Brain Fog

[vit-d]

Hi everyone,

Let me give a little background before I go into my question.

I am 37 and I was diagnosed with Moderate Sleep Apnea last year. I began consistent CPAP treatment around 6 months ago. I have been compliant with it, and my AHI and leak rate seem to typically be pretty good.

I felt amazing for the first few weeks of CPAP use, then I slid back into feeling better, but not nearly as good as I had originally. The past few months have been more of an up and down sort of thing. Some days I feel pretty decent, some days I feel almost as bad as I did pre-CPAP.

For me, the symptom that seems to be the hardest to get rid of is the brain fog. I have long stretches where I have difficulty concentrating, communicating, and remembering short term memory types of things. For whatever reason, the brain fog usually goes around about 5:00 or so, and I feel better until the next day when I wake up again.

So, I guess my overall question is, given that I am 6 months in to compliant CPAP usage, does it make sense for me to still be up and down like this? Also, have any of you been able to get rid of your brain fog, and is the fact that my brain fog is still present at this stage in the game a sign that something else is going on?

Thank you in advance.

[Pugsy]

How many hours of sleep are you averaging?
Of those average hours do you remember waking often?
Do you take any medications of any kind? If so, what?
Any other mental or physical health issues that might impact how a person would feel during the day?

[Guest]

Thank you for asking.

I would say that I am averaging around seven hours a sleep during the week and maybe eight on the weekend.

I do feel like I wake up a little bit more often than usual because of the CPAP, but it doesn't feel excessive. Mostly wake up, adjust something, and fall back to sleep. It is fair to say that I am stressed at work, but I have been stresses for year and it never really caused brain fog, so I am not sure that I think that is the source.

The one thing I should say is that I just recently changed the part that connected the hose to the mask and I noticed a small difference right after that. My leak numbers were always pretty good, but it now sounds like things are a little more quiet and leaking less.

I don't know, I guess I am just trying to figure out why I am still feeling pretty run down. I was hoping for better results than this, although to be fair, I am at a bit of a low ebb right now.

[Pugsy]

Multiple wake ups during the night for any reason will impact how we function during the day.
While a few wake ups are considered normal (like it's normal to wake after a REM sleep stage that we may or may not remember) if we remember a lot of wake ups then it's fairly safe to assume that there were more arousals that we don't remember. Multiple arousals will mess with the normal progressive nature of the sleep cycles so that we don't get optimal restorative sleep.
Not saying that all of your unwanted daytime symptoms are from arousals but it is possible that they are a factor. We have to "give it time" anyway.....so make us of the time to try to figure out what can be done to improve sleep quality and limit those arousals.

I think it took me almost 6 months for my brain to stop waking me up for no apparent reason other than to say "hey dude, did you know you have an alien stuck on your face blowing air up your nose"

If you aren't taking any medications that might account for unwanted daytime symptoms and you don't have any other health issues that might impact sleep quality and your hours of sleep are sufficient then it may simply be something else going on or you may need to just give it more time.
I know that a lot of us who are diagnosed with OSA tend to want to put all our unwanted symptoms in the OSA basket and expect the machine to fix everything...and fix it pretty much in a short time frame...it doesn't always work out that everything gets resolved. There's just so much more to feeling those good numbers than getting them.

So take a long hard look at your sleep hygiene...google "good sleep hygiene" and see if there is anything that you might be doing that could maybe be improved upon. It won't hurt to try and it might help.

If the symptoms persist.....see a doctor because something else might be going on and it might be totally unrelated to OSA and the machine can't fix problems unrelated to OSA.

Couple of things to have checked (besides the usual routine testing which should include thyroid function) for guys...testosterone levels and for everyone Vitamin D levels.

[Pugsy]

Another couple of questions.
What machine are you using and at what pressure....and are you using cpap mode or apap mode and if apap mode what is the range of pressures..?

How about sharing an image of a detailed software report to see if we spot something that could maybe be improved upon that might help. There are things that aren't included in the AHI numbers or leak numbers that might point to a potential suspect.

https://sleep.tnet.com/reference/tips/imgur

https://sleep.tnet.com/equipment

and some examples of what we like to see here in this thread
viewtopic/t103468/Need-help-with-screen-shots.html

[Guest]

Thank you for your thoughtful response. I hope you don't mind if I bug you with one more question.

