Lack of mental focus, slurred speech after starting CPAP

[edmundg]

Hello all, first time posting here, so I'll give you my story and hopefully it leads to a better understanding of what could be wrong.

Nearly 2 years ago in February of 2016 I had roughly a month where I was extremely tired all of the time, and my energy and motivation were fairly low. I saw doctors who generally told me that it is likely stress related to work or home life. Now, while I had become a father about one year earlier and all of the sleep issues that arise from that, there was nothing in my work life that would lead to any amount of stress that could account for this issue that I was having. In fact, I very much enjoy my work as I run my own company and is generally a lot of fun to work on a daily basis. The only real stress that I had was not being able to work efficiently, something that I'll get to a bit later.

Long story short, nothing meaningful happened and things got better about a month later. About one year after that in Feb of 2017 the same things started happening again, but this time it continued and got far worse until I was given my CPAP. From Feb to June when I got the CPAP I went from hitting the pillow and being asleep almost instantly for 8-9 hrs a night to having insomnia that generally kicked in about 1hr after falling asleep around 11pm and staying awake until 3-4am most nights. Almost like clockwork I'd sleep at 11, then wake up at 12 and be awake, and full of stress/anxiety until 4am then finally get a bit more sleep until maybe 6 or 7am.

This pattern that lasted for about 5 months left me physically and mentally wrecked, clear signs of sleep deprivation, and just falling apart in every way. None of the doctors thought to look into sleep apnea, and it took a friend of mine telling me about it that made me specifically question the doctors to the point that they asked the right questions, and we had our answer. My initial sleep test showed an AHI of 32.9, and I was given my CPAP a couple of weeks later. Almost instantly, I was 100x better than I had been in months, sleeping instantly and staying asleep and only needing 6hrs to feel refreshed versus 9hrs and still being sleepy. I went from never having been a "morning person" to being just fine waking up. This brings me to my main issue:

In the roughly 6 months that I've been using the CPAP, I now have a new issue. When I sleep for 7+ hours, in general I will wake up a bit dizzy, which stays with me for a few hours at least. Additionally, I am very prone to fumbling things now like keys, toothbrush, etc which has never happened before. The biggest thing is that when I get those 7+ hours now (all on CPAP every day since I got the machine) for the rest of the day for the most part, my mind is quite slow, unable to focus, very poor memory, slow reaction time (physically and mentally), and my speech can be slurred and/or I will mix up similar sounding words quite often, like "exhale and exhume" or something similar to that. I find that in general my best times mentally are around 8-9pm at night, about as far away from when I woke up as it gets.

Now, when I tend to get under 7 hours, like 5-6, I wake up much more alert, not dizzy, and my mental abilities are basically "back to normal", pre-CPAP days. The downside is that I'm physically tired throughout the day, but at least my mind is much sharper, something that I need as a business owner. This isn't sustainable of course, so I tend to try to be somewhere in the middle so that I can be more alert but also not physically tired.

As for my details, I am now 40 years old, BMI of 30, with stable weight for my entire adult life. I am not on any medicines, and have been a snorer my whole life as far as I know. I went from AHI 33 untreated to about 1-2 (almost instantly) on my Philips Dreamstation 500 with a dreamwear nose mask (which appears to fit fine, generally listed as 100% fit by the software).

I'm sure you'll be asking for my readings from Sleepyhead, and I can look to post those at a later time once I'm at home. Also, I'm sure I'll get a lot of "that's just sleep debt, just keep at it" but these are new symptoms that never existed before, and clearly only happen once I've slept longer, and almost not at all when I sleep less.

If anybody has had any similar issues, I'd love to hear if they persisted, and if there was any sort of solution that you've had. The Dr that perscribed my CPAP has heard all about it, things it's not normal, but tells me to continue just using it and see what happens. I've also run an MRI on my brain about 3-4 months into using the CPAP but it didn't show anything abnormal.

Thank you all in advance!

[Wulfman...]

You've given us virtually no information to go on.
Please fill in your equipment profile and include all of your settings......pressure, humidifier, exhale relief, etc.

Take control of your therapy. YOU need to figure out what is or is not working with your therapy. Could be you're having massive leaks and nullifying your therapy benefits, but until you see it on the reports, you can't know what to fix.


