Brain Fog & CPAP

Hello. I've read a few topics on here about brain fog symptoms that apnea sufferers have dealt prior to beginning CPAP therapy or even issues that began pre-therapy and continued into the early stages of CPAP.

I'm a new CPAP user. I was diagnosed with OSA 2-3 months ago. Pre-therapy symptoms included general fatigue, anxiety, frequent heart palpitations (PVCs, etc.), and probably a wealth of other issues. I would occasionally wake up gasping for air and suffer from night sweats where I would wake up with my head in a pool of sweat on my pillow. I am overweight (325lbs) and have had Type II diabetes since 2012. Last A1C was 7% so it is fairly controlled. I also have GERD (reflux), also controlled with meds.

I finally received my machine last week: the DreamStation Auto CPAP machine with an Amara View face mask. The machine varies pressure between 5.0cmH20 and 20.0cmH20. Humidity is set to 3%. Ramp setting starts at 4.0cmH20 and takes thirty minutes to ramp up.

I had a very hard time the first few nights. I managed to get about 2 hours in on the first night. Felt very claustrophobic with the mask at first. I didn't do it at all on night 2, and on night 3 I managed just 15 minutes. I initially wanted to try a nasal mask but after speaking with the folks who provided my machine, it seemed like the best option was to press onward. The next four nights were better, I was able to keep it on pretty much all night (6 hours or more). The AHI's have gone down from 13 on Thursday to 4 last night.

Last Thursday at work, however, after using the machine for only about 15 minutes overnight on Wednesday, and not at all on Tuesday, I realized that I was beginning to suffer from brain fog. My mind just wasn't clicking like it normally did (which is very bad in my line of work). I stumbled over what I wanted to say, couldn't recall things as quickly, etc. The moment I became aware of it, I started worrying about it, which made it worse.

I've had more success with the mask and keeping the CPAP therapy going since then, but the brain fog has persisted. I'm much slower at processing what's said to me and my own responses. And I feel absolutely exhausted. I wake up in the morning and sit on my couch where I pretty much doze off again right away. This happens off and on throughout the day and has persisted since Thursday of last week. The timing of it doesn't seem to line up with the CPAP therapy because it didn't begin in earnest until Thursday night (after my first day of fogginess). My mask fit has been near 100% every night but one (a strap came loose and it fell off on Friday night, resulting in a 44% mask fit according to the DreamMapper app). I've yet to find an article or testimony where the user begins experience brain fog after starting therapy. It was not one of my pre-therapy symptoms.

I don't think I've dreamed pretty much all week. When I do dream, I typically remember it but the only dream I can remember the past week happened one morning after I took my mask off and dozed again for another 90 minutes or so. Even though I'm making it through the night, I often lay in bed for a long time after the mask is on and I simply cannot get to sleep. I wake up frequently throughout the night, but my wife says I seem to be in a deep sleep if she happens to wake up. It's not that uncomfortable. I just haven't quite adjusted to it. I was hoping getting through a few good nights of use would help to alleviate the exhaustion and the brain fog but it seems like my sleep quality is worse right now. Which seems to be common, sans the brain fog part.

There are some other mitigating factors that could contribute:
- Recently diagnosed with a dental abscess that required antibiotic intervention. Was on Clindamycen for almost 2 weeks. During those weeks, my sugar went up pretty high and has yet to come back down to normal range. (I *have* experienced mild brain fog due to high sugar, but that was much higher levels than what it is now.)
- An extreme amount of personal stress, including an upcoming new job, oral surgery to remove some damaged teeth, and the very, very unexpected passing of a team member at work (only 32 years old) that has me pretty shaken up, awaiting an esophagus biopsy from my reflux checkup, and of course tons of financial stress, which most of us share.
- General Anxiety Disorder and obsessive thinking that tends to exacerbate everything

The brain fog is quite frankly a terrifying symptom for me. My mind is usually very sharp, and having to think and re-think what I'm trying to say (or type - this post is taking me much longer than it normally would), combined with the near-constant state of exhaustion, is very worrisome.

