel rested until I've slept 9 hours. I've learned to except that my body just needs a little more than most people. My DH feels rested after only sleeping 7 hours. I think 8 hours is a general number and that you may need to customize your sleep habits for you own body.

First, I'd like to thank everyone for all the replies - even the ones that I may not want to hear!

I realize that my weight may certainly be a contributing factor to this issue, and that losing weight may help. At the same time, I just can't believe that it's simply excess weight that's causing me to sleep 9 or 10 hours a night and still get drowsy any time I sit still. I don't feel tired or physically exhausted, I just get sleepy and doze when I'm sitting in meetings or any time I'm not on my feet. It's frustrating to feel like a slacker and know that my professors may not realize that I'm trying like crazy to pay attention.

As for my usual routine - I'm typically up at 6, grab a quick snack (a banana or protein bar) and a bottle of water on my way out the door to the pool (M,W,Th,Sat) or before a run (4 miles Tues, 3 on Fridays). I eat breakfast around 7 after my workout (1 or 2 hardboiled eggs/WW toast/fruit/milk, or a WW waffle/peanut butter/fruit/milk), pack my lunch, and bike or walk to work (under a mile). I have an apple with peanut butter or a oatmeal bar as a snack mid-morning. Lunch varies, but I usually try to get some sort of lean protein, whole grains, and as many veggies as I can (yesterday was salmon with 1/2 cup brown rice, a salad with viniagrette, and steamed frozen broc-and-cauliflower). I have another fruit and cottage cheese or yogurt mid-afternoon and try to head out for a bike workout 2 afternoons a week (before it gets dark) and then leave work around 6-7. I often eat something small before leaving work or as soon as I get home (fruit or raw veggies) before starting to cook dinner (similar to lunch - aim for lean protein, lots of veggies, and around 400 calories or less). I do some quick weights in my basement after dinner 2-3 nights a week, and now that it's getting warm out, I sometimes go for a walk or go rollerblading after dinner, but lately I'm ready for bed by 9 and out cold well before 9:30.

For the past year or so, I've been using a device called a bodybugg (not sure if posting the link would violate the "external link" rules), which uses a variety of sensors to estimate your calorie burn through the day (kind of like a pedometer on steroids - supposedly measures calorie burn within 95% accuracy). Along with a food log, it keeps a pretty close report on how much of a calorie deficit I accumulate through the day - I typically eat about 2200-2500 calories and burn 3000-3400 when in full training (like now). I know that when I fall short of my intake goal, I can feel more tired, but if I keep things within range I do pretty well, especially if I space things out through the day (I eat a lot of snacks and my "meals" are usually small).

Once I started realizing what a problem this sleepy issue is, I've become more frustrated. I'd noticed it off and on for the last few years, but assumed I was just not sleeping enough, etc; I finally decided to make an effort to get good quality sleep for 30 days straight and it didn't really remedy things. I started to check out what might be causing problems - I modified my diet one way and then another, I laid back on my training for a few weeks, I kicked my cats out of my bed, etc. Several things helped my energy levels slightly, but nothing really fixed the problem. That's when I figured it went beyond my own control, and started bringing the doctors into it. Blood tests, physicals, and now the sleep study - none of which have really given any information.

I know that my diet and exercise habits affect my energy levels - I feel 100% better when I'm eating lots of fresh produce and minimal processed junk and I'm staying active. But it still isn't really alleviating the fact that I fall asleep at the most inopportune moments.

Again, thanks for the thoughts - I'm not in denial about my weight and that it could affect my health. At the same time, telling me that I have weight-related sleep apnea when the tests say the opposite seems like handing me cholesterol-lowering drugs when my blood tests are perfect, just because I'm fat and fat people have high cholesterol.

okay...so let me get this straight?????? you are eating 2200-2500 cals a day and burning (according to your bodybugg) possible upt to 3500 cals a day. Well no wonder then you are tired...sounds like you are overworking your body and not giving your poor body fuel. Usually you need you don't want to burn more than you have taken in. This really could be your problem. It may very well be you aren't eating enough for all you are doing. And you may actually be starving your body. I would first try with eating a heck of a lot more calories. Let us know what happens. good luck

Well, as I'm trying to lose weight, I need to maintain net loss of calories - that's how it works: you eat less than you burn in order to lose weight. Using the bodybugg has helped me see how much I actually burn, which explains why I was really suffering in previous diets when I thought I needed to stay below 1500 calories/day to see any outcome. As it is, I burn about 500-1000 calories more per day than I take in (I aim for an average of 750/day, while not obsessing over any given day), which allows me to lose about a pound and a half per week (500/dayx7=3500=1 pound) while still fueling my workouts. I cut back my workouts to burn under 2500 while maintaining 2000+ calories in for two weeks back in October to see if I was overdoing - if anything, I felt more sluggish because I lost the energy that working out gives me.

I make sure I eat enough to keep myself fueled and to (hopefully) avoid any nutrient deficiencies. I know that if I fall below 2000 calories a day, I tend to get lightheaded and feel less than optimal - as long as I stay about 2000 or a little more, and, more importantly, keep my food "clean" (minimal refined sugar and processed junk), I feel good and have plenty of energy for my day and my workouts.

Your food list looks pretty good, and it sounds like you really know what is going on in your body, Rock Chalk. What if you lowered your workouts and food, though, so you were only burning, say, 2600-2700 calories a day, and eating 2000-2200 cals? That would mean slower weight loss, but might mean more energy.

I'd probably drop dead if I were working out that much! You must be a young thing. ;)

BTW, have you been losing weight during the past 6 months, and your S/C/G just doesn't show it? Because if the number of calories are accurate, you should have lost many pounds during that time.

Jay

DO is a doctor of osteopathic medicine, and not all DOs have chiropathic background (it depends on their schooling), as I know one D.O. who functions like an MD anesthiosiologist.

It seems like you're following the "model plan"; all the exercising, calorie deficits, nutritious foods. My question is, if this is how you normally eat, how did you become obese? In other words, how long have you been following this model healthy lifestyle and what was your lifestyle like before you started your weight loss plan? Years of eating non-nutritious foods and not exercising can take its toll on ones health I would guess. But then again that would be describing DH and he never gets sick..though he's naturally thin (body fat is 8%) so maybe its just really really hard on your body to carry extra weight.

I've never been more than 10 pounds overweight before this past year, and I can tell you the difference in my energy levels from an extra 30 pounds was astounding and so noticeable to me. Also, fat does affect hormone levels (especially some very dangerous ones from belly fat that cause havoc on the body), which can have a major impact on how we feel.

But I do agree, regardless of the fact that being obese is somewhat of a starting point when trying to guess the cause of a disease, there may be some sort of underlying factor at this point that would cause such abnormal symptoms (i.e. most overweight people do not report falling asleep at meetings etc).

With regard to doctors, I dont think they're miracle workers and in most cases they're not scientists either, just technicians to implement the latest tests and medications. They're just average folks who are performing a service and they should not be held up on a pedastal, either to trust and hang on their every word in lieu of your own judgment as to what is right for you, nor should they be expected to stay up nights researching your issue..they do not have laboratories and they are not scientists testing theories and that. Expect out of them what you're getting. Shop around in case someone else can get to the bottom of your problem. Hope you feel better.

Ok, your old roomie thought you were preggies simply because you slept a lot??!! That's a new one on me! :D Seriously though, I'm in the same boat as you on this issue, because I frequently find myself having to sleep during the day before I can "refresh" myself for the rest of the day. Will look up some vitamins and see how that goes for myself. Thanks!

