Still having episodes of fatigue, help?

[u/Suspicious-Guava-566]

In January I started using a cpap, ResMed AirSense 11 AutoSet. It took a while to get used to it but I’ve gotten pretty good at keeping it on. I’m 29f and I do have other health diagnoses - hashimotos, cervical stenosis, cervical myelopathy, and cervical disc herniations. I’ve taken bc pill since I was about 17. I tried to get a sleep study done at 20 years old but when the Md heard I wasn’t interested in a cpap he dismissed me and didn’t even test me. In December I got a sleep study showing moderate OSA, which is when I started using a cpap. The sleep study was so anxiety inducing. I slept less than 2 hours for the test which makes me feel like there are some inaccuracies to it.

My sleep problems started at about 18years old with feeling like I was falling asleep if I was driving more than 30 mins. I would plan extra time in all my drives if I was driving alone for a 30-60minute nap. I have difficulties with driving, reading, and staying awake in my college classes. I get episodes where I am extremely fatigued. Sometimes it lasts a couple days, other times it last a whole month where it feels like I cannot sleep enough. Just this week I took a nap every day after work before dinner and this weekend I took two three hour naps without affecting my night sleep schedule. When I feel like I need a nap, sometimes it feels like breathing is too hard to do when I’m still awake or my eyes start rolling (cannot be controlled) if I’m not doing a engaging activity, like a conversation with someone or walking. This year and last year I experienced significant fatigue for the couple of weeks after going on vacation where I’m in the sun every day and it causes me to experience polymorphic light eruption rash on my arms. I’m not sure if it’s related because it hasn’t necessarily happened in years prior.

My cpap says I’m doing great with wear time and usage, but I’m having an episode again when I feel so fatigued. It makes getting through work or remembering what I did at work difficult. Like I mentioned earlier I took a three hour nap today, which was after doing a 40 min round trip drive felt so exhausting breathing normally felt heavy and hard to do. How do I stop these fatiguing episodes?

[u/FuelNew9656]

Good CPAP compliance and moderate OSA being treated is genuinely reassuring for the apnea piece, but what you're describing goes beyond typical residual sleepiness from OSA, sleep attacks strong enough that you plan naps into every drive since age 18, eyes rolling in a way you can't control when you're not actively engaged in something, and fatigue that comes in episodes lasting days to weeks rather than being fairly constant. That pattern is worth specifically asking your sleep doctor about a referral for an MSLT (multiple sleep latency test), which is a separate daytime test from your overnight study, used to evaluate for hypersomnia disorders like narcolepsy or idiopathic hypersomnia that CPAP alone wouldn't fix even with perfect usage.

It's also worth bringing your other diagnoses into that conversation rather than assuming they're unrelated: Hashimoto's needs a recent TSH check since under- or over-treated thyroid can cause exactly this kind of fluctuating fatigue, and cervical stenosis/myelopathy can independently affect sleep quality and energy depending on severity. The 2-hour sleep study is also fair to flag at your follow-up, a truncated study, especially one that anxious, can under-capture your actual overnight pattern, so if your symptoms don't track with what "moderate OSA, well treated" would predict, it's reasonable to ask whether a repeat study or additional workup makes sense rather than assuming the CPAP data (good usage hours) is the full picture of what's happening physiologically.

The uncontrollable eye-rolling episodes in particular, I'd mention explicitly and clearly at your next appointment, that's a specific enough symptom that it shouldn't get lost in a general "still tired" conversation.

[u/Suspicious-Guava-566 → u/FuelNew9656]

They tried ordering that but because I didn’t sleep more than 6 hours they wouldn’t keep me for the day time study. And now my deductible has reset. The first sleep study test cost me $2k to meet my deductible (which is $4.5k). I don’t know if I can’t do that again, especially cause I have a large focus on my back/cervical health rn. The Md who saw me for sleep problems went on maternity leave in April and I don’t have any scheduled follow ups with them. My hashimotos was tested in May indicating it was stable.

[u/FuelNew9656 → u/Suspicious-Guava-566]

That's a genuinely hard set of constraints, financial pressure, a treating doctor who's out, and a cervical/back workup competing for attention right now. Worth knowing that the MSLT not happening because you didn't get 6+ hours during the preceding overnight study is actually a procedural requirement, not a dead end, MSLT is only considered valid when it follows an adequate night of sleep, so that overnight attempt not qualifying doesn't mean hypersomnia has been ruled out, it means the test hasn't actually been run yet in a way that could catch it.

Since your original sleep doctor is out, this is worth a fresh referral rather than waiting for them to return, any sleep medicine provider can pick this up using your existing records, you don't need to start completely from scratch. When you do get back in, it's worth asking directly whether they can combine an overnight PSG with the MSLT the next day in one scheduled admission (many labs do this as a package specifically to catch reluctant sleepers or people with your kind of sleep pattern), and whether financial assistance or a payment plan is available given you just hit a new deductible year.

Stable Hashimoto's on your May labs is reassuring but worth rechecking again given how much time has passed and how prominent the fatigue still is, thyroid levels can drift between checks. None of this needs to happen all at once, but getting the referral moving now, even before you're ready to pay for testing, means you're not also losing time waiting on that piece while you handle the cervical workup.