Any Idea Why My Brain is in a Fog?

[edm_msu]

Last February I was diagnosed with moderate sleep apnea. Overall AHI = 22.3, NREM AHI = 24.9, REM AHI = 3.1, Supine (on back) AHI = 69.9.

Since starting CPAP in March, I've been 100% compliant and my average AHI is less than 1.0

I sleep pretty well. My ZEO score is consistantly around 70. My weight is a little high, 205 lbs, 5'-11" tall.

I take Simastatin for cholesterol. Otherwise, all my blood test are good. Other than my apnea and cholesterol, I am healthy.

I feel worse when it rains. My doctor put me on Zoloft five weeks ago. My mood is better, but my thinking is no better.

My brain is always in a fog. My thinking is slow and I'm baffled and frustrated.

Any ideas?

Thanks,
Ed M.

[lazer]

Simvastatin is known to disrupt the quality sleep stages. Just a thought. I used to be on this and after some low-carb weight loss along with going on the xPAP, been able to reduce and change my statins.

Just an idea. Might want to look into some alternative Statins that aren't know to mess with sleep as bad and discuss with your doc.

[archangle]

What's your pressure range? Have you tried raising the minimum pressure for a few nights?

[Jay Aitchsee]

Blood tests? Full thyroid panel including free T3 and T4, not just TSH? How about Vitamin D3 and Ferritin levels?
Zeo score? How about # of awakenings and percentages of REM and Deep. Look OK?
Any other meds? Including OTC? Different dose or type of anti-depressant? Alcohol? Switch to water soluble statin such as pravastatin?
Diet? Maybe cut back on refined carbs and sugar? caffeine?
Exercise?

Just some thoughts.

Jay

[edm_msu]

lazer on Wed Oct 31, 2012 8:40 am

Simvastatin is known to disrupt the quality sleep stages. Just a thought. I used to be on this and after some low-carb weight loss along with going on the xPAP, been able to reduce and change my statins.

Just an idea. Might want to look into some alternative Statins that aren't know to mess with sleep as bad and discuss with your doc.

I just started simistatin five weeks ago. I do not know if it affects my sleep. I feel a little worse, but that could be because of Summer ending. I'll be sure to ask my doctor when I see her next week.

archangle on Wed Oct 31, 2012 9:59 am

What's your pressure range? Have you tried raising the minimum pressure for a few nights?

My pressure range is low at 6 to 10. What is the benefit of raising the minimum pressure if my AHI is already low?

Jay Aitchsee, those are specific questions that I don't have the answers for now. I'll get them tonight.

Thanks for your replies,
Ed M.

[edm_msu]

Replying to Jay Aitchsee questions:

Blood tests? Full thyroid panel including free T3 and T4, not just TSH? How about Vitamin D3 and Ferritin levels?

TSH-3rd Generation (ssTSH) = 1.46 (0.30-5.50 mIU/L)
25-Hydroxyvitamin D = 34 (25-80 ng/mL)
Ferritin = 45.8 NG/ML

Zeo score? How about # of awakenings and percentages of REM and Deep. Look OK?

Zeo Data, Last 30 Days:
Average Zeo Score = 67.8
Average Awakenings = 2.7
Average REM = 28.2%
Average Deep Sleep = 6.1%
Average Light Sleep = 65.8%
Average time Awake = 6.1%
Average Total Sleep = 6:47

Any other meds? Including OTC? Different dose or type of anti-depressant? Alcohol? Switch to water soluble statin such as pravastatin?

Daily multivitamin and Fish oil
I'll ask about doctor anti-depressant
Light alcohol drinker
I'll ask about water soluble statin such as pravastatin

Diet? Maybe cut back on refined carbs and sugar? caffeine?

Pretty good diet. Not much junk food. Have fruit and/or vegetables everyday. 2+ cups of milk a day.
Normal amount of refined carbs and sugar
I drink too much caffeine because I need to make it through the day. Probably 4 to 5 12 oz. cups a day.

Exercise?

I don't excersize a lot. Am fairly active in my life. Not a couch potatoe

How does everything look? Does anyting jump out at you?

Thanks for your help.
Ed M.

[Jay Aitchsee]

Ed, I forgot B12, you'd want a level > 400.

Your TSH is normal, but we don't know about free T3 and T4 – ask your Doc for those next time.

Your Ferritin level is nominally low (less than 50) - could be a contributor to PLMS. http://www.rls.org/Document.Doc?&id=1296 Member VVV has posted about ferritin levels.

Your D3 is WNL, but low. Generally accepted, now, is somewhere around 60. You may want to supplement it with 2000-4000 iu per day. But if you do, you should do follow up testing to make sure your levels don't get too high (above 80). http://www.vitamindcouncil.org/

Thyroid, Vitamin D, Ferritin, and Vitamin B seem to be inter-related and seem to have an influence on sleep. I suggest working with your doctor to bring those into optimal ranges. Remember, they seem to be inter-related. Raising Vitamin D, for example, could raise the others.

