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Fatigue that no one has been able to explain.

You're tired no matter how much you sleep

Waking unrefreshed. Afternoon crashes. That heavy, wrung-out feeling that doesn't lift even after a weekend off.

You haven't been the same since you got sick

Long COVID. Post-viral fatigue. Post-mono. The feeling that a virus flipped a switch and you never came back to baseline.

Every test comes back “normal”

CBC normal. TSH normal. Ferritin low but “fine.” You know something is wrong. You need a workup that goes further than the standard panel.

Our philosophy

Fatigue is a symptom, not a diagnosis.

Chronic fatigue almost always has a mechanism — often several stacked on top of each other. Mitochondrial dysfunction. Poor sleep architecture. Chronic viral activation. Hormone imbalance. Methylation blocks. Gut inflammation. Cortisol dysregulation. Standard labs miss most of them. We use functional testing to find what's actually broken, then rebuild it in the right order.

Test, don't guess

Functional labs go beyond a normal CBC and TSH. Methylation, DUTCH cortisol, MRT food sensitivity, gut microbiome, and mitochondrial markers change what we treat.

Fix in the right order

Sleep and mitochondrial cofactors first. Hormones and gut second. Advanced therapies (ozone, IVs, peptides) once the foundation is set. Skipping steps wastes months.

Track what changes

Validated symptom scales (fatigue, sleep, post-exertional malaise), wearable data, and repeat labs measure whether the plan is actually working.

The mitochondrial framework

Why energy fails at the cellular level.

Mitochondria are the tiny power plants inside every cell. When they underperform — from oxidative stress, nutrient depletion, infection, medications, or toxin exposure — every system that runs on ATP falters. Muscles fatigue. Brains fog. Immune systems misfire. Fixing the roots means giving mitochondria what they need (cofactors, oxygen, low inflammation) and removing what's stressing them.

What drains mitochondria

Chronic viral reactivation (EBV, CMV, HHV-6)
Poor sleep & untreated sleep apnea
Nutrient depletion (CoQ10, B-vitamins, magnesium, carnitine)
Chronic inflammation & oxidative stress
Hormone imbalance (thyroid, cortisol, sex hormones)
Medications (statins, some antibiotics, long-term PPIs)
Environmental toxins & heavy metals

What restores them

Deep, uninterrupted sleep & sleep apnea treatment
Targeted mitochondrial cofactors — CoQ10, PQQ, acetyl-L-carnitine, D-ribose, magnesium
NAD+ & glutathione IV therapy
Ozone therapy (mitochondrial oxygen utilization)
Hormone and thyroid balance
Reducing inflammatory load — gut, food, environment
Structured, graded activity — not overtraining

The root-cause workup

Testing that goes beyond standard labs.

Every test is optional. Your workup is a subset chosen from your intake.

Methylation & MTHFR panel

MTHFR genetics, homocysteine, methylmalonic acid, B12, and folate — to see whether your methylation cycle can actually produce energy, neurotransmitters, and detox capacity.

DUTCH complete hormone testing

Full sex hormone panel plus a 4-point cortisol rhythm — critical for understanding fatigue, sleep disruption, and adrenal contribution.

MRT food sensitivity testing

Mediator Release Test identifies foods driving low-grade inflammation. Often the missing piece in patients with unexplained fatigue and gut symptoms.

Gut microbiome (GI-MAP)

Comprehensive stool analysis: pathogens, dysbiosis, gut inflammation markers (calprotectin, secretory IgA), and digestive function.

Cardiometabolic & inflammation panel

hs-CRP, ferritin, homocysteine, HbA1c, insulin, ApoB, and a full lipid panel — inflammation and insulin resistance are silent fatigue drivers.

Chronic viral panel

EBV, CMV, HHV-6, and Lyme co-infection screening when indicated. Viral reactivation is one of the most-missed causes of chronic fatigue.

Therapeutic pillars

What the plan can include.

Choose from the toolkit — your plan is built from the pieces that fit your case.

