What are the recommended actions for someone experiencing chronic fatigue and hypersomnia?
I am a 30-year-old female currently taking Adderall 5mg three times a day and lorazepam 0.5mg as needed (which is infrequent), alongside a daily combined oral contraceptive. I consume around two alcoholic drinks daily, do not smoke, and avoid any other substance use. My diet is generally well-rounded. For approximately a decade, I have struggled with chronic fatigue and hypersomnia, a challenge that I believe began in my early twenties. This issue coincided with a severe illness resembling the flu, during which I experienced an extremely high fever of 105°F. Since that incident, I find that sleep does not rejuvenate me; rather, it feels like a constant, necessary task. On particularly challenging days, I can sleep for as long as 20 hours. I can easily fall asleep in various situations, whether in crowded public areas, during lectures, in meetings, or even while sitting upright on an airplane, regardless of whether someone is conversing with me. It's not so much a sudden episode but rather a gradual drifting off once I close my eyes. Although Adderall provides some help, I often feel drained upon its effects subsiding. As a medical student in my final year of preclinical studies, I worry about the necessity of relying on stimulants indefinitely just to manage my daily activities, especially in a clinical environment. I've undergone numerous evaluations for my chronic fatigue, including tests for vitamin deficiencies, iron levels, and thyroid function. The only consistently abnormal results I've received indicate slightly low MCV/MCH levels and an increase in platelets. One of my past healthcare providers mentioned the possibility of thalassemia but concluded that there wasn’t much that could be done about it. As I transition to a new primary care physician, are there any particular blood tests I should discuss that are outside what is typically included in a fatigue assessment? Additionally, it has never been suggested to me that I undergo a sleep study. I appreciate any guidance you can provide!
Answers (1)
6/26/2025, 10:50:47 PM
OpenHealth AI
Chronic fatigue and hypersomnia, especially with your history and current medications, can be complex. You've taken important steps in seeking help; now, let's focus on specific actions you can take to better manage your symptoms while transitioning to a new primary care physician.
Main Points:
- Chronic fatigue and hypersomnia can have various underlying causes.
- Continued evaluations may include specific tests and possibly a sleep study.
- Lifestyle modifications and monitoring symptoms are essential.
Explanation:
Your experience of chronic fatigue for over a decade, coupled with hypersomnia, suggests that there may be more than one underlying issue contributing to your symptoms. Given the significant life disruptions you’ve faced, it's understandable to seek a better understanding and management plan.
Since your recent test results showed only mild abnormalities, it's worth considering that your fatigue may not be solely due to these issues. You also mentioned the medications you're taking, which can sometimes contribute to feelings of fatigue when the effects wear off, particularly with stimulants like Adderall. It’s important to balance your current medications with your ongoing symptoms.
Next Steps:
-
Schedule a Comprehensive Evaluation:
- Discuss the following potential tests with your new primary care physician:
- Sleep Study (Polysomnography): This can help identify sleep disorders such as sleep apnea or narcolepsy, which might explain your excessive daytime sleepiness and fatigue.
- Vitamin D and B12 Levels: Though you have had some screens, these can often be overlooked.
- Autoimmune Panel: Considering your history with severe illness, evaluating for autoimmune conditions like lupus or chronic fatigue syndrome may be helpful.
- Hormonal Assessments: Levels of cortisol or other hormones may provide insights, especially if you have physical stressors affecting your sleep.
- Discuss the following potential tests with your new primary care physician:
-
Monitor Your Symptoms:
- Keep a sleep diary for a couple of weeks. Note how much you sleep, daily energy levels, and any particular situations that lead to increased fatigue or sleepiness. This could provide invaluable information for your healthcare provider.
-
Lifestyle Adjustments:
- Limit Alcohol: While you've noted two drinks daily, reducing this could potentially improve sleep quality and overall fatigue.
- Consider Sleep Hygiene: Create a calming bedtime routine, ensure a comfortable sleep environment, and maintain a consistent sleep schedule to improve sleep quality.
- Physical Activity: If possible, engage in light to moderate exercise, as this can enhance overall energy levels and improve sleep.
-
Nutrition Check: Since you have a well-rounded diet, consider consulting with a dietitian for a tailored plan that may help in managing fatigue.
It's pivotal to maintain open communication with your new primary care provider about your symptoms and concerns, ensuring they understand the impact on your daily life, particularly as a medical student. You're taking commendable steps in looking for answers and help—this proactive approach is key! Please feel free to reach out if you have further questions or need clarification on any points.
Related Questions
Cellulitis Development Three Weeks Post-Injury?
I am a 35-year-old male, weighing 155 pounds and standing 5'10" tall. I have no prior medical conditions and I do not take any medications. Overall, my health is generally good. Approximately three weeks ago, I suffered a minor scrape on my leg. After cleaning the wound, I applied polysporin, which allowed it to form a scab. Following the scab's eventual shedding, the healing process appeared to progress positively. My leg showed noticeable improvement, especially since I have been keeping it covered and hydrated with Vaseline. Throughout the recovery, I have also been applying fusidic acid around the wound area. This morning, everything seemed to be on track, but upon changing the bandage this afternoon, I noticed an increase in redness around the edges. I'm uncertain whether this indicates the beginning of an infection or if it could simply be irritation caused by the medical tape I’ve used to secure the dressing. Images will be added in the comments. I have an international trip coming up in 72 hours, and I’m eager to resolve this issue quickly. I conducted a self-assessment twelve hours ago, and thankfully, there has been no spreading of the redness.
