Brain Fog

[SleeplessInOttawa]

I've seen some threads on this topic but thought I would put up a new one as many of the existing threads were about one individual's condition. Is brain fog something that many people experience on CPAP? I had way less of it before I went on the machine, ironically. However, I'm only in my third week of using the CPAP so I figure I could be experiencing sleep debt.

This is very frustrating though - I used to be able to concentrate extremely intensely for long periods of time, and now I feel too hazy and tired to do even a fraction of that.

I got my first results from the data download from my CPAP and they showed my AHI down to 2.2, with almost no leaks, but with "flow limitations" averaging around 5.1 per hour. I'm not sure what "flow limitations" even refer to; I don't think it directly correlates with RDI. I'm averaging around 7.5 hours per night on the CPAP.

I also exercise daily, eat healthily, practice sleep hygiene, etc. I take vitamins and have gotten complete blood chemistry and other workups several times including recently, with everything being normal. So no other obvious culprit.

The brain fog has only been there since I went on the CPAP. I figured there would be an adjustment period, but right now I may have to turn down some contracts because I'm not sure I can focus well enough to complete them. That's a bit scary because I don't like turning down work. (I'm a consultant so you never know when work will pick up or drop off.)

Grrrr....

[jen4700]

Hi - welcome to the forums.

Three weeks is still very early on in your therapy. It can take weeks or months for your body to recover from the damage that OSA has done. I was in a constant brain fog before Is started CPAP. It took about a month maybe 6 weeks before the fog truly lifted. It was very gradual and I wouldn't have noticed if I hadn't been paying attention. Your numbers look good. I think if you're patient and compliant you will get there.

[chunkyfrog]

For most of us, cpap means the end of our brain fog.
Mine was so dramatic that my boss noticed it.
If yours started with cpap, give yourself a little time to get used to the therapy.
The unfamiliarity may be reducing your sleep time and quality.
This should be temporary, but could also be a matter for your doctor.

[SleeplessInOttawa]

Grrrrr.... Just wrote a long post and then clicked something wrong and lost it. BRAIN FOG!

Thanks very much for the posts - I'm glad to hear that it gets better. I was surprised that the brain fog started with the CPAP - I will definitely talk to the sleep doctor about it.

Right now when I try to concentrate / focus I actually start to sweat... Blegh.

[archangle]

Don't be afraid to experiment a little to see if you can get rid of the brain fog more quickly. More/less sleep, different pressure, etc.

Flow limitations are basically where your airflow is being restricted part of the time while you're breathing. Think of it as being like breathing with your nose partially stuffed up. However, you're still breathing regularly instead of stopping and starting the way you do with apnea or hypopnea.

Flow limitations show up in the shape of the waveform as you breathe.

Unfortunately, your ICON machine doesn't record airflow waveforms where you could see the shape of the waveform.

I think that unless they're really bad, flow limitations don't affect you nearly as much as apneas or hypopneas.

[SleeplessInOttawa]

Don't be afraid to experiment a little to see if you can get rid of the brain fog more quickly. More/less sleep, different pressure, etc.

That seems like a good idea. I wonder if more pressure is always a good thing to try vs. a lower pressure? Maybe I could get my AHI down closer to zero and my flow limitations lower as well.

Flow limitations are basically where your airflow is being restricted part of the time while you're breathing. Think of it as being like breathing with your nose partially stuffed up. However, you're still breathing regularly instead of stopping and starting the way you do with apnea or hypopnea.

Thanks very much for this information. The technicians at the CPAP supply store didn't know what it meant...

Unfortunately, your ICON machine doesn't record airflow waveforms where you could see the shape of the waveform.

I've heard this a lot on the forum. Is there a CPAP machine that everyone agrees is the best? I'm thinking of not going with the ICON (I'm on a trial currently) because of the data shortcomings. However, other than the data problem and minor issues, I like the ICON and don't want to necessarily switch to a different machine that would 'feel' different.

[nangiggles]

My brain fog is a mess because I have severe OSA and ADHD, I dont take any medication for it yet because my Dr wanted to wait until I was on CPAP before exploring treatment, he insisted it would probably go away on it, if anything I now have more energy so I'm SUPER hyper and lose concentration easily.

Ooooh look a butterfly!

[SleeplessInOttawa]

My brain fog is a mess because I have severe OSA and ADHD

Ouch! That must be really tough. What I have found a little disheartening is that I didn't have this brain fog before the CPAP... However, since I'm so early in the process I figure patience is my friend. As well as potentially increasing the pressure a little.

if anything I now have more energy so I'm SUPER hyper and lose concentration easily. Ooooh look a butterfly!

Wow, that sucks. Maybe once you get medication for the ADHD it will make a big difference.

