Brain fog--raise pressure?

[nightcrawler]

Hi there, I've been tested with an average of 8.2. Currently my APAP is set 7.5-12. However, I've got bad brain fog--should I raise the pressure?

[Pugsy]

What brand machine are you using?
I wouldn't go changing anything until I evaluated software data .
Maybe your leak is bad and that is impacting therapy and thus how you feel.
Do you have the software?

[simplyme]

Do you get any feeling of shortness of breath or lack of air while using your cpap? Or do you feel like you have been hyperventilating and dizzy? Or neither one?

[cosmo]

.

[simplyme]

With lack of air feeling I would say could be low pressure, but from what I have learned high pressure can make the o2 and co2 amounts get messed up so that can cause a light headed dizzy feeling.

[Otter]

Hi there, I've been tested with an average of 8.2. Currently my APAP is set 7.5-12. However, I've got bad brain fog--should I raise the pressure?

If your sleep study titrated you at 8.2 cm H2O, you could raise the lower limit for APAP that far, at least. If your machine provides any efficacy data at all, it makes sense to look at it before making changes. If it doesn't you could still try adjustments, but working blind is a lot more tricky, especially when your brain is fogged in. Excess pressure can cause central apnea for some folks. My RT tells me that's a lot more rare than most people think, but still, if there's anything to look at, look first.

Have you been fog free since starting therapy, or have you been foggy all along?

[Pugsy]

Excess pressure can cause central apnea for some folks. My RT tells me that's a lot more rare than most people think,

This is indeed true.
If a person is going to end up with centrals triggered by the presence of cpap pressure it is just as likely to happen at relatively low pressures. I have seen people with complex sleep apnea (with zero centrals during sleep study) have a ton of centrals with just a modest 7 cm pressure. It can happen with any pressure and when it does it's relatively uncommon...something like 10 to 15 % of the people.

I routinely see up to near 20 cm pressure on my APAP and I don't ever have any more centrals during periods of higher pressure than I might have during periods of lower pressure.
There are a lot of people using bilevel machines (like mine and not the ASV type) with pressures in excess of 20 all night long and they don't have centrals above what would be a normal amount blamed on sleep onset or turn over in bed.
There are a lot of people using straight cpap at say 18 cm with no signs of complex sleep apnea.

So it's not just higher pressures..it can be any pressure.

It is of course a wise thing to do to evaluate the AHI to make sure that we don't already have more centrals than we would like to see because we sure don't want to risk making them worse. It never hurts to play it safe and be extra cautious but a lot panic is needlessly generated by insinuating that anyone who increase there pressure has a increased substantial risk for developing CSA. The risk is minimal and even if it did happen...it isn't the end of the world. That's why we have those high dollar fancy machines.

Now there are some people who may have a threshold where above so and so pressure they do have more centrals than we are comfortable seeing and below that pressure the centrals aren't present...hopefully right below that threshold their obstructive events are well controlled...if not...that's why we have those high dollar machines.

In the situation here that the OP has presented.....chances of centrals being an issue are relatively rare but I always prefer to play it safe whenever possible and that is why I would want to review the data first...if there is any available.
Heck for all we know the issue may be leaks causing ineffective therapy....or maybe meds.
If no data available...then we go by how we feel. Not the greatest way of course but worth a try.
Since I have seen people with CSA at low pressures (even though they are rare) that chance (small as it is) is always in the back of my mind. Those people should have had the CSA show up on the titration study though.

[Otter]

We're definitely on the same page this time, Pugsy.

In the situation here that the OP has presented.....chances of centrals being an issue are relatively rare but I always prefer to play it safe whenever possible and that is why I would want to review the data first...if there is any available.
Heck for all we know the issue may be leaks causing ineffective therapy....or maybe meds.
If no data available...then we go by how we feel. Not the greatest way of course but worth a try.