1 · Ozone therapy & EBOO

Medical ozone modulates the exact biology that fails in mitochondrial dysfunction — oxygen utilization, oxidative-inflammation balance, and the Nrf2 pathway. Major autohemotherapy (MAH) is well-tolerated; EBOO delivers a more comprehensive session for patients who fit.

Major autohemotherapy (MAH)
EBOO — Extracorporeal Blood Oxygenation & Ozonation
Insufflation protocols
Ozonated saline & oils

2 · IV nutrient therapy

Direct-delivery mitochondrial cofactors when oral absorption is impaired. Personalized to your labs — not template drips.

NAD+ infusions
Glutathione (antioxidant & detox)
Myers cocktail & high-dose vitamin C
Methylated B-complex + magnesium

3 · Targeted mitochondrial supplementation

Not shotgun stacks. Specific cofactors chosen from your workup.

CoQ10 (ubiquinol) & PQQ
Acetyl-L-carnitine
D-ribose
Magnesium (glycinate, threonate, malate)
Alpha-lipoic acid, NAC

4 · Hormone, thyroid & adrenal support

Fatigue rarely resolves while cortisol, thyroid, and sex hormones are off. Bioidentical HRT when indicated; thyroid replacement when the labs warrant it; adaptogens and lifestyle scaffolding for adrenal recovery.

Bioidentical HRT (perimenopause / menopause / andropause)
Optimized thyroid replacement (T4/T3 when appropriate)
DHEA, pregnenolone (when labs support use)
Adaptogens: ashwagandha, rhodiola, holy basil

5 · Peptide support

Select FDA-approved and clinically established peptides used inside the fatigue framework. Full details on our Weight Loss & Peptides page.

Thymosin alpha-1 — chronic viral reactivation
Sermorelin — GHRH-axis support (screened patients)
Tesamorelin (Egrifta®) — where indicated
GLP-1s — when metabolic dysfunction is driving fatigue

6 · Long COVID & post-viral protocols

Long COVID and post-viral fatigue have a distinct signature — mitochondrial dysfunction, endothelial inflammation, and immune dysregulation. Our combined ozone + IV nutrient + immune-modulation toolkit is a strong fit for this population.

Ozone / EBOO adjunct
NAD+ & glutathione IV support
Thymosin alpha-1 for immune modulation
Graded activity plan (PEM-aware)

Sleep evaluation & optimization

The single biggest lever most patients haven't pulled.

Poor sleep is the most consistently undertreated driver of fatigue, brain fog, hormone imbalance, weight gain, and immune dysfunction. Fixing sleep changes the trajectory of almost every other treatment.

Comprehensive sleep evaluation

A thorough sleep history, symptom screening, and review of wearable data (Oura, Whoop, Apple Watch, Fitbit). Circadian assessment. Screening for sleep apnea, insomnia, restless legs, and circadian rhythm disorders.

STOP-BANG apnea screening
Wearable data review
Circadian assessment
Sleep diary / actigraphy review

Sleep study coordination

Home sleep testing (WatchPAT, Nox) or in-lab polysomnography referral when clinically indicated. We interpret results with you and coordinate treatment — you don’t have to figure out CPAP setup, oral appliance fitting, or ENT referrals on your own.

Home sleep testing referral
Polysomnography referral
Full treatment coordination (see menu below)
ENT & sleep specialist referral network

Sleep medication evaluation

Careful review of what you're taking. Deprescribing benzodiazepines and Z-drugs (zolpidem, eszopiclone) when appropriate. Evaluating better options — trazodone, doxepin, ramelteon, dual orexin antagonists (suvorexant, lemborexant) — for the right patient.

Deprescribing benzodiazepines & Z-drugs
Trazodone, doxepin evaluation
Ramelteon (melatonin receptor agonist)
Suvorexant / lemborexant (orexin antagonists)

Non-pharmacologic sleep support

CBT-I is the strongest evidence-based treatment for insomnia — we refer and coordinate. Targeted supplements dosed and timed correctly. Circadian light hygiene. Sleep-friendly HRT and progesterone strategies in perimenopause.