Does the "up and down" nature of how I am feeling make any sense? At my last sleep doctor appt, which was around 6-7 weeks ago, I remember telling him that I was feeling pretty good, and that I while I wasn't perfect, I was basically feeling what I considered to be "normal person fatigue." Now, 6-7 weeks later, I am back to feeling like a zombie and having a difficulty string together sentences.

I feel like there are people out there who say that it took them awhile to feel better on CPAP, but I don't feel like I hear too many talking about it being a rollercoaster.

Thanks again. Much appreciated.

[vit-d]

Just saw the message about the sleep data. Will try to post something when I get home later tonight

[Pugsy]

Actually the up and down nature of your statement is fairly common.
When people feel markedly improved for a short period of time and then tend to back slide.
We have talked about it before....the honeymoon period is over.

I don't know that we have ever been able to isolate what causes the honeymoon to end when all the other stuff (software reports, AHI, sleep quality, etc) seem unchanged.
I suspect it is something along the lines of the sleep was like crap before cpap and the body was used to that feeling like crap as being "normal"...then cpap comes along and OMG there is such a big difference in how we feel...then that "good" feeling becomes the new "normal" and there isn't such a dramatic change like we first saw.

I would bet that if you slept without your cpap for 2 or 3 nights that you get a rude awakening as to just how bad things used to be or could be again (not saying to do that though).

So you aren't the first to mention the honeymoon was over....but we have never really figured out what happens when the honeymoon ends. You can search the forum archives for "honeymoon" and probably find lots of reading material.

All I know to do is keep turning over rocks (looking at anything that could maybe point to a reason) in hopes of stumbling across something that helps or explains why a person doesn't feel the good numbers or as good as they did initially.

[lowsats]

I agree with the sentiment that ups and downs are normal. Im only a week in, but on the first three days, I noticed a HUGE improvement, then I did a bit of a backslide and now I'm on the up again. The comparison to how I feel now and before CPAP as a whole, that one is no contest.

Just taking a shot in the dark, but perhaps the quick feel better phase that we all have, the "honeymoon" phase as Pusgy puts it, occurs because with OSA we become so accustomed to huge levels of cortisol in our systems that the rapid reduction of it when we begin therapy makes us feel much better. Then as the levels stabilize to a more realistic level, and life stressors continue on, we feel a little down again. I'm sure the process is much more complicated than I'm making it here, but it certainly makes sense to me.

Good luck and stay strong!

[vit-d]

One piece of info and then two comments...

First off, when I went to my sleep doctor last time, I asked about that honeymoon period phenomenon. What he told me is that we have sort of a REM rebound effect once we start getting quality sleep. According to him, whereas a normal night with good sleep you might get 3-4 hours, when a person first gets on CPAP, they are may get 5-6 hours. Is it true? Who knows, but that's what he said.

In regards to the other person's comments about coritsol or whatever, I have suspected that as well. I always wondered if part of the continued initial fatigue is part of my body getting used to living without the adrenaline pumping through my body due to the frequent sleep disruptions at night. I can say for sure that I feel now like there is less adrenaline in my body that there was prior to CPAP. Less racing heart-rate, etc. Prior to the CPAP I felt like my heart was always beating fast.

My last comment is that, in regards to my earlier posts, I don't think this is exactly a honeymoon period type of thing. I had a clear one of those early on, but then things started getting a little better again. This is almost like a second dip, and that is the part that has me scratching my head. Anyway, I will try to provide some chart data later.

[vit-d]

I am using a ResMed AirSense 10.

Here is a link to my sample readout. I'm having a hard time posting a thumbnail. Now that I got this whole deal figured out, any additional info you would like?

http://i.imgur.com/tthOqer.png?3

[Pugsy]

I don't see anything in that report that screams out "fix me". The little cluster of events right prior to turning off the machine I bet were awake/semi awake breathing irregularities that fooled the machine (it's easily fooled because it only measures air flow and can't measure awake/asleep status).

The flow limitation number in the statistics even at max is still very low so I doubt your flow limitation graph is very exciting either.

I wish that there was something exciting on the report that was just screaming out "fix me and you will feel better" but I don't see it. Maybe you just need more time...maybe you need to be looking at other potential areas for possible causes.