In the case where there is no data and we're forced to make adjustments "blind" like they did back olden times, I still think the riskiest thing to do is to stick with settings that you know don't work. You could get a new machine or a new titration study, but it probably makes sense to experiment even while you're waiting for that to come together. Nothing you're going to do to yourself is likely to be that much worse than CPAP that leaves you in a fog every day. Of course, you do need to pay attention to your symptoms and keep a log of both symptoms and pressure changes so you can make intelligent decisions. And if the fog is severe, it makes sense to get help with those decisions from competent professionals or experienced users, because, let's face it, on a foggy day, none of us are particularly bright.

Since I have seen people with CSA at low pressures (even though they are rare) that chance (small as it is) is always in the back of my mind. Those people should have had the CSA show up on the titration study though.

One would hope. But with all the variables, what happened in the lab may not be what happens at home.

[Pugsy]

But with all the variables, what happened in the lab may not be what happens at home.

Very true...that's why I said "should" be noted.

In the case where there is no data and we're forced to make adjustments "blind" like they did back olden times,

Actually he does have data.. because he has an APAP machine and even if it was the S9 Auto Escape we would have AHI
I don't know of any APAP that doesn't offer efficacy data of some sort...now getting to it might be a challenge if the machine was some off brand.

Currently my APAP is set 7.5-12

So he probably does have some data somewhere available. That's why I asked for brand of machine so that I could hopefully point to the software so he doesn't have to dial a wing blindly.

[Otter]

Actually he does have data.. because he has an APAP machine and even if it was the S9 Auto Escape we would have AHI
I don't know of any APAP that doesn't offer efficacy data of some sort...now getting to it might be a challenge if the machine was some off brand.

Ah, good. It certainly makes sense for an APAP to have efficacy data, but then, it makes sense for any machine to have efficacy data. <avert rant>

[Pugsy]

but then, it makes sense for any machine to have efficacy data

Yeah, don't get me up on that soap box or we will be here all day.

I can see if someone doesn't want to bother with looking at the data but I think that leak data (along with AHI) is critical in case someone is having problems. At least have it available in case of a problem like the OP is having.

But then the docs wouldn't get to order a new sleep study and miss out on the big bucks would they?

[Otter]

But then the docs wouldn't get to order a new sleep study and miss out on the big bucks would they?

#^(|!^& mercenary 8@$+@/)$!

[chunkyfrog]

Are referral fees LEGAL?

[nightcrawler]

Thanks to everyone for your input. I've updated my machine, software. etc. However, I'm still awaiting my memory card from CPAP.com to transfer all data. I know that I can pull the codes from my Devilbiss, which I will do later today. I've done this before, but reading the results at Devilbiss.com is quite complicated--I'll do my best.
To answer a couple of the questions.

Do you get any feeling of shortness of breath or lack of air while using your cpap? Or do you feel like you have been hyperventilating and dizzy? Or neither one?

None--just foggy and it's killing me

Maybe your leak is bad and that is impacting therapy and thus how you feel.

What should my leak be?

What is the AHI and leak from the IntelliPAP's code?

I will try to get this today.
Thanks!

[Pugsy]

See if this helps you understand what you see when you get the smart code report.
http://www.devilbissclinicaleducation.c ... nology.pdf

Regarding leaks....Devilbiss doesn't start worrying about leaks until they reach 95 L/min. That's the beginning of their large leak territory. So...stay well below that number and you should be fine...I think smart code may show a certain percent in large leak.
Like say 2%...that just means 2 % of the night you were in large leak territory. Not a horrible number...now if you see double digit percentages then we have another discussion.

Their AHI is only obstructive apneas and hyponeas.

NRI is the non responsive index...they keep it separate...explained in the link above but it can be central or other things that the machine doesn't respond to.

So your AHI is all obstructive...where those of us using other machines have our "centrals" or clear airway events included in our AHI.
SleepyHead will work with your machine and I have links for it in my signature line.
It has a Mac version also.
So once you get the stuff to be able to use the SD card you can use SleepyHead if you wish.