[SleeplessInOttawa]

Hi - welcome to the forums.

Thanks very much!

Three weeks is still very early on in your therapy. It can take weeks or months for your body to recover from the damage that OSA has done.

That's good to hear. I know that empirically my sleep is better from a lower AHI, etc. Also, I used to writhe around in my sleep so that my sheets were always torn out no matter how firmly I secure them. Now that's gone. Also, the number of nightmares I get from PTSD are radically reduced. I also feel more physical energy, despite the fog. It's a very weird process.

I actually feel like my personality is changing: I have lower anxiety, I am more calm, I don't have the same desire to do things I used to (play poker, video games, etc.). It's disorienting although positive overall - I feel like a totally different person.

[SleeplessInOttawa]

If yours started with cpap, give yourself a little time to get used to the therapy.
The unfamiliarity may be reducing your sleep time and quality.

Great advice, thanks. I wouldn't be surprised if it takes some time to get sufficiently acclimatized to the CPAP that regularly good sleep is possible. *Fingers crossed*

[stage0]

I hear from my pts that experience this brain fog if I have to awaken them from stage-3 of sleep or REM stage. Stage-3 is when your brain is most disconnected from sensory input; so it takes time to engage. Awaking from REM stage (upruptly) will sometimes cause an irritation and confusion. I agree that you could still be in "sleep debt". If your OSA casused some disruptions to your Circadian Cycle; you brain may be adjusting BACK to the normal cycle (causing the fog).

[nangiggles]

My brain fog is a mess because I have severe OSA and ADHD

Ouch! That must be really tough. What I have found a little disheartening is that I didn't have this brain fog before the CPAP... However, since I'm so early in the process I figure patience is my friend. As well as potentially increasing the pressure a little.

if anything I now have more energy so I'm SUPER hyper and lose concentration easily. Ooooh look a butterfly!

Wow, that sucks. Maybe once you get medication for the ADHD it will make a big difference.

Wel on a positive note I do feel fantastic and somewhat focused at times, I can feel the difference thanks to the CPAP, gotta check my data though, placebo can be powerful, lmao

[SleeplessInOttawa]

I hear from my pts that experience this brain fog if I have to awaken them from stage-3 of sleep or REM stage. Stage-3 is when your brain is most disconnected from sensory input; so it takes time to engage. Awaking from REM stage (upruptly) will sometimes cause an irritation and confusion.

That's really interesting. I wonder if that suggests I am waking up from REM abruptly?

I agree that you could still be in "sleep debt". If your OSA casused some disruptions to your Circadian Cycle; you brain may be adjusting BACK to the normal cycle (causing the fog).

I think this may well be the case. I've experienced a lot of subtle and not so subtle positive changes, with the sleep fog and some intense fatigue being the only real negatives so far. It's hard to know whether to tweak my pressure as was suggested right away, or to wait a few more weeks until my Circadian cycle is normalized and I've begun to pay back more of my sleep debt.

[SleeplessInOttawa]

Wel on a positive note I do feel fantastic and somewhat focused at times, I can feel the difference thanks to the CPAP, gotta check my data though, placebo can be powerful, lmao

Nice - glad to hear.

[archangle]

Unfortunately, your ICON machine doesn't record airflow waveforms where you could see the shape of the waveform.

I've heard this a lot on the forum. Is there a CPAP machine that everyone agrees is the best? I'm thinking of not going with the ICON (I'm on a trial currently) because of the data shortcomings. However, other than the data problem and minor issues, I like the ICON and don't want to necessarily switch to a different machine that would 'feel' different.

I think the ICON is fine, but having airflow waveforms is a good tool and is worth getting if you have a choice, especially since it probably won't cost more. If you had them, you could look at them and see the "ugly" waveform of your flow limitation and maybe understand more. Airflow waveforms are also good to look at and figure out if your apnea was long, how complete it was, did you gasp for air before or after, etc. When you have problems, it gives you a lot of extra clues about what's going on if you know what to look for.

The Philips Respironics (PRS1) Pro, Pro with AutoIQ, or Auto have airflow waveforms.
The ResMed S9 Elite and AutoSet have airflow waveforms.

All of the above are excellent machines. The Auto versions are preferable because they can be set to work exactly like the manual CPAP versions if needed, but also offer auto pressure.

PRS1 Plus and S9 Escape and Escape Auto lack airflow waveforms plus a lot of other data.
Note to say "S9 AutoSet," not "S9 Auto" because there's an S9 Escape Auto that doesn't do waveforms.

PRS1 vs. AutoSet is roughly a tossup in terms of quality. Each one has some mostly minor drawbacks or advantages, but they about balance out.

PRS1 is currently transitioning from "plain" PRS1 to PRS1 60 series. The main difference is that the 60 series has the option of a heated hose.