Compromised Consciousness

I have an odd "mystery" condition that I've had for as long as I can remember and that affects my daily quality of life.  The only way I know to describe it is a "compromised consciousness".  Think of a time when you are very sleepy and about to go to sleep; you feel a bit displaced from everything and "away" from the world around you.  I feel that way all the time.  It is not a psychological thing; it is physiological.  It is actually something making me feel this way, I just don't know what.

As a result, I have bad headaches, I'm tired all the time (I could sleep around the clock), I have low blood pressure, blurry vision, and depression.  I've had this for many years.  I've been treated for seizures when some "seizure activity" showed up on a scan.  That didn't help; I got all of the side effects of the meds with no benefit.  Last year, I had open heart surgery (at age 33) to repair an aneurysm the size of a navel orange in the right chamber of my heart.  I was so hopeful that that had caused this "compromised consciousness" feeling, perhaps cutting oxygen to my brain, etc.  While the surgery repaired the aneurysm, it did nothing to alleviate the feeling in my head.

The feeling gets more intense as years go by and someday I'm convinced that I will just go completely unconscious and never wake up.  It affects my ability to drive, to go into crowds, to see books properly, everything.  It affects every aspect of every moment for me.

And yet, no doctor can figure out what it is.

Any ideas here?  Please help.

[Shazia Alam, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I cannot comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

The most common cause of excessive daytime sleepiness is usually due to a combination of not getting enough sleep, inadequate sleep hygiene, and work schedules. There are sleep disorders that are associated with excessive daytime sleepiness, such as sleep-related breathing disorders, such as obstructive sleep apnea, circadian rhythm sleep disorders, medication-induced sleepiness.  

Excessive daytime sleepiness is characterized by persistent sleepiness, and often a general lack of energy, even after a good night’s sleep.  There is also an intense urge to take naps.

Given that you describe fatigue, one thing that causes headache and fatigue is sleep apnea. This is more likely to occur in overweight people who snore but can occur in anyone. Symptoms include snoring, daytime sleepiness, lack of concentration, and headaches. Untreated, sleep apnea can cause many medical problems, and with treatment many symptoms improve. The diagnosis is made by a sleep study, called a polysomnogram, and treatment involves a mask placed over the nose and/or mouth that is adjusted to improve ventilation during sleep.

I would recommend a PSG (polysomnography), a sleep study in addition to a prolounged EEG which monitors for seizure activity.