I think a second opinion is in order. I've had similar problems because I have a big fat red "DEPRESSION" stamped on my medical file from my past (even though I've been successfully treated). When I started having debilitating pain, so many doctors tried to pin it on my mental illnesses. It took a long time to find a doctor who would look past that and see if there was really something going on. Turns out, there was actually something physically wrong with me -- of course there was! I know my body, and you know yours. There are wonderful doctors out there who will listen; it's just a matter of finding them. I've been in and out of doctors' offices for years, and had my share of both.

The other option is to come back after you've lost some weight and say "SEE? I TOLD YOU SO!" Not the most mature option, and not good for you in the meantime, but that might feel pretty darned good. ;)

There is always the possibility that the doctor is right; I started having massive fatigue problems from gaining just 10 pounds, because that little bit pushed me over the threshold where I was healthy...that said, you know your body better than any of us here. If you believe the doctor is wrong, you should listen to your body.

Good luck to you. Please keep us updated. :)

yes i do understand you need to maintain a net loss...but almost a 1000 cal difference seems like a lot....but i'm not an expert. Maybe you should go see a nutritionists and talk to them. See if you are eating too few for all you are doing? If the nutritionists thinks its looking ok...then still see an internist specialist or a holistic dr. Good luck and let us know.

also one other thing i would note...you may want to log and time everything you do. What i'm getting at...is trying to pinpoint if a food is possibly giving you the issues. So in otherwords. if you notice that everytime you eat whole wheat bread...30 min later you fall asleep....maybe its the whole wheat???? just a suggestion..not sure if it will get you anywhere..but worth a shot.

Her ticker and S/C/G don't show a big loss becuase she just joined 3FC this month.... What I don't understand is how a person who eats so well and is soooo active could possibly be overweight. That puzzles me, becuase even if you were eating alot more cals before the "diet", you still should have been burning most of it off, or at least breaking even with all that excercise.

I've lost some weight over the last few months, but a lot of ups and downs. My diet is pretty solid NOW, but I've bounced around a lot and used to eat a lot of processed foods and a lot more of it than I should. Add in graduate school and a lot of time spent in front of the computer, and I've gained quite a bit of weight over the last 4 years (about 20 pounds since '03).

I've "dieted" on and off over the years, but always felt I needed an extreme restriction which I always rebelled against - I'd lose 5-10 pounds and then get tired of the hyper-restrictive diet, gain it back plus a little. When I picked up the bodybugg, I was ready to try again, but I didn't want to "diet" - this let me eat whatever I wanted, and as long as I kept a calorie deficit, I could lose weight even eating junk food and takeout. I started to train for a triathlon last summer (I'd been swimming but wanted something new), while keeping my diet essentially the same, and lost about 15 pounds, slowly. (I was eating a LOT - average day of buying lunch and a BIG processed dinner meant about 3000 calories. Add in a pint of ice cream or a half-dozen cookies and I was easily over 4000!) Regardless, on average I lost. And because I let myself eat anything I wanted, without any "diet" judgement, I started to learn what made me feel better and not - I know that chips taste good at the time but make me feel slimy and lazy for 3 hours afterwards... not worth it. Once I started to make those associations, greasy stuff didn't even taste good (wish I could say the same for sweet!).

So, I was down to 190ish at the end of last summer, but work started to get the best of me and I started to eat poorly again, not wearing the bugg and barely working out (about 20-25 min 2-3 days a week - still moving but not my usual). I gained back to my highest weight just after Christmas, and decided it was time to get moving again. I started to get back in the pool, and started running again. I didn't lose any weight, but I got my fitness level back up. March 1, I finally picked a triathlon and decided to actually train again - which means I needed to clean up my diet to fuel the amount of activity I was doing. I've lost about 8 pounds since the first of March, with a bounce back up this last week because I've been babying a knee injury and have been eating out while my fiance is visiting. (I'm since back down to 196 - time to update!)