The right answer here is to call the doc. Sadly, with this being a holiday, no one's in the office. So I thought I'd share my story here in the hopes that I'm not the only one who has had brain fog after starting CPAP, who did not have it before. Or maybe get some insight into the entire process. I am committed to making it work, and I understand it will take time. I can accept the fog if it's a temporary thing - I won't obsess over it as much. But right now, it's front and center in my obsessively anxious mind. I'll be calling my PCP and the sleep center folks tomorrow to try and get some answers. Although "high sugar" is not on the list of side effects for Clindamycen I've done some research indicating that a fair amount of people report it (and the dentist who prescribed it mentioned it as well).

Thanks for reading my lengthy first post. I'll definitely be around, as this seems like a welcoming and supportive environment for OSA sufferers.

Get sleephead software. Your pressure range is idiotic except for the first couple of nights. You need to see where the pressure needs to be.

It can take up to a month for your body/mind to accept that thing on your face and allow you to sleep deeply. Once it kicks in you will probably want to sleep a lot more for a while in order for your body to do its repair work.

To get used to the mask wear it and turn on your machine wile watching some good movies.

Hi, first of all you have the ramp set to go from the machine's default low pressure setting of 4... to the whopping high setting of 5. No point at all in doing that and for those 30 mins you're not being fully treated... which brings me to the fact that 5 is such a low setting (commonly 'prescribed' by doctors who think auto machines will automatically catch any events at any level regardless of how low the setting) that most aren't very comfortable breathing at it to begin with and at that level will have a hard time addressing any apneas at a higher level of any significance.

I would first just turn off the ramp altogether (most of us do in the first week unless our low pressure setting's very high, e.g. <15) and second, would bump up the low to 6 or 7, still low, but better for now, though it's very possible you will bump it again in future. I would feel foggy at such low settings myself, and fog wasn't even a symptom I had to begin with. Then give the changes a couple of nights and see how you feel then.. and come back to this thread so we can follow what happens.

Thanks for your reply! I do have it on before bed for about half hour, usually I'm in my laptop to unwind while wearing it. That has helped a lot.

I'll check into the Sleephead software. Thanks!

Julie thanks for the advice, I will try that and see.

[quote="thegrimmsleeper"]Hello. I've read a few topics on here about brain fog symptoms that apnea sufferers have dealt prior to beginning CPAP therapy or even issues that began pre-therapy and continued into the early stages of CPAP.

I'm a new CPAP user. I was diagnosed with OSA 2-3 months ago. Pre-therapy symptoms included general fatigue, anxiety, frequent heart palpitations (PVCs, etc.), and probably a wealth of other issues. I would occasionally wake up gasping for air and suffer from night sweats where I would wake up with my head in a pool of sweat on my pillow. I am overweight (325lbs) and have had Type II diabetes since 2012. Last A1C was 7% so it is fairly controlled. I also have GERD (reflux), also controlled with meds.[/end]

I am relating only to the highlighted issues: I also suffer from type 2 diabetes (but only borderline). In my case I also have nightly sweats, I think that it because I take Amlodipine (generic Norvasc) 5 mg tablet to lower blood pressure. I have been splitting the tablet in half (to 2.5 mg). To reduce sweating on my back I place an outdoor chair cushion on the mattress and lay on it. It provides some ventilation. Yes, lying on my back all night is bed. My A1C is abnormal at 6.1( not fasting). Should be below 5.6. A Pre-diabetes is 5.7 to 6.4. About your weight even if you are 6.5' tall you need to lose at least 100 lbs, down to 200 lbs.

I would not relate to other of your issues unless you register properly and fully.

Julie wrote:...would bump up the low to 6 or 7, still low, but better for now, though it's very possible you will bump it again in future. I would feel foggy at such low settings myself, and fog wasn't even a symptom I had to begin with.

What are the implications of manually adjusting the pressure settings? I hadn't fully realized until I did some research based on your suggestion to up the lower level that these are only available in provider mode (which I have learned how to access). I don't want to get into muddy waters with the insurance company as I can't buy the machine outright (have a monthly co-pay for a few months). Currently all settings on the device are what the sleep folks programmed in. I've already been told if I don't "maintain compliance" (i.e. use it at least four hours per night, six nights per week) I'll get billed for the whole thing. I'm discovering that the folks who program and hand out the machines don't go into a lot of detail or help you understand what you're really getting into. Most of this stuff was glossed over or skipped entirely.

