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Where do the tiredness symptons come from
Apr 1, 2013

Hi Nigel,

First I want to tell you that I realy admire you. You have answered question that I send before. At the moment I am still doing quite well. Not on medication, almost 3 years infected and having a CD4 count of 1179 and a viral load that even went down from 6000 to 2017.

There is only one thing that is realy bothering me. I keep falling asleep when I need to drive longer then half an hour on the high way, write documents, watch boring TV and other dull things that people need concentration with. The worst times in the day are early morning and in the early afternoon. I am not sure if HIV is the cause because I am also overweight (1,86 meter and 125 kg) and snore like a fog horn while sleeping at night (that is realy loud).

What should I do keep some Red Bull or other energy drink close to me all the time or is there anything else that you can suggest. I am very much afraid of losing work because of this or worse cause accidents.

I hope you will have time to answer again. I would be happy to hear from you if it could be related to my HIV.

Thanks Jules

Response from Mr. Vergel

I would bet money on the fact that you may have sleep apnea.

Talk to your doctor about getting a sleep test done.

Weight loss can help improve sleep apnea. Some people may need to use a CPAP machine or oral device.

You may want to read these pages from my last book (Testosterone: A Man's Guide- on amazon.com)

Sleep Apnea:

Sleep apnea is a sleep disorder in which a person briefly stops breathing or breathes shallowly many times during sleep and therefore does not get enough restful sleep; oxygen levels drop in the blood, starving the brain of oxygen. In addition to causing daytime fatigue, it can increase blood pressure and cardiovascular risks. Testosterone replacement therapy has been associated with exacerbation of sleep apnea or with the development of sleep apnea, generally in men who use higher doses of testosterone or who have other identifiable risk factors for sleep apnea (high body weight, thick necks, snoring, alcohol consumption, and others). Upper- airway narrowing does not seem to be caused by testosterone replacement therapy, suggesting that testosterone replacement contributes to sleep- disordered breathing by central mechanisms rather than by means of anatomical changes in the airway.

If your spouse or partner complains that you snore loudly at night and you suffer from fatigue, tell your doctor. The only real way to find out if you have sleep apnea is to have your doctor refer you to a sleep lab for a sleep study. If you are diagnosed with sleep apnea, a Continuous Pressure Airway Pressure (CPAP) machine can be prescribed to help you open up your airways with a small air pump while you sleep. Some people love it while some hate wearing a mask while being hooked up to a machine at night. I have seen men regain their quality of life after starting CPAP. It is paid by insurance, Medicare and most HMOs.

A new emerging option for those who hate CPAP machines with mild to moderate apnea is the use of oral appliance. Worn in the mouth like an orthodontic appliance during sleep, oral appliances keep the soft tissue from collapsing and interrupting normal breathing patterns. The purpose of the oral appliance may be to reposition the lower jaw, tongue, soft palate, and hyoid bone into a certain position, to keep the airway open with stabilization of the tongue and jaw, or to provide artificial muscle tone to prevent collapse and resulting airway blockage. The doctors will fit your oral appliance for comfort by using a mold of your mouth to design your unique fit.

Sleep apnea appliances fall into two categories: fixed and adjustable. Here are brief descriptions of some commonly used sleep apnea dental appliances:

TAP® 3 (Thornton Adjustable Positioner) The TAP® 3 is the smallest, most comfortable member of the TAP family. It is a two-part custom-created sleep apnea appliance that fits over the teeth in much the same way as a sports mouth guard. The TAP® 3 projects the jaw forward to prevent the tongue and soft tissues from impeding the airway. The lower jaw positioner is adjustable, which means that it can be altered to suit the comfort level of the wearer. The TAP® 3 appliance can accommodate the three main types of malocclusion, and allows the lips to fully close.

OASYS Appliance The OASYS appliance is designed to move the base of the tongue toward the front of the mouth by gently repositioning the jawbone (mandible). This shift opens the oropharynx and strengthens the upper airway. An extension of the upper shield projects toward the nose, creating a larger nasal opening and less resistance to normal airflow. This adjustable appliance is comfortable to wear and extremely patient friendly.

KlearwayTM Appliance The KlearwayTM Appliance is generally used to alleviate obstructive sleep disorder and eliminate snoring. The patient or dentist can project the jaw forwards in increments of .25mm at a time. This ensures maximum comfort for the sleeper. The KlearwayTM appliance is made from VariflexTM heat softening acrylic, which makes it easier to insert. Running warm water over the appliance makes it pliable, but once placed in the desired position, the acrylic hardens again.

Herbst Telescopic Appliance The Herbst appliance is held in the mouth by clasps and friction grips. It is made of acrylic, and contains adjustable metal wiring. The advantage of this appliance is that the wearer is able to move vertically and laterally without dislodging the appliance. The Herbst appliance is usually used in mild and moderate cases of sleep apnea, and can also alleviate loud snoring effectively. If you have questions or concerns about sleep apnea appliances, please ask your dentist. To locate a dentist in your area that uses these products, visit: endsnore.com/request-form.aspx

Stimulants:

Some physicians prescribe drugs like Nuvigil, Ritalin or Adderall when everything else fails.

Armodafinil (brand name Nuvigil) is used to treat excessive sleepiness caused by narcolepsy (a condition of excessive daytime sleepiness) or shift work sleep disorder (sleepiness during scheduled waking hours and difficulty falling asleep or staying asleep during scheduled sleeping hours in people who work at night or on rotating shifts). Armodafinil is also used along with breathing devices or other treatments to prevent excessive sleepiness caused by obstructive sleep apnea/hypopnea syndrome. Armodafinil is in a class of medications called wakefulness-promoting agents. It works by changing the amounts of certain natural substances in the area of the brain that controls sleep and wakefulness. Some insurance companies do not want to pay for it. It is not an amphetamine and it does not require a special prescription since it not a class III DEA regulated drug. Many doctors have samples so that you can try it before you commit to using it.

I hope this helps you to discuss this important topic with your doctor. Also, please be careful driving while you are tired!

Nelson



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