Den

.

[MrsRinPDX]

... This brings me to my main issue:

In the roughly 6 months that I've been using the CPAP, I now have a new issue. When I sleep for 7+ hours, in general I will wake up a bit dizzy, which stays with me for a few hours at least. Additionally, I am very prone to fumbling things now like keys, toothbrush, etc which has never happened before. The biggest thing is that when I get those 7+ hours now (all on CPAP every day since I got the machine) for the rest of the day for the most part, my mind is quite slow, unable to focus, very poor memory, slow reaction time (physically and mentally), and my speech can be slurred and/or I will mix up similar sounding words quite often, like "exhale and exhume" or something similar to that. I find that in general my best times mentally are around 8-9pm at night, about as far away from when I woke up as it gets.

The first thing that comes to mind is that those are stroke warning signs and this might not be related to sleep at all. I would make an appointment with your doctor and soon. http://www.strokeassociation.org/STROKE ... mePage.jsp

[49er]

... This brings me to my main issue:

In the roughly 6 months that I've been using the CPAP, I now have a new issue. When I sleep for 7+ hours, in general I will wake up a bit dizzy, which stays with me for a few hours at least. Additionally, I am very prone to fumbling things now like keys, toothbrush, etc which has never happened before. The biggest thing is that when I get those 7+ hours now (all on CPAP every day since I got the machine) for the rest of the day for the most part, my mind is quite slow, unable to focus, very poor memory, slow reaction time (physically and mentally), and my speech can be slurred and/or I will mix up similar sounding words quite often, like "exhale and exhume" or something similar to that. I find that in general my best times mentally are around 8-9pm at night, about as far away from when I woke up as it gets.

The first thing that comes to mind is that those are stroke warning signs and this might not be related to sleep at all. I would make an appointment with your doctor and soon. http://www.strokeassociation.org/STROKE ... mePage.jsp

I definitely agree with the advice to see your doctor asap. Please don't delay.

[Rainmom17]

I share some of your issues (dizziness, feeling better at night), but mine have been around pre and post cpap. I am becoming convinced it is from an issue other than my apnea. Have you changed anything else in this time period - added supplements, changed your diet, for example? I agree with seeing a doctor to run a bunch of blood work if you haven't done that. A neurologist would be great because they could tackle both the dizzy problem and the slurred speech.

[Mogy]

Hi edmundg,
I also get a headache when I use my machine for the whole night, which is not very often. I usually sleep about 3 or 4 on, and 3 or 4 off. That will probably not go over well here but it seems to work the best for me right now.
I had the mental fog before I got my machine but it is much better now.
Have you thought about losing some weight. I was at a BMI of 30 when first diagnosed. I went down to about 22.5 but I am now back up to 25. I can notice a difference in how I feel between 22.5 and 25.
Everything (mind and body) was better at 22.5 and I am trying to get back there.
Do you have an oximeter that records overnight? I am convinced my brain fog was mostly related to the low oxygen before my diagnosis. Other things besides apnea can affect your oxygen at night, which was my case.

[edmundg]

... This brings me to my main issue:

In the roughly 6 months that I've been using the CPAP, I now have a new issue. When I sleep for 7+ hours, in general I will wake up a bit dizzy, which stays with me for a few hours at least. Additionally, I am very prone to fumbling things now like keys, toothbrush, etc which has never happened before. The biggest thing is that when I get those 7+ hours now (all on CPAP every day since I got the machine) for the rest of the day for the most part, my mind is quite slow, unable to focus, very poor memory, slow reaction time (physically and mentally), and my speech can be slurred and/or I will mix up similar sounding words quite often, like "exhale and exhume" or something similar to that. I find that in general my best times mentally are around 8-9pm at night, about as far away from when I woke up as it gets.

The first thing that comes to mind is that those are stroke warning signs and this might not be related to sleep at all. I would make an appointment with your doctor and soon. http://www.strokeassociation.org/STROKE ... mePage.jsp

I definitely agree with the advice to see your doctor asap. Please don't delay.

Hello,

First off, I've updated my profile to list a few pieces of information on my end, and wouldn't mind putting my sleepyhead data somewhere for review.