Your Zeo scores are a little low, primarily from a lack of total sleep time. You may feel more rested with scores above 70 and total sleep time > 7:00. Are you waking with an alarm? Is light waking you early? See articles on sleep hygiene for advice. Your deep sleep is a little low, too. 10% would be better. Maybe, bringing the vitamin and hormone levels mentioned above to optimum will improve deep sleep. I have done so and noticed a gradual improvement.

I suggest no caffeine after noon.

I suggest no alcohol < 4 hrs before bedtime.

“Normal” consumption of sugar is probably too much.

I suggest trying to get in a 30-60 minute walk daily. Good exercise for mind and body.

Ed, your situation, like that of many of us, is tough. You've got the apnea portion licked, but now the hard part is to determine why your sleep still isn't optimal. I offer the above only as suggestions as places to start looking. None are likely to be miracle workers. But working on sleep hygiene and bringing vitamins and hormones into balance could result in an improvement. Sometimes, I think those of us who have suffered a long time from untreated apnea or other sleep disturbances must relearn how to sleep. Good luck.

Jay

[archangle]

archangle on Wed Oct 31, 2012 9:59 am

What's your pressure range? Have you tried raising the minimum pressure for a few nights?

My pressure range is low at 6 to 10. What is the benefit of raising the minimum pressure if my AHI is already low?

AHI isn't everything. Sometimes, you get airflow restrictions that don't show up as apneas or hypopneas. UARS and RERAs are examples, but there are other less obvious restrictions. I find I feel better if I raise my minimum above what fixes my AHI.

It's just one cheap and easy thing to try.

[Jay Aitchsee]

Kind of going along with what Arch says, you might want to try straight CPAP. I find I sleep better, more refreshed, with CPAP rather than APAP with the same AHI. I think the pressure changes of APAP might disturb my sleep, though I'm not conscious of it. I also seem to record more deep sleep on straight CPAP. Leaks are another thing that disturb my sleep. Even if the leaks are within machine tolerance, I find if they approach the "red line" my sleep is not as refreshing, though my AHI might not be affected. Generally, I would sacrifice some AHI by lowering the max pressure to reduce leaks if need be.
In any event, I agree with Arch that you should at least try raising the minimum pressure which is a step toward CPAP. I think the smaller the spread, the less likely to be disturbing and the better.
Remember, an AHI of 5 or less is considered "normal". Your goal, now that you have the respiratory part licked, is to find out what else is preventing you from obtaining restorative sleep.

Jay

[archangle]

Let me be clear. I don't think it's THE answer. Just something easy to try that might work.

[edm_msu]

For a long time I was looking for THE solution. I couldn't find it. On the basis of all the helpful replies, I think the solution is numerous little things. Basically, I need to make little improvements so I sleep better. I think I'll feel good if I sleep better. I'll consider all of the suggestions the three of you made and ask my doctor about Vitamin B12, Simistatin, free T3 & T4, and Zoloft.
I felt better today because it was sunny.
I just got done walking 50 minutes and I'll run a straight 9 CPAP tonight. That was my original prescription.
Thanks so much,
Ed M.

[MaxDarkside]

On the basis of all the helpful replies, I think the solution is numerous little things

Or none of the above.

[edm_msu]

MaxDarkside on Thu Nov 01, 2012 9:28 pm

edm_msu wrote:On the basis of all the helpful replies, I think the solution is numerous little things

Or none of the above.

Well, what do you think it is then?

[MaxDarkside]

Well, what do you think it is then?

Hard to say, not a Dr, nor able to run tests. It could be something else, tho. I have fairly severe brain fog / grog and I have the above well within limits, I even went off Simvastatin due to other reasons. No difference for me going off of it. I do have neuropathy that is advancing, affecting my feet and organs now and my fog / grog seems to be worsening with it, so I'm starting to suspect might be related to that. I don't know. There are also brain chemicals that cause sleepiness, natural ones your body makes, the ones that make you want to sleep. Perhaps they are not "clearing" fully during sleep. Who knows. I, too, consume a bit too much caffeine to compensate.

[old64mb]

Average Total Sleep = 6:47

That jumps out at me more than anything else. If you're averaging less 7 hours of sleep a night and feeling lousy, before going down all sorts of different and complicated routes...try to get 8 for a while and see how you feel?

However, on what's more than likely an unrelated topic, it's worth a conversation with your doctor if there's another statin that is appropriate - Simvastatin has recently gotten (deservedly) a lot of criticism in the medical literature and now has an FDA warning when prescribed at higher doses. Given you can usually achieve the same results treating hyperlipidemia with different doses of other statins, it's a little surprising that they prescribed it first line.

Don't get me wrong; it may actually be the best medication for you depending on how you react to it, and if your doctor thinks it's fine it probably is...but it's worth a conversation.