Narcolepsy/sodium oxybate/unrefreshed sleep

[kmil1999]

I have chronic fatigue syndrome (1994), Narcolepsy/mild sleep apnea (2005).  I started on sodium oxybate and for the first two weeks, I felt better than I had in 10 years.  However after the initial 2 weeks, I continue to wake up unrefreshed.  The medication still helps with catatplexy though and I am able to sleep without waking up for the two 4 hours segements.  My last sleep study showed 2.% TST in stage 1, 61.5 % TST in stage 2, 35.3 in stage 3, 0% in stage 4 and 1.1 in REM.  Previous studies have never shown any stage 4 sleep and up to 86% in stage 2.  I know my am cortisol was 3.6ug/dl (N=8.7-22.4) but the doctors didn't do anything with that.  My questions are:  1. Where should I go for help to figure out how to wake up more refreshed? 2. How can I help heal my chronic pain issues if I do not have stage 4 sleep and very little REM sleep? 3. Is there anything I can do to increase stage 4 and REM sleep?  4. Could the cortisol level be a culprit in all of this?  Thank you in advance for the multiplicity in questions.  I am not sure where the next steps were.   Karen

[Steven Y Park, MD]

1. Try talking to your sleep doctors about it. Maybe they can adjust your medication or try something different. You could also have upper airway resistance syndrome.

2. You're right. Lack of deep sleep can aggravate your chronic pain issues.

3. Are you treating the mild sleep apnea? If you can't tolerate CPAP, perhaps an oral appliance may be another option.

4. Although it does seem low, having a low cortisol is probably a sign of something else going on. However, there is something called adrenal fatigue syndrome. You may want to see someone about your chronic fatigue syndrome.

[kmil1999]

1. I have talked to my sleep doctor.  We have increased the morning stimulant.  It is just the unrefreshed sleep I am trying to change.  

2. Is there anything I can do to encourage more stage 4 and REM sleep?

3. I am using CPAP every night.

Thanks for the reply.