Fatigue, Brain Fog, & Recovery

All,
I was experiencing many instances of extreme fatigue prior to getting a sleep study ordered (33 year old male, in good shape). After 4 months & 2 sleep studies, and now 6 months of using CPAP, albeit with no doctor oversight or active monitoring, I've begun to take a much more active approach to my apnea.

I've read a few threads regarding people's experience with CPAP and how quickly / slowly they began to see the positives, but I am curious to hear more from people who dealt with brain fog and extreme instances of fatigue, as well as what ultimately helped them eliminate these items, or at least to hear from people that I am on the right track (as I've been getting myself a little nuts lately).

I've always been healthy, but before being diagnosed, I noticed that I wasn't recovering from exercise or getting stronger. I was able to get into the gym, but I found myself dreading activities with friends and preferring to go home at times. I was also getting extremely worn down / hungover from alcohol (even 2-3 drinks).

My goal is to optimize and input:

1. Diet - I tend to eat paleo-ish, but I've played around with intermittent fasting (eating low carb meals between 12 - 8 pm).
2. Physical Exercise - I usually run/lift 4-5 times / week. I also play basketball regularly. I usually have the energy to push through this, the fatigue is a bit more mental.
3. Supplements - I took whey protein for a long time, usually 1-2 scoops per day. I came across a Youtube video where someone said that whey was contributing to fatigue for them, so I stopped completely. Hard to tell if anything changed. I've heard good things about magnesium, but haven't purchased. I've tried different amounts of melatonin, they help me fall asleep, but I usually wake up.
4. Sleep - this should obviously be #1. I've always had pretty good sleep hygiene (cold room, eye mask, avoid electronics near bedtime), but I've now made a point of deep breathing, trying to go to sleep by 10 instead of 10:30-11 pm. I've noticed that my REM % on my fitbit is going up slightly. I've read tons of articles on how best
5. Stress - I don't find myself getting stressed too often, but I am a bit of a over-analyzer.
6. Alcohol - I've basically cut it out other than special occasions, but I think I am in my own head here. Usually, when I have a drink or 2, I free my mind completely, but want to cut out these items until I feel @ 100%.
7. Medications - none.
8. Caffeine - I drink a black tea in the AM, but nothing after 12 pm.

Any other areas that people have noticed? My doctor (who I do trust) told me that all of my bloodwork was normal (happy to share if anyone has insight), and that he believes all of my issues related to sleep issues.

Thanks all for your support, wouldn't be the same without everyone.

It is hard when you see yourself not being the best you can be. But don't be hard on yourself, it doesn't help speed things up.

If you are getting a full night of xPAP therapy every night and are getting a good AHI pretty regularly, then you are doing a lot. It took time to build up and will take time to break down.

Not sure if you are using SleepyHead, but if not, download it and monitor your results. It will tell you if you are on track..

If your brain fog and extreme fatigue are caused by sleep apnea, it will help.

In what way is the brain fog affecting your life. There are methods to help alleviate the situation until it rights itself.

You've had 6 months of CPAP but no monitoring. The 6 months has been valuable in that it has helped you get used to the machine and now you need to check to see if your settings are working for you.

If you have downloaded Sleepyhead, feel free to post your results here so that the gurus on the forum can help you to tailor your settings to suit your needs. You also should tell us what machine and mask you are using. This can be done by editing your profile.

I've been through the brain fog and fatigue and it wasn't until I got onto forums like these that I was able to take control of my therapy. With this, my brain fog vanished, my fatigue levels decreased significantly and my memory, both short and long term, came back.

Thanks Cpapian and Holden4th.

If you are getting a full night of xPAP therapy every night and are getting a good AHI pretty regularly, then you are doing a lot. It took time to build up and will take time to break down.
I've been using it for 7+ hours per night, usually closer to 8-8.5.

Not sure if you are using SleepyHead, but if not, download it and monitor your results. It will tell you if you are on track..
Thanks. I am using, I am posting under a separate chain for that.
viewtopic/t66391/viewtopic.php?f=1&t=15 ... 4#p1191834

If your brain fog and extreme fatigue are caused by sleep apnea, it will help.
It does seem to get better little by little, but obviously when you don't sleep well, the next day, you don't feel function.

In what way is the brain fog affecting your life. There are methods to help alleviate the situation until it rights itself.
I typically don't have the energy to spend time out with friends, particularly when it involves a bar or drinking. I tend to think about getting back into bed while at work, but for the most part, it hasn't affected my performance.
I've also noticed in extreme situations involving fatigue, I get pretty close to having a panic attack - having a feeling of not knowing how you will get home, not trusting yourself to make it there. I have also noticed being stressed very earily and over seemingly minor things. What recommendations would you have to alleviate the situation?


You've had 6 months of CPAP but no monitoring. The 6 months has been valuable in that it has helped you get used to the machine and now you need to check to see if your settings are working for you.
It's prettty frustrating when you feel on your own with the treatment (until I found this).

