The numbers look good, but fog is back

[HoseMann]

Hi all,

I have no problem (or minimal problems adjusting to my CPAP). I have had my CPAP since end of Dec 2010 (for about 5 months now).
There was a short period about 2 months ago where I had great energy level and it seemed that finally it was time to say good bye to mental fog for good. There were few times when I woke up happy. But this great feeling lasted only short while and now it's definitely better than before the times before CPAP. But, I don't know why it's no where as good as few days that I experienced.
My pressure level is 9 and my AHI, total AI, and central AI per night is less than 1. Some times I see leaks in the range of 5 - 7, but most nights the leak registers 0. If my nightly numbers were bad, then I could at least do something about it. But with numbers being so good, I can't figure out what is the problem. I am not expecting that every night sleep should be completely awsome, but at least once or twise a week should be great. Any way, the last time I had great sleep was about the last week of Feb this year (over two months ago).
This is now allergy season (I live in North Texas), so I don't know whether the allergies are interfering. I don't feel allergies symptons though.
Any thoughts/ ideas as what the problem might be please? Should I try APAP machine (even though per my numbers above, I don't think my CPAP is the problem)?
Thanks in advance for your time. Best Regards.
I am currently using:
ResMed S9_Elite w/ H5i humidifier and Climate Control
ResMed Swift FX – Nasal Pillows System

[JDS74]

Hi HoseMann:

Are you waking up during the night now for any reason? Can you remember for those few nights when it was great, did you sleep straight through or waken fewer times than now?

Can you post your sleep study numbers from before the machine as well as the pressure numbers you now have?
Do you have the software so that you can go back and see values from when the results were much better?
I'm assuming here that you have the plain S9 Elite and not the auto-adjusting model.

It sometimes happens that after a short while on CPAP for obstructive sleep apnea, you develop central apneas as a result of the OSA treatment and that can result in a low AHI number for OSA but disturbed sleep anyway.

[lcosborn]

You can buy one of those diabetes glucose monitors pretty cheaply at any box box store or pharmacy. Start checking your blood glucose. New research suggests that the usual blood glucose ranges defined as "normal" by the medical establishment are way too high. I find that I get brain fog when my glucose is over 140 or under 80. You might have a blood sugar issue. That's actually extremely common with OSA patients. Up to 40% of us have diabetes. It's probaly worth the $25-50 you would spend on a monitor. I know that's a stretch on a tight budget, but if there are sugar problems, it is way, way more expensive than not knowing. Plus, the monitor is about the cost of a doctor's co-pay. I found that it is more than worth it.

[Bobby269]

When is your next physical? When my B-12 gets low I have no energy and feel like I'm in a fog. The first month on Cpap this happened.
I was glad to find out all I needed was a B-12 shot. Took a shot a month for 5 months to bring my level up. But I felt much better after each shot.

[seventyone]

I was the same (felt great for a while then a fog came back). I had to get my presuure adjusted (raised but not much) and the fog went away.

[HoseMann]

Hi to all.
This place is blessed with so many awesome people who are so willing to help. THANK YOU.
Below are my responses to your kind comments:
No, I am not waking up during the night for any reason. The only thing that was un-usual when I felt really good was that I was waking up real early in the morning (between 4:00 to 5:00 am) and going to sleep around 9:00 pm or so. Few months before I got my CPAP, I maintained the same routine for a week or so and I felt really good (not as good as with CPAP though). I don’t know why sleeping early and waking up early seems to cause such a rush of energy even though I am sleeping the same number of hours. Anyway, I will try the early morning routine again. It’s tough to get up so early when there is dark out and you don’t have to get up to go somewhere.
Below is URL to my chart. I don’t know for sure the exact dates when things were really great, but I suspect it is one of the two internals highlighted (February the 3rd through 13th or the February 19th through 26th). But I don’t see anything un-usual in my charts during those dates?
http://www.flickr.com/photos/62400248@N04/5678304148/