This issue has been happening just about every single morning for 6 months since starting the CPAP therapy, so I'm fairly sure I'm not in a quasi-stroke state every morning. I've told the doctors about it and they don't think that it's a stroke, plus I have no other signs of stroke like numbness in one side, etc. If anything, it's similar enough to when you've been awake far too long, and are just exhausted to the point where thinking and speaking suffer as a result. I appreciate the concern regarding stroke, but the doctors don't seem to see that being the case.

[edmundg]

Hi edmundg,
I also get a headache when I use my machine for the whole night, which is not very often. I usually sleep about 3 or 4 on, and 3 or 4 off. That will probably not go over well here but it seems to work the best for me right now.
I had the mental fog before I got my machine but it is much better now.
Have you thought about losing some weight. I was at a BMI of 30 when first diagnosed. I went down to about 22.5 but I am now back up to 25. I can notice a difference in how I feel between 22.5 and 25.
Everything (mind and body) was better at 22.5 and I am trying to get back there.
Do you have an oximeter that records overnight? I am convinced my brain fog was mostly related to the low oxygen before my diagnosis. Other things besides apnea can affect your oxygen at night, which was my case.

Hi Mogy,

Given that I've been a BMI 30 for just about forever, I've given plenty of thought over the years to losing weight, and given that I now have physical energy again after starting my therapy I've made it a point to go running 1-2 times a week for about 3k, something I couldn't even fathom doing before when I was a physical wreck.

I don't have an oximeter, but I was thinking along the same lines. I bought a standard one that does real-time measurements and have noticed that pre-CPAP I was always in the 93-95 range and now I tend to be 97 or so in general now, which is an improvement. That said, I don't have measurements for what happens at night.

Still trying to figure out why less sleep results in a sharper mind, while more rest seems to be the enemy. Now that my AHI is reported to be in the 1.X range, you would think that my mental capabilities would be greatly increased/normalized compared to the oxygen starved nights prior to treatment.

Any additional help or comments are greatly appreciated.

[klv329]

Some sleepyhead screens shots would be helpful.

Does your machine show any AHI numbers or any 90% or 95% pressure numbers. --- I'm not familiar with what information you can read from that machine?

A starting pressure of 4 seems low, but it's impossible to tell without charts and numbers.

Those symptoms were familiar to me when i had inappropriate cpap therapy.

And always consult with your physician and get a check up.

[Julie]

Cpap usually lowers BP by a bit to a lot, so if you wake up with a lower BP than usual, you could feel a bit dizzy and 'off' for a while, but the other symptoms are a ilttle worrisome and having had them a while doesn't mean they're harmless. TIA's (transient ischemic attacks) are mini strokes... many people have them and don't know they've happened, but they signal potential future trouble, so I'd ask your MD about the possibility right now. You won't be wasting his time and could be saving your life.

[chunkyfrog]

I wonder if your doctor thinks you are "too young" to have a stroke,
and this attitude has become a block to his judgement.
Get a second opinion.

[Rainmom17]

If you ever figure out what's going on, I'd love to know! I usually have a better day after 6 hours of sleep than the nights where I get 7 1/2-8 hours. Just like you said.
I also agree with you that it's unlikely you're having any sort of stroke or TIA, given you've said it's been every morning for 6 months. Not the way strokes work (I had one, so I've got some knowledge about this).

[Julie]

Rainmom - it's quite possible he now low BP in the a.m. and this does NOT rule out having had a TIA in the past which has left residual symptoms coincidental with now low BP.

[Rainmom17]

The T in TIA stands for transient. So, by definition, a TIA resolves with no residual symptoms within 24 hours. If symptoms don't resolve, it's considered a minor stroke (which is what I had even though my symptoms resolved in less than 24 hours.) A stroke (as opposed to a TIA) will show up on an MRI, and the OP said their MRI was fine.
The OP said their doctors don't think its stroke-related. So, this possibility has been evaluated by professionals. Certainly 2nd opinions are great to get. But it's also important to consider all the many other alternatives. Dizziness can be caused by a huge number of things. Such as an inner ear disorder or a mineral deficiency, for a couple of examples.

[Julie]

Well, we don't know everything that happened, or if he had any scans, MRI, etc... and there are other things that may cause e.g. slurring, etc... which I won't mention now, but I hope he comes back with more info.