Severe Fatigue

     I am a 58-year-old male who has worked hard in construction all his life and also played hard all his life. I have broken both legs, both arms, ribs, and had orthoscopic surgery on both knees. I have back problems, fibromyalgia,  COPD, and hypothyroid. I also take medication for depression, high blood sugar, high cholesterol, pain, ulcers, and anxiety. I have lost 55 pounds in the last 6 months. I weigh 190 pounds. I am 5'7" tall.
     My current problem is that during the day, for the past few months, I get so sleepy that I have to drink coffee (I hate coffee) or do something to keep from nodding off. I am afraid to drive more than 20 miles alone. Now, I get as much sleep as I ever had and I am not doing anything to make me overly tired. In fact, because of my problems I hardly ever do much physically at all.
     I have had a sleep study to rule out sleep apnea. I was told I was at 89% oxygen when I sleep, whatever that means. I don’t have narcolepsy either. me stay awake during the day. I don’t know if “water diabetes” would cause the problem of staying awake or not.
     I have also found out that hypothyroidism can cause a person to want to sleep all of the time. As you have seen mentioned in this monologue before, I have hypothyroidism. The problem is that according to my doctor my blood tests show that my thyroid numbers are in the normal range.  
     That’s all I can think of to tell you. So, as far as this current problem I am having, do you have any idea as to what it could be. I am really getting tired of forcing myself to stay awake. Like right now, writing this, I keep nodding off and forgetting what I am doing. I just finished my first POT of coffee (the pot holds 12 cups).
Please help me!

[Kevin Pho, MD]

I agree with the workup thus far, including the sleep study, which would have excluded sleep apnea.  If there are any apneic events during the test, that is, periods where you stop breathing, a CPAP machine can be considered.

Other potential causes can include anemia, which can be evaluated via blood test.

Furthermore, depending on any associated symptoms, like decreased exercise tolerance, testing the lungs via pulmonary function tests or the heart with an exercise stress test can all be considered.

These options can be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

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Twitter.com/kevinmd