Is sleep apnea still causing this?

[nathanm]

I am 28 years old with severe fatigue. I have high blood pressure as well and take 20mg of lisinopril per day, and have sleep apnea and sleep with a CPAP machine nightly. I was re-titrated in January at 6.0 pressure. I went to my primary care Doctor in January. 2009.

Calcium - 10.3 mg/dl
vitamin D - 14 ng/ml
B12 low

I was put on vitamin B12 shots, and continue those monthly now, and also was given a weekly vitamin D prescription for 50,000 IU's per week.

My Doctor next texted ionized calcium, and that came back normal. The Doctor then re-ran calcium, and PTH, and calcium was 9.8 this time, with a PTH at 37 pg/ml.

She then tested total testosterone which came back as 225 ng/dl. She ordered an MRI of my brain as well, and that came back as normal.

My Doctor referred me to an endocrinologist.

He ordered a 24 hour urine calcium test which came back at 223 mg/day which he said was normal.

He also tested:

aldosterone - 5.9 ng/dl
renin - 24.5 ng/ml/hr
Plasma metanephrines normal
A.M. testosterone 219 ng/dl
LH 3.8 mIU/ml
FSH 3.6 mIU/ml

I have absolutely no signs or symptoms of low testosterone.

Next, my endo ordered:

Calcium, PTH, and vitamin D again, (after completing my Vitamin D therapy) total serum estrogen, and FSH, LH and prolactin.

Calcium - 9.8 mg/dl
PTH - 25 pg/ml
Vitamin D - 23/ng/ml
total serum estrogen - 133 pg/ml which he said was a bit high...
FHS, LH and prolactin levels were all normal.

I just talked with him again following another round of testing. He said that the total testosterone level is still low, but that the protein that binds the testosterone is also low so he is not concerned about my low total testosterone. My estrodial is slightly elevated.

Basically, he has said at this point that he does not know what is causing my fatigue.

Can you help? Can you see anything here, or suggest anything additionally that I need to try or look for? Thank you in advance... I am really, really frustrated.

[Steven Y Park, MD]

Thanks for your detailed question. Unfortunately, I'm stumped as well. It sounds like you have mild sleep apnea based on your low CPAP setting. Sometimes, having chronic pain/muscle spasm issues can disrupt the quality of your sleep, despite proper treatment for sleep apnea. You may not officially have chronic fatigue syndrome of fibromyalgia, but you have many of the features of these conditions.

Sometimes, it can take 3-6 months of CPAP to feel an improvement. Do you have a data recording capable machine? You also have to make sure that you're using the machine effectively, despite using it every night.

If you've exhausted every conventional option, you may want to look into alternative and/or holistic modalities. Doing yoga or tai chi regularly can also help many people in your situation. It's difficult to recommend which one to start with since everyone is different.

[nathanm]

Also just to add to this.... I have leg twitching. I told my sleep doctor this, and he prescribed Mirapex for me. It seemed to work at first, however after a couple of days the twitches were still there. RLS didn't show up at all on my sleep studies. I also have very bad head/neck pain, and when I wake up in the morning, I have to crack my neck at least a few times. This usually continues throughout the day, and when I feel neck/head pain I crack my neck and it seems to make me feel a bit better. There seems to always be a pain in my neck/head though that doesn't go away.

I have no idea what to do anymore. My sleep doctor says it's not sleep apnea causing the fatigue, and my endocrinologist says it's not anything that he can find that's causing it either.