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Posted by Stuart Holtby MD ABSM on March 30, 1998 at 20:46:01:In Reply to: Always tired & tried everything posted by Mike on March 24, 1998 at 14:03:22:
Dear Mike,
You aren't alone. Probably every sleep doc in the world sees people just like you. That's the good news. The bad news is that your problem can be really hard to treat.
Some normal people have alpha intrusion in their sleep EEG, and some people with "fibromyalgia" have alpha intrusion and many people that just feel tired in the morning have this. We don't know the cause.
I am assuming that your sleep study just showed alpha intrusion and didn't show a lot of brief awakenings (so called microarousals). If it did there is a chance you have a variant of sleep apnea called upper airway resistance syndrome.
Alcohol may suppress alpha intrusion which may be why you feel better when you drink, but I would NOT recommend that as a way of treating this.
Other options include (and you may need to patiently work your way through the list):
L-tryptophan gradually increased up to 1500 mg at bedtime; zolpidem or zopiclone; a benzodiazepine such as flurazepam or clonazepam; or an antidepressant such as nefazodone or sertraline.
Each has its own side effects.
You might benefit from having a sleep study repeated with an objective measurement of sleepiness in the day.
Re your questions:
We very commonly see a very big difference in snoring in the lab compared to at home. In some instances it relates to the fact that the techs ear is not 6 inches from your mouth like your wife's ear; in other instances it relates to how light a sleeper other family members are; how deep you sleep in the lab; how plugged your nose is in the lab; how much alcohol you normally drink at home compared to the night in the lab; etc etc.
On the other hand people have looked very carefully at how consistent sleep apnea is night to night and found that if you DO NOT see it in the lab and you slept, it is very unlikely that you have significant apnea.
You asked how the sleep study could be so out of synch. It isn't. Alpha intrusion commonly correlates with fatigue.
Re the followups:
I disagree or at least would be very cautious with Ms. Head's idea that you might benefit from methylphenidate. It usually doesn't help people with alpha intrusion related fatigue.
Occasional patients of mine rave about magnetic mattresses or pillows solving their fatigue, but I have not seen any hard data on this.
If you do find an answer let me know- I am always interested in success stories.
Good Luck.
Stuart Holtby MD ABSM
Northern Nights Sleep Disorder Centre
Thunder Bay Canada
(807) 628-0000
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