My mixed outcome on the weight loss has been impacted by the sleep issue - I started tweaking my daily schedule 6 months ago - eating more, eating less, moving more, moving less, sleeping more, etc... my routine was thrown off for several months. When I returned from vacation March 1, I decided it was time to get myself back into a firm training schedule, regardless of the sleep issue. So, the demo schedule I listed above is what I've been doing for the last month, not the last year.

Okay. Well--to be frank, yours is not a plan that I can see working in the long run. In fact, it really isn't working very well in the short run, judging from your results. If it had been, you would be down from 30 to 60 pounds in the last 6 months. (That would be a rate of 5 to 10 pounds per month, which is quite possible.) I realize that you weren't following the plan all that time, though, and that could be part of the problem.

I think you're basically running yourself ragged and that's why you feel tired all the time. Just my opinion--no big deal.

I'm hearing a lot of resistance to restricting your eating--and that will only work as long as you continue to overexercise.

You might want to try changing a few other things about your lifestyle before you blame the drs. for not finding "the cause" of your tiredness. Sorry to be blunt--but that's how I see it. ;)

Good luck! Hope you feel better in any case!

Jay

I appreciate the advice, I really do. However, the main difference between what you're recommending and what I'm doing is the goals in mind. If I were looking to lose weight at all cost, I would gladly cut back on the amount of exercise and food intake, balancing the two out and losing weight quickly. I've done this in the past, but it's not a life I could (or would want to) maintain - it's not "me." In my case, my first goal is to be a successful triathlete, with weight loss as a distant second. I would like to lose, since I'll look better, be faster, etc - but it's going to come as a side effect of my activity levels, rather than the other way around (exercise as a means to weight loss).

I'm pretty happy with the way I am right now, and I feel energized and healthy with the level of activity I'm at right now. I suppose part of the miscommunication here is that I haven't made that entirely clear - I'm not physically tired or wiped out all the time. I feel darn good during my waking hours, with plenty of energy - but when I sit in a meeting or in front of a computer, I go from alert and energized to sleeping in a matter of 2-3 minutes. That just doesn't seem right - and it doesn't seem to be tied to my eating or exercise habits, which I've modified in any number of ways (a month of minimal workouts, a month of generous or limited eating, a month of eliminating potential allergens, etc) - part of why I'm back to a higher weight is that I haven't been able to stick with what works for me, which is staying active and eating for fuel.

I realize this isn't the way for everyone, but it works for me. What's frustrated me so much about the doctor's advice is that it seemed like a blow-off because I'm overweight. It wouldn't have surprised me to hear them advise me to cut back on my training, but to hear "lose weight with diet and exercise" just seems like such a pat answer that they aren't considering my history in the matter.

Again, I really do appreciate the advice you've given, and I will take it into consideration as things go on.

Just a couple of things I wanted to point out -

Because of your level of activity you could have a lot of muscle mass stored up (and if you don't now you will), which would mean that your weight on the scale isn't going to be as accurate as most people's. If I were in your position I'd seriously consider relying more on your body fat/measurements than on the scale, and this should also be something you should tell you doctor about.

Secondly, is your net calorie estimate taking into account your RMR as well? I wouldn't suggest that you cut down on activity necessarily (beyond a 1-2 week rest for training cycles, and I see you've done that in the past which is good), but that if your loss slows you UP your food intake for about a week or so. I mean up it to within about 500 calories of your burned calories total (including RMR), so that you have a calories deficit of no more than 500. This might sound scary and make you feel like you're backtracking on some progress, but you want to make sure you're mixing things up and not pushing yourself too hard.

Bottom line: programs that figure in net calories are not 100% accurate for everyone, especially those who train hard. It may be necessary to tweak your food a little based on how your body responds. If you're not getting enough food then it will not only have some effect on your metabolism sooner or later, but it will also start to effect your performance.

It doesn't sound like it's the reason for your fatigue, but it's a good idea in general to make sure it's not an issue. You don't want to push yourself too hard.

Also, can I just say that I think your goals are awesome? ;)