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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 32301
Experience:  Over 20 yrs of Family Practice
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I'm not sure which specialty my question for; maybe a

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i'm not sure which specialty my question for; maybe a neurologist.
often i feel quite tired around 5 or 6 pm and will lay down and take a 30 to 40 minute nap. often when i awake i feel disturbed; very groggy; lethargic;and, sometimes jittery. i do suffer from depression and anxiety disorder. i do take meds for this. but, iv'e had these sensations throughout most of my life long before i was diagnosed and started taking meds. i often feel lethargic and at times weak throught the day. that's fairly new maybe last 4 or 5 years. i don't think the jitteriness is low blood sugar as i eat regularly throughout the day. over the last 2 years iv'e had many tests; blood; cardiac cat scan; mri's; endoscopy/colonoscopy; all normal. last year i did have low thyroid/tsh but, is now normal. what would cause the sensations after taking a nap and, weakness/lethargy during the day. thanks, j
Hi--do you know what your most recent TSH level was and have you had your cortisol levels checked?
Customer: replied 4 years ago.

yes, iv'e had cortisol checked was told it was normal. last tsh test on may 29, 2013 was .861.

if you don't take the nap, this doesn't happen? How's your sleep at night?
Customer: replied 4 years ago.

my sleep at night is sporadic; some times ok; some times not always good. iv'e had 3 sleep studies; 1996, found 327 brain awakenings; 1999, leg movement; 2001; combination of both. however, this daily lethargy has only been about last 3 may be 5 years.

What was suggested for the sporadic sleep?
Customer: replied 4 years ago.

some behavior things. iv'e taken most of the modern day sleepings meds with no help. trazadone ; seroquel; and, clonopin help the most. i currently take 50mg of trazadone; 1mg of clonopin; and, some times 75 mg of seroquel. but, iv'e taking these on and off for years with no effect on daily energy level.

OK--were you screened for chronic fatigue syndrome with Epstein-Barr virus titers?
Customer: replied 4 years ago.

not that i've been ever told.

OK--just to go back for a moment--what happens if you don't take the nap?
Customer: replied 4 years ago.

i generally feel ok and get a second wind.

OK--here's my thoughts. Despite the previous sleep studies I think you need another one to look specifically for sleep apnea. That said, I would screen you for chronic fatigue syndrome. As for what happens with the nap, hard to say exactly but it may be that the nap either isn't long enough or simply doesn't accomplish what a "power nap" is supposed to do. It would seem, for now, the, better idea for you is not to take the nap and instead take a brisk walk at that time of day.
Customer: replied 4 years ago.

well, i was just curious what would cause what i would consider a pschological effect, i.e. feeling disturbed; somewhat confused; from a nap. past sleep studies have not shown apnea.

why wouldn't current sleep doc do another sleep study. why wouldn't he or various internist; endochronologist do test for chronic fatigue or epstein-bar. thanks, j

Are you saying you currently see a sleep specialist? As for why the chronic fatigue hasn't been considered, I really can't say but it definitely is in the differential and since you don't have a thyroid insufficiency problem or low cortisol problem (and, I forgot to add this but I assume it's been checked--anemia), that would be my next disorder on the list

Customer: replied 4 years ago.

anemia is normal. i do have a sleep doc same one since 2000. prescribes the trazadone and clonopin.

has he remarked on the problems we've talked about here?
Customer: replied 4 years ago.

yes. for about the past year he has prescribed meds. advises going to bed earlier, getting up earlier; something he calls compressing sleep time. hasn't helped.

Customer: replied 4 years ago.

yes. he has prescribed meds. advises going to bed earlier; getting up earlier; something he refers to as compression time.

Well, I personally would do another study to look for apnea. I might also consider weaning you off one or more or your sleep meds for a time to see if by chance that could be part of the problem
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