As far as I can tell, my charts are great? I don’t need to adjust the pressure as suggested by seventyone (thanks for your suggestion seventyone)? I don’t know if this makes sense, but is it possible that even though your charts look fine, but by replacing CPAP with APAP it might help some how? Meaning that APAP might help with some underlying problem that is not detected nor corrected by CPAP?
Hi JDS74, per your comment “It sometimes happens that after a short while on CPAP for obstructive sleep apnea, you develop central apneas as a result of the OSA treatment and that can result in a low AHI number for OSA but disturbed sleep anyway.”> If this situation is occurring, then how do I confirm this and correct this issue? Can you confirm whether this is happening or not happening by looking at my charts?
Hi lcosborn, thanks for your kind suggestion. I will get the diabetes glucose monitor ASAP.
Hi Bobby269, thanks for your kind suggestion. I will get my physical done ASAP and pay close attention to B12 levels.
Again, thanks for all feedback/ suggestions/ comments. Best Regards

[bayourest]

I am wondering if there is a habituation response. I have noticed a similar effect. After a difficult period of adjustment I started to feel better and more rested. But now (6 months in) I am starting to be very sleepy during the day at times. And for the last few days, nodding off when I "shouldnt." I am getting good numbers (a i is normally around 2 or lower) but I am noticing drowsiness creeping back in. (However, I will clearly state that my worst day with apap is so much better than my best day without it). I was anticipating a level of improvement that was rapid, consistent, and linear!! maybe it's a question of 2 steps forward and one step back??? I'd be happy for thoughts on this from those who are much more experienced. I may wake up 1-2 times during the night and now usually go immediately back to sleep (maybe have a trip to the bathroom). I do notice that I tend to have more clusters of events early in the a m than at other time of night. Last night I woke after 5 hrs....my ahi was 0.9. But after 7.5 hours the ahi was 2.2.

[JDS74]

Hi to all.
Hi JDS74, per your comment “It sometimes happens that after a short while on CPAP for obstructive sleep apnea, you develop central apneas as a result of the OSA treatment and that can result in a low AHI number for OSA but disturbed sleep anyway.”>

If this situation is occurring, then how do I confirm this and correct this issue? Can you confirm whether this is happening or not happening by looking at my charts?

I'm not familiar with the software that printed out your report so I can't be sure that there is additional data that could be printed but wasn't.

So ... what I see is for the time period that you suspect was the "good" times (the second marked period), the number of hours usage was uniform and longer than what you are doing now. The fragment and short intervals of your current usage may be contributing to the "fog" you are currently experiencing.

The missing information is some report that separates the obstructive data from the central data. All I see is AHI and AI data reported as sums of events, not the underlying data on CSA, OSA, Hypopneas, etc. Without that it will be dificult to tell.

Your observation of going to bed about 9:00 PM and getting up about 5:00 AM coincides with the "good" times so that might be a reasonable experiment to do for a week or so.

We have another poster whose RT has her getting almost exactly 6 hours of sleep at night to help control insomnia. Are you short usage times related to insomnia?

You also mention that you aren't waking up periodically at night but your usage data suggests otherwise with several days in which the usage is less than two hours and several more with a break in usage. If you look at the chart, the breaks show as a horizontal line in the usage bar chart for any particular day. Can you remember what happened that caused that kind of usage? Bathroom break? Insomnia? Machine turned itself off? etc.

A more capable machine that provides auto titration will also provide additional data on the various types of apneas so you can then see whether you are now having CSA's.

[Janknitz]

I had a similar situation. After a few very good months of CPAP suddenly I was waking with night sweats and not feeling so great anymore. But my numbers looked good--AHI was always around 0.5. When I checked in with the RT, she concluded it must be "menopause" --too bad, nothing to be done.

But I'd just gotten the software, and I asked her to look closely at my data. I have an autopap, and what the charts showed is that my pressure was maxing out all the time to keep my AHI's low. We increased my pressure by 2 cm, and viola--no more "menopause" symptoms.

It's a bit harder to tell with a fixed CPAP pressure if this might be the issue for you, but you could try upping your pressure incrementally while watching the data to be sure you're not increasings CA's. I would raise it half a cm, wait a few days, and watch the data to see if anything changes. If you get no results and no additional problems, try going up another half cm or so. That may just do the job.