If you have downloaded Sleepyhead, feel free to post your results here so that the gurus on the forum can help you to tailor your settings to suit your needs. You also should tell us what machine and mask you are using. This can be done by editing your profile.
Thanks. I posted above. I have the equipment in my other post, not sure why it didn't stay in my profile:

Machine: DreamStation Auto CPAP Machine
Mask: Wisp Nasal CPAP Mask with Headgear - Fit Pack
Humidifier: DreamStation Heated Humidifier



I've been through the brain fog and fatigue and it wasn't until I got onto forums like these that I was able to take control of my therapy. With this, my brain fog vanished, my fatigue levels decreased significantly and my memory, both short and long term, came back.
Can I ask how long it took for you to deal with this? Did any actions speed it up?

I'm sorry I don't have any advice for you, but I'll be watching this thread with interest as I can completely relate to your symptoms. You've done cpap therapy longer than me, I'm only a month, but it is very frustrating to not really see improvement. Good luck to you!

Holden4th wrote:You've had 6 months of CPAP but no monitoring. The 6 months has been valuable in that it has helped you get used to the machine and now you need to check to see if your settings are working for you.

If you have downloaded Sleepyhead, feel free to post your results here so that the gurus on the forum can help you to tailor your settings to suit your needs. You also should tell us what machine and mask you are using. This can be done by editing your profile.

I've been through the brain fog and fatigue and it wasn't until I got onto forums like these that I was able to take control of my therapy. With this, my brain fog vanished, my fatigue levels decreased significantly and my memory, both short and long term, came back.

Wauu, Holden4th, so you think there is HOPE ? Did you recover memories from before you started CPAP ?

I have been diagnosed with ADD a memory disorder... 17 years ago and got CPAP about a year ago. Do you think there is still hope ?

While ADD and CPAP likely started before they were identified, I sure hope CPAP can bring back some of my memories. On the other side I am terrified to find out what else I likely screwed up in my life pre CPAP.

It looks like you've covered most of the basics above. However, your PAP treatment is not optimized as reflected by your AHI in the 3.0 range as reported in your other thread. IMO, you need to be shooting for a sub 2.0. I'm not going to offer any suggestions as far as PAP treatment, I don't care to look at Respironics results and you are in good hands with Pugsy. However, I would be looking to the cause of all the VS2. You have some periods of what looks to be depressed breathing with Flows around 20L/min, or lower. I'm guessing that to be while supine. Not necessarily bad, but it stands out.

Have you a partner that has observed any abnormalities in position or movement while you are asleep? Did your PSG make mention of any significant PLM (Primary Limb Movement)? You might want to do a time lapse video of your sleep. Many laptops have the capability. You can see the links in my signature line for some ideas. I do time lapse at around 20sec intervals and then speed it up to watch. That condenses the night down to a couple of minutes of video. Windows has most of the software needed, probably Mac, too.

How about depression? Have you explored that possibility? Often sleep difficulties and depression go hand in hand. Talk therapy, or CBT, seems to be quite effective in treating mild to moderate depression, but many medications have an adverse effect on sleep.

I have been thinking about your situation. From your examples, you seem to lack energy more than suffer from brain fog. Since you have limited energy, it needs to be carefully allotted to your day's activities.

For example, if you had a poor night's sleep, maybe reschedule your workout to a better day. Or cut back on the intensity/duration of the workout.

Alcohol doesn't seem to work for you, so your idea to eliminate/reduce quantities is good. If you want to be sociable cut consumption way back and drink lots of water, before, during and after.

If you had a poor sleep the night before, when out with friends, head home early, so you don't get panic attacks.

You are young and it seems single so you want to enjoy yourself, which is normal and good. Maybe try to go out when the next day is not a work day.

Do you have a physically active job that is draining your energy. Can you take some time off for vacation and just rest.

One thing that strikes me is that you are doing everything. Could you be asking too much of yourself?

These are just thoughts and reflections. No science or facts involved.

I've read literature saying it can take up to a year of proper CPAP use to recover full brain function, and obviously you need to maintain after that. That being said I've had vast improvements over the last 6 months, but sometimes I'm very grateful that I'm a tester as I was able to test and eliminate many configurations to get to a good one. Even today I'm considering improving it, as my chin strap slipped off partially last night (not enough for me to realize it wasn't working properly), and I woke up several times to mouth sputter, I finally realized the issue, repositioned the strap, and finally fell asleep and was able to dream. So I'm going to try the ultimate chin strap next, because I definitely feel a bit foggy today due to the chin strap issue and I don't want that to ever happen if possible.

Thanks All.

It looks like you've covered most of the basics above. However, your PAP treatment is not optimized as reflected by your AHI in the 3.0 range as reported in your other thread. IMO, you need to be shooting for a sub 2.0. I'm not going to offer any suggestions as far as PAP treatment, I don't care to look at Respironics results and you are in good hands with Pugsy. However, I would be looking to the cause of all the VS2