I did download Sleepy Head and reviewed the preferred chart order etc. for here. This is what I've got so far. The software indicated that the leaks are too high. I don't notice them when I'm falling asleep, but I wonder if it's that high because of the one night when I didn't have it strapped properly and it fell off.



avi - working on the weight loss. I had lost about 20lbs last summer and my blood sugar dropped like a rock to normal levels. Sadly, I gained it all back. Working on it again, exercise, watching carbs, etc. And of course hoping that some quality sleep will help as well.

The insurance co's couldn't care less about anything but compliance regs, certainly not whether you've bumped your therapy by a couple of cms or not... there's no one keeping score (or informing them) and we've all been doing it for years.

Just think about diabetics. They modify their highly toxic meds on a daily basis based on their data. You are talking about AIR!

You couldn't inflate a balloon with cpap pressure. The only caveat is if you have heavily damaged lungs, in which case it is criminal to leave the settings wide open, a big leak could trigger a full 20 cm/H2O.

Your DME might bitch because they won't get paid for doing the adjustment.

thegrimmsleeper wrote:The software indicated that the leaks are too high.

You are using the DreamStation from Respironics and the SleepyHead software defaults to leak threshold data for the ResMed machine.
So SleepyHead will tell you that leaks are worse than they really are based on the default.

Open SleepyHead and go to Preferences..then cpap tab...and on the right side change the 24 L/min red line threshold to something more appropriate for your machine...maybe around 70 L/min.
Or just turn it off by removing the check mark.
Respironics never gives us an exact red line threshold to use so we have to ball park it.

If you have any large leaks your machine will show them on the Events graph on the top right...see the line on the left that has LL...that's large leak. It will show up there if you have any time in large leak.

I can't read your posted reported (too small) and I can't click on it to make it bigger so I can't tell for sure if you had any large leaks but it appears that no prolonged time in large leak was flagged.

So change that red line threshold or turn it off...and SleepyHead won't scare you with "you have major leaks" warning when you didn't have any large leaks to speak of.

thegrimmsleeper wrote:

Julie wrote:...would bump up the low to 6 or 7, still low, but better for now, though it's very possible you will bump it again in future. I would feel foggy at such low settings myself, and fog wasn't even a symptom I had to begin with.

What are the implications of manually adjusting the pressure settings?

better sleep.

Pugsy wrote:

thegrimmsleeper wrote:The software indicated that the leaks are too high.

You are using the DreamStation from Respironics and the SleepyHead software defaults to leak threshold data for the ResMed machine.
So SleepyHead will tell you that leaks are worse than they really are based on the default.

Open SleepyHead and go to Preferences..then cpap tab...and on the right side change the 24 L/min red line threshold to something more appropriate for your machine...maybe around 70 L/min.
Or just turn it off by removing the check mark.

Thanks for this. I'll make the change. I'll also get a better screenshot that includes last night, when I didn't do as well.

BlackSpinner wrote:Just think about diabetics. They modify their highly toxic meds on a daily basis based on their data. You are talking about AIR!

You couldn't inflate a balloon with cpap pressure. The only caveat is if you have heavily damaged lungs, in which case it is criminal to leave the settings wide open, a big leak could trigger a full 20 cm/H2O.

Your DME might bitch because they won't get paid for doing the adjustment.

I am a diabetic, though I don't modify anything as I'm only on Metformin daily. I understand that medically, changing the pressure is not something dangerous in my situation. My reason for the question is simply because changing prescribed settings on a machine seems like one of those little things that an insurance company would jump on so they don't have to pay for the equipment. My machine sends my daily results to Advacare so that they can monitor progress and compliance (and have already warned me that not being on the machine for x number of hours, x number of days per week would result in the insurance dumping the bill on me anyway). Glad to hear that I overthought the situation, and that it's not an issue for anyone. I will definitely consider making the change.

thegrimmsleeper wrote: My reason for the question is simply because changing prescribed settings on a machine seems like one of those little things that an insurance company would jump on so they don't have to pay for the equipment.

there have been zero reported instances of an insurance company actually caring whether or not cpap works for you, much less caring if you change the settings so it works better.

all they've ever cared about, so far, is whether you're using it at least half the night, 3/4ths of the time.... which is nowhere near enough to make a person feel appreciably better.