Heavy Head Symptoms: Is Sleep Apnea the Culprit?

Q: Heavy Head Symptoms: Is Sleep Apnea the Culprit?

Hello Alvin： If you have been diagnosed with sleep apnea, it is advisable to continuously wear a CPAP machine while sleeping. <br>Since all tests show no significant abnormalities and you are experiencing weight loss and physical discomfort, it is recommended that you consult a p

The back of the head has been heavy for nine months?

Hello doctor, I started experiencing a heavy sensation in the back of my head at the beginning of February this year.
Initially, I thought it was a cold, but after more than a month, I went to see a doctor.
The doctor said I was overweight (116 kg) and prescribed me diabetes medication (Forxiga 10 mg), which he said could help with weight loss.
After taking it for a week, I felt discomfort near my heart.
An ECG showed no issues, but the doctor noted that my blood pressure was high (155/101) and prescribed antihypertensive medication (Olmetec).
After taking it for three days, the heaviness in my head worsened, and I experienced numbness in my scalp and limbs.
A friend called an ambulance, and upon arriving at the hospital, the doctor attributed my symptoms to medication side effects.

Two days later, I began experiencing insomnia, and the pulsating sensation in the back of my head made it difficult to sleep.
On the third day, I finally managed to sleep, but this marked the beginning of my journey of medical consultations.
I underwent numerous tests, including blood tests, urine tests, brain CT, brain MRI, neck CT (which showed small bone spurs that the doctor said wouldn’t affect my dizziness), intracranial blood flow studies, autonomic nervous system tests, head ultrasound, EEG, abdominal ultrasound, 24-hour ECG, exercise ECG, and colonoscopy, all of which returned normal results.
I am also scheduled for an echocardiogram because I have had a slow heart rate (40-55 bpm) since I was young.
During my annual aviation medical examinations in my youth, doctors often questioned this, but they said my heart was very healthy.

Now, some doctors suspect that the heaviness in the back of my head may be related to my slow heart rate.
I also underwent a sleep apnea test, which revealed severe sleep apnea seven years ago (when I weighed 109 kg).
I used a CPAP machine for a month but stopped due to discomfort.
Recently, a doctor suggested that my brain may have been deprived of oxygen for a long time.
I had another sleep study this year, which indicated moderate sleep apnea (at a weight of 96 kg, AHI: 54, blood oxygen level 48%) after losing nearly 20 kg in the previous two months due to constant anxiety about my health and fear of dying.

I am still experiencing heaviness in the back of my head, a feeling of pressure, occasional numbness in my left hand and foot, and weakness in my limbs, but I do not have insomnia now.
I have been using the CPAP machine for over two months.
I would like to ask if my symptoms of autonomic nervous system dysregulation are caused by sleep apnea, and why did the autonomic nervous system tests show no issues? Thank you.

Alvin, 40~49 year old female. Ask Date: 2016/12/03

Dr. Liang Sunyuan reply Psychiatry

Hello Alvin: If you have been diagnosed with sleep apnea, it is advisable to continuously wear a CPAP machine while sleeping.
Since all tests show no significant abnormalities and you are experiencing weight loss and physical discomfort, it is recommended that you consult a psychiatrist for an in-person evaluation, as depression and anxiety disorders may also contribute to related symptoms.
Wishing you all the best.

Reply Date: 2016/12/03

More Info

Your symptoms of a heavy head, along with the history of sleep apnea and other health issues, certainly warrant a thorough examination. Sleep apnea, particularly obstructive sleep apnea (OSA), can lead to a variety of symptoms, including excessive daytime sleepiness, fatigue, and cognitive difficulties. The condition is characterized by repeated interruptions in breathing during sleep, which can result in decreased oxygen levels and fragmented sleep. This can lead to a range of complications, including cardiovascular issues, metabolic disorders, and neurological symptoms.

Given your history of severe sleep apnea, it is plausible that your current symptoms, including the sensation of heaviness in your head, could be related to this condition. The fact that you have experienced significant weight loss is a positive step, as weight reduction can often improve the severity of sleep apnea. However, the persistence of your symptoms despite using a CPAP machine suggests that there may be other factors at play.

The heavy sensation in your head could be attributed to several factors. One possibility is that it is a result of chronic hypoxia (low oxygen levels) due to untreated sleep apnea in the past. Long-term oxygen deprivation can affect brain function and lead to symptoms such as headaches, cognitive impairment, and a general feeling of heaviness or pressure in the head. Additionally, the stress and anxiety associated with your health concerns may also contribute to these sensations.

Your experience of numbness and tingling in your extremities could indicate peripheral neuropathy or could be related to anxiety and stress. It is essential to consider that anxiety can manifest physically, leading to symptoms such as muscle tension, which can further exacerbate feelings of heaviness or discomfort in the head and neck area.

Regarding your autonomic nervous system (ANS) evaluation, it is important to note that autonomic dysfunction can sometimes be subtle and may not always be detected through standard testing. The ANS regulates many involuntary bodily functions, including heart rate, blood pressure, and digestion. While your tests may have returned normal results, it is still possible to experience symptoms related to autonomic dysregulation, especially in the context of chronic health issues and stress.

To address your concerns, I recommend the following steps:
1. Follow-Up with a Sleep Specialist: Since you have a history of severe sleep apnea, it is crucial to have regular follow-ups with a sleep specialist. They can assess the effectiveness of your CPAP therapy and make necessary adjustments to improve your sleep quality.

2. Consider a Multidisciplinary Approach: Given the complexity of your symptoms, a multidisciplinary approach involving a neurologist, cardiologist, and possibly a psychologist or psychiatrist may be beneficial. This can help address both the physical and psychological aspects of your condition.

3. Lifestyle Modifications: Continue focusing on weight management through a balanced diet and regular exercise, as this can significantly impact your overall health and sleep apnea severity. Additionally, practicing stress-reduction techniques such as mindfulness, yoga, or cognitive behavioral therapy (CBT) can help manage anxiety and improve your overall well-being.

4. Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and managing your condition.

5. Further Testing: If symptoms persist, consider discussing with your healthcare provider the possibility of further testing, such as a repeat sleep study or additional imaging studies, to rule out any other underlying conditions.

In conclusion, your heavy head symptoms may indeed be related to your history of sleep apnea, but it is essential to explore all potential contributing factors. A comprehensive evaluation and a tailored treatment plan can help improve your quality of life and address your ongoing concerns.

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