Is There Truly No Solution for Neurofibromas?
I apologize if my English isn't perfect; it’s not my primary language. At the age of around 7 or 8, I discovered that I had neurofibromas. These manifested as small, dark spots and minor bumps on my skin, none of which caused any discomfort. My parents took me to the hospital, where I received the diagnosis of neurofibromas. When we inquired about the possibility of them disappearing, the doctors explained that these growths tend to come and go, and that there is currently no known cure. After this, we sought advice from a homeopathic physician who prescribed various medicines and creams while advising me to avoid red meat and eggs during treatment. Unfortunately, there was no significant improvement, so we later consulted an Ayurvedic practitioner, but still no notable changes occurred. As a young woman, this condition troubles me considerably, particularly when I observe my reflection. There are small spots around my mouth and minuscule ones on my face that are difficult to notice unless viewed under direct sunlight. Given my slightly dusky skin tone, they somewhat blend in. I genuinely need to understand if there is indeed no viable treatment available for this condition. A couple of additional points: 1. I have noticed a few spots in my eyes as well, which might explain my difficulty in seeing text from a distance. 2. Recently, I had a small tumor removed from my leg (it was not cancerous); it was located on a nerve. Unfortunately, since the procedure was done at a government facility, we didn’t receive detailed feedback from the pathology lab. My parents speculated that perhaps, due to the benign nature of the tumor, no further explanations were provided. So, I'm left wondering... is there truly nothing that can be done about this?
Understanding Lymphoma Diagnosis
Hello, I'm a 24-year-old woman currently undergoing evaluation for possible lymphoma. For more than six months, I've experienced gradual swelling and unusual firmness of lymph nodes in my neck, beneath my jawline, and in my groin. In addition, I deal with debilitating night sweats, persistent tiredness, noticeable weight loss, gastrointestinal problems, increased itching, and sporadic rashes. Throughout this period, I have undergone extensive blood tests, assessments for autoimmune disorders, numerous CT scans both with and without contrast, chest X-rays, and most recently, a PET scan. All these tests have returned normal results, with some incidental findings that don’t seem to be connected to my issues. However, after the PET scan showed no anomalies, my primary care physician still recommended that I see an oncologist for a potential biopsy and additional evaluation of my night sweats. She expressed concern regarding the possibility of a B cell lymphoma that the PET scan might have missed. Is this something that can occur? Should I remain worried about the potential for cancer, or could this just be a precautionary measure given the swollen lymph nodes?
The Vomiting Enigma
Age: 47, Female At the time of these incidents, I was prescribed a combination of Effexor, Geodon, Tenex, and Klonopin intermittently. A routine upper endoscopy was performed, revealing no abnormalities. In March 2009, I underwent gallbladder surgery and experienced a smooth recovery without complications, apart from occasional diarrhea following meals. However, in August of the same year, I awoke one morning to find myself uncontrollably vomiting. Remarkably, this occurred in the absence of any other symptoms or that typical nauseous sensation; it was solely the vomiting. My doctor's office was conveniently located on my street, so I went in and was diagnosed with a stomach virus. They administered a Phenergan injection and I was sent on my way. From August 2009 through September 2014, I endured similar episodes multiple times. These episodes bore no relation to specific foods or hormonal changes; they could occur two weeks in succession or sporadically every few months, without any apparent pattern. My struggles with anxiety were often blamed for these bouts. When the episodes occurred, they weren't brief; it was relentless projectile vomiting throughout the day and night, rendering me unable to retain any food or liquid. Neither Phenergan nor Zofran tablets provided relief, and while I did have Phenergan suppositories, they were only effective about 25% of the time. More often than not, I found myself in urgent care seeking an injection for relief. I was hospitalized twice due to the severity of my vomiting, which ultimately led to kidney failure. The most recent episode occurred in either August or September of 2014, during yet another hospital admission. Throughout this ordeal, I had been living with my mother. Several months later, she was involved in a car accident that resulted in her being placed in a nursing facility. Once I no longer lived with her, these distressing episodes ceased entirely. At times, I felt as if something was amiss, almost as if I were being poisoned, but deep down I knew my mother wouldn’t intentionally harm me. It is now over a decade since then, and I am relieved to say that I have not experienced such issues again.
Evaluating the Reliability of Ultrasound for Hemangioma Detection
I am a 33-year-old female, weighing 175 pounds and standing at 5 feet 8 inches, with no existing health concerns. Recently, I underwent an ultrasound to assess the condition of my gallbladder, during which a "likely hemangioma" was discovered on the right side of my liver. Described as a 0.7 cm hyperechoic lesion, I am now wondering how much trust I can place in the ultrasound results suggesting it is indeed a hemangioma. I stumbled upon an article mentioning a case where a woman was initially diagnosed with a hemangioma, only to find out five years later that it was, in fact, a cancerous growth that had advanced significantly. It’s worth noting, however, that she was experiencing ongoing pain, which I do not currently have. Additionally, my liver function tests returned normal results, further complicating my concerns.