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

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.