CBT-I referral
Melatonin timing & low-dose strategy
Glycine, magnesium threonate, apigenin, L-theanine
Progesterone / HRT for perimenopausal sleep
Light therapy & circadian coaching

Sleep apnea treatment menu

The right treatment is the one you’ll actually use.

CPAP works — when patients tolerate it. Roughly a third of people prescribed CPAP stop using it within the first year. That’s not failure — it means they need a different tool. We coordinate the full menu so you can find what works for you.

CPAP & BiPAP through Apria Healthcare

For moderate-to-severe obstructive sleep apnea, positive airway pressure remains the gold standard. We coordinate directly with Apria Healthcare for machine setup, mask fitting, and ongoing supply resupply.

APAP (auto-adjusting) — the most common starting point
CPAP (fixed pressure) once titrated
BiPAP for higher pressure needs or central apnea overlap
Mask trials — nasal pillows, nasal, or full-face
Compliance data review at follow-up

Oral appliances (mandibular advancement)

For mild-to-moderate OSA, or for patients who can’t tolerate CPAP, custom-fitted oral appliances advance the lower jaw forward to keep the airway open during sleep. Made by a dentist trained in dental sleep medicine.

Referral to local dental sleep medicine providers
Custom-fitted — not the drug-store versions
Travel-friendly, no machine, no cord, no noise
Follow-up sleep study to confirm effectiveness
Often covered by dental insurance or FSA/HSA

Myofunctional therapy

A structured tongue-and-airway exercise program taught by a myofunctional therapist. Strengthens the tongue and upper airway muscles to reduce collapse during sleep. Evidence supports it as adjunct therapy for mild OSA, snoring, and mouth breathing — and it can improve CPAP tolerance.

Referral to certified myofunctional therapists
Adjunct to CPAP or oral appliance therapy
Standalone option for mild OSA and snoring
Helpful for tongue thrust, mouth breathing, TMJ overlap

Positional therapy & weight-focused options

For positional OSA (worse when supine), simple positional devices can be highly effective. For patients whose sleep apnea is closely tied to weight, we coordinate weight-loss support alongside — GLP-1 therapy, nutrition, and metabolic care — recognizing that treating apnea and treating weight are linked.

Positional therapy devices & sleep position training
GLP-1 medications for OSA-linked weight (semaglutide, tirzepatide)
Recent FDA-approved OSA indication for tirzepatide
Nutrition & metabolic support

ENT & surgical referral

Some patients need an anatomical evaluation — enlarged tonsils, deviated septum, nasal obstruction, or candidacy for Inspire hypoglossal nerve stimulation. We refer to ENT and sleep surgery specialists when the airway anatomy is the driver.

ENT evaluation for anatomical obstruction
Inspire (hypoglossal nerve stimulator) referral
Nasal surgery / turbinate reduction referral
Pediatric referral for kids with tonsillar hypertrophy

CBT-I for insomnia & overlap

Many patients have both sleep apnea and insomnia (called COMISA — comorbid OSA and insomnia). Treating one without the other rarely works. CBT-I is the first-line, evidence-based treatment for chronic insomnia and often has to be done alongside apnea therapy.

CBT-I referral — in-person and telehealth options
Stimulus control & sleep restriction techniques
Sleep-friendly medication review
Coordinated with apnea treatment when both are present

The bottom line: if CPAP hasn’t worked for you, we don’t give up on treating your sleep apnea — we move to the next option. Untreated apnea drives fatigue, brain fog, cardiovascular risk, weight gain, hormone disruption, and cognitive decline. There’s almost always a workable option.

Who this is for

The program helps people with:

Unrelenting fatigue

Fatigue that isn't fixed by rest
Post-exertional malaise (PEM)
Waking unrefreshed
Morning exhaustion despite sleeping

Long COVID & post-viral

Fatigue persisting after COVID or another infection
Cognitive changes post-infection
Exercise intolerance
Autonomic symptoms

Perimenopause / menopause fatigue

Hormonal energy crash
Sleep disruption
Brain fog + fatigue combined
Weight gain with low energy

Athletes & overtraining

Unexplained performance decline
Chronic soreness & poor recovery
Hormonal / immune dysregulation
Sleep quality changes

Chronic stress & burnout

Wired-and-tired pattern
HPA-axis dysregulation
Anxiety with fatigue
Poor sleep + poor recovery

Chronic infection recovery

EBV / CMV reactivation
Post-Lyme / co-infection support
Recurrent viral illness
Immune dysregulation

An important note

This is a wellness and functional-medicine program. It does not diagnose or treat ME/CFS, POTS, or other complex chronic illnesses as a standalone. When those diagnoses are present, we coordinate with specialists.
If your fatigue is sudden, severe, or accompanied by chest pain, shortness of breath, unexplained weight loss, or neurologic symptoms — that's an urgent workup, not a wellness program. Please seek immediate evaluation.
Some testing and therapies discussed here are cash-pay. We'll walk you through what's covered and what isn't at your discovery call.

The evidence library

Selected studies behind the plan.

Mitochondrial dysfunction in chronic fatigue & long COVID

Mitochondrial dysfunction in long COVID — systematic review.
Mitochondrial dysfunction and chronic fatigue syndrome — review.
Ozone, Nrf2 pathway & oxidative-inflammatory balance — Ageing Research Reviews.

NAD+ and mitochondrial cofactors

NAD+ precursors — systematic review of neurologic outcomes — BMC Neurology, 2025.
NAD+ metabolism and neuroinflammation — Journal of Neuroinflammation.
NAD+ & precursors: cognitive outcomes — Nutrients, 2022.

Sleep apnea & fatigue / cognitive impact

Sleep-disordered breathing & risk of dementia — meta-analysis — 2025.
Cognitive impairment in obstructive sleep apnea — meta-analysis — 2025.
Sleep apnea & incident cognitive impairment — JAMA Neurology.

CBT-I & sleep medication evaluation

CBT-I as first-line for chronic insomnia — Annals of Internal Medicine (ACP guideline).
Deprescribing benzodiazepines & Z-drugs in adults.
Orexin antagonists (suvorexant, lemborexant) for insomnia.

DUTCH cortisol testing & HPA-axis dysregulation

DUTCH Test — clinical validation summary (PDF).
HPA-axis dysfunction & chronic fatigue — PubMed reference.

Thymosin alpha-1 & chronic viral reactivation

Thymosin alpha-1: comprehensive review — World Journal of Virology.
Thymosin alpha-1 safety & efficacy update — 2024.

Studies are provided so you can read primary sources. They inform our thinking; they don't guarantee any individual result.

Common questions

What people usually want to know.

How is this different from going to my regular doctor for fatigue?

Standard workup usually stops at a CBC, TSH, and iron. Those are worth doing — but if they're normal and you still feel awful, the workup shouldn't stop there. We add functional testing (methylation, DUTCH, MRT, gut, viral panels, mitochondrial markers) and treat what we find with tools most primary care offices don't offer.

How long does the program take?

Most patients see meaningful change within 60–90 days. Full mitochondrial recovery — especially post-viral or long COVID — is often a 6–12 month arc. We build the plan in phases so you're not paying for tests or therapies you don't need yet.

Is any of this covered by insurance?

Some office visits and standard labs may be reimbursable out-of-network via a superbill — see Billing. Functional testing (DUTCH, MRT, gut, mitochondrial), IV therapy, ozone therapy, and peptides are typically cash-pay. HSA and FSA are often eligible.

Do I have to do all the testing at once?

No. We phase testing based on what your intake suggests is most likely — usually a foundational panel first, then targeted follow-up. You're never billed for tests we don't need.

Will I need to change my medications?

Sometimes. If a medication is contributing to fatigue or mitochondrial stress (some statins, PPIs, benzodiazepines), we'll discuss whether adjusting or replacing it makes sense — always coordinated with your other prescribers.

Can I speak Spanish with the provider?

Yes. Rosita is bilingual in English and Spanish, and the full program can be delivered in either language.

When your labs are “normal” but you feel awful, we look deeper.