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Should a medical doctor or sleep doctor treat my symptoms? Or both?

I have SO much going on and need some advice. 37 year old healthy and fairly fit, muscular male. 5'8 and 150 pounds. I've been "tired" for a lot of my life and couldn't focus that well. School was a big struggle and so is driving to this day. Not mentally alert enough. March 2018 sleep study showed 4.7 AHI with 18 RDI. Ridiculous amounts of RERAs listed. One in-lab study chart says 166 arousals+awakenings in 2.75 hours. 50 breathing events noted. No drops in oxygen levels below the low 90's, however. That sleep doc didn't recognize/treat Upper Airway Resistance Syndrome, so I got pushed by the wayside and denied a CPAP.  July 2018 my ENT doc did turbinate reduction and deviated septum surgery. I have breathed better since in regards to inhaling and exhaling, but sleep was still the same. Did a home sleep study a few months after surgery and got a 5.2 AHI over 6 hours of sleep. ENT doc wrote me a prescription to get a CPAP simply because she was floored that the sleep doc wouldn't give me one. It hasn't been titrated, particularly for the Respiratory Effort Related Arousals (RERAs). I used the APAP mode set to 7 starting pressure and 12 max to gauge my general obstructions. It never went above 9cm max to clear obstructions and usually hovered in the upper 7's to 8's on average. Brought the AHI down to 0.5 and even 0.0 at one point for an entire night, but still felt awful for months.

3 months ago I went to the ER after I was getting ready for bed one night and felt a cold feeling in my chest. My heart started racing, blood pressure went up pretty high (170/100), I felt faint-like, my whole body was trembling, etc. I never had that happen before. All told, I ended up going to the ER 3 times during various isolated incidents. Other times I had symptoms and stayed at home until I shook myself to pieces and it went away. Had all kinds of EKG's at the hospital, endless blood work for everything, had an MRI of the abdomen, a contrast CT scan of the abdomen, etc. They even checked for blood clots, heart attack, etc. Nothing. So they had no reason why my blood pressure or heart rate was suddenly up. GP doctor did all kinds of blood work a few months ago over several visits. Even blood work for adrenal tumors and such. My MRI and CT scan showed every organ as normal. I went to a Cardiologist and while my blood pressure was high sitting there, he had no idea why. I came back the next day and did a full Stress Echocardiogram, they looked at my heart beating in real-time via ultrasound and were able to see blood flow rates and everything digitally. They gave me an event monitor to press to my chest during these "attacks" and while I used it, they never noted anything out of the ordinary when I sent the results in.

Yet to this day I'm getting palpitations and my blood pressure monitor shows an alert for heart race bouncing up and down quite rapidly. Previous GP doctor tried to blame it all on anxiety and wanted me to keep taking Metoprolol to get rid of the symptoms, but not figure out why I have them. I've found another local GP doctor that I have a telemedicine visit with in the morning until I can get into the office when they accept more patients. They have a critical care provider that they may refer me to in the meantime.

I have an in-person visit with a very well-known sleep doctor/ENT doctor at a local hospital campus on 4/15. It is a whole team of people that deals with sleep disorders and ENT issues combined. He wants me to bring my CPAP, the sleep studies, etc. They're doing one day a week in-person appointments due to all of the Coronavirus stuff.

For the past 1.5 weeks, I've gotten to the point of being dizzy all day long from the time that I get up until the time that I go to bed. Chest pains, weird "cold" and tingling feelings in both legs (but more so the right than the left) are an everyday thing for me now as of the past 3-4 days. Even sexual activity makes me feel like I'm about to faint (I suspect due to the temporary reallocation of blood flow). This may be Postural Orthostatic Tachycardia Syndrome, which I've never had any issue with. My pulse does go much faster as soon as I stand up every morning. It is slow when I'm lying down. My blood pressure goes up and down all day. Could be in the 140's over 90's to 100 and then go back down to normal just a minute or two later.

I've had Gastritis for 3 months and I'm under the care of a GI doc for that. I may not be absorbing some vitamins because I'm on Nexium 40mg twice a day (for about 2 months now) to keep acid low. I'm taking a Stress B-Complex, 250mg Magnesium, Calcium, Vitamin C, Vitamin D3 and a multivitamin at intermittent levels and just started doing that 2-3 weeks ago after taking the meds for 1.5 months. I've read that they can cause low vitamin levels. I take the multivitamin daily. I try to stagger the others so that I don't take them all at once or too often. My GI doctor recently requested blood work, but nothing came back wrong other than high cholesterol. That's because I haven't been exercising much due to how poorly I feel. I'm trying to average at least 20-30 minutes a day on a recumbent bike and also eating more stuff like Avocados, broccoli, etc., trying to get my cholesterol down to a reasonable level. But with the rapid heartbeat and the odd dizzy-like feeling I get on a daily basis, it also makes working difficult.

Anyone had any first-hand experiences with sleep apnea or UARS causing this? My understanding is that the autonomic nervous system and sympathetic nervous system can be malfunctioning and cause all sorts of weird stuff. Can a GP doctor do anything or give me any meds to help regulate the POTS or dizziness?

I recently came across a medical term - Cyanosis - that describes some of the stuff I used to see. For instance, my fingernails would get a light bueish/purplish under them sometimes when I was cold or nervous. Also, all over my body if I get cold I start getting this light reddish/blueish look on my skin. Not as dramatic as the pure purple-like color that the people in photos of Cyanosis seem to get, but my fingernails and toenails do get a decent shade of blueish/purplish certain times. Should I be concerned?
1 Responses
Avatar universal
Suggest you continue working with your docs to either treat or eliminate the possibility of unaddressed med issues causing this.  If none, then you should consider the possibility of either psychiatric or nonmedical causes, including anxiety and stress.  To address those, have you ever used a full CBT sleep training system?  This will give you a comprehensive structure to address all the usual nonmedical root issues.  By doing so, at least you can eliminate those as a possible basis.
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