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Suggest Treatment For Moderate Sleep Apnea And Exhaustion

Posted on Thu, 11 Dec 2014

Question: I'm a male age 64, 5'8" tall and weigh 165 lbs. I am not overweight and don't currently exercise although I have most of my life. I've been diagnosed with moderate sleep apnea but although I used the bipap machine for quite some time I never felt much better on it so I went off of it about 6 months ago. I have been struggling with exhaustion since 2009 that's what prompted me to get a sleep study. I wake up tired and are tired all day. My muscles feel heavy and somewhat sore. I have some memory loss and it's difficult to concentrate at times. I am not depressed although I have been under a large amount of stress during the last year. I meditate 5 days a week and do other stress reducing activities like self hypnosis and prayer. I am currently taking Holy XXXXXXX and just started taking Ashwagandha. I worked in a prison for 25 years which was very stressful and have been working at a small school helping students who don't fit in at the high school to finish their high school diplomas. I have had issues with dehydration and low blood sugar which has made me pass out a few times in the last 5 years. I wonder about adrenal exhaustion and also Lymes' disease as I am outdoors a lot a have had a number of tick bites. Any suggestions would be most welcomed. Thanks, XXXXXXX

Answered by Dr. Shehzad Topiwala (1 hour later)

Brief Answer:
Endocrine

Detailed Answer:
Sorry to learn about your symptoms.

I can help you look into some potential hormonal causes of your symptoms.

When I see someone like you in my practice, I order the following tests (obviously after a thorough examination):

CBC
CMP
TSH
Free T4
25 hydroxy vitamin D
Total Testosterone
SHBG
Serum cortisol

Fasting is not necessary but it is important to do these tests at 8 am strictly.

Results of these tests will give clues towards the possible reasons for your condition.

Low vitamin D, testosterone and cortisol or thyroid problems can explain the problems you are experiencing.

Check with your primary care provider regarding Lyme's disease.

It is good to see the type of social work you are doing now

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (12 minutes later)

Can you explain what the following tests will show? What numbers are considered normal for each test? Do any of these tests reflect adrenal exhaustion? Should I be tested for C-reactive protein, which indicates inflammation?
CBC
CMP
TSH
Free T4
25 hydroxy vitamin D
Total Testosterone
SHBG
Serum cortisol

Answered by Dr. Shehzad Topiwala (8 hours later)

Brief Answer:
Follow up

Detailed Answer:
CBC will reveal if you have anemia or not. Low blood hemoglobin levels can cause fatigue

CMP includes liver and kidney function tests along with electrolytes and glucose. Abnormalities in any of these can also result in a sense of exhaustion, in addition to other symptoms.

TSH, Free T4 will test your thyroid function. If it is not normal, then it you have either an under active or an over active thyroid.

25 hydroxy vitamin D, when low, affects bone and muscle health.

Low testosterone can present with a variety of symptoms. Exhaustion is one of them. SHBG allows one to compute the free testosterone levels in the blood using an online calculator.

Serum cortisol drawn at 8 am is a good screening test for adrenal insufficiency. Anything above 15 is considered good. Below that cut off, the endocrinologist needs to examine you systematically and decide if further testing is necessary based on his or her clinical judgement.

It is not possible to give you absolute cut offs for these laboratory values indicating a threshold above or below which things are abnormal. You have to remember doctors treat people, not reports.
Labs can give ranges and flag abnormal values but it takes many years of intense training for doctors to decide which abnormality is worth treating. This typically entails the opportunity to evaluate the person live.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (2 days later)

Are these blood test amenable with getting a physical? Can I request them and are they very expensive. I have Blue Cross Blue Shield insurance. Thanks, XXXXXXX

Answered by Dr. Shehzad Topiwala (14 hours later)

Brief Answer:
Second follow up

Detailed Answer:
They are unlikely to be covered in an annual physical. Yes, they can be expensive if you have to pay for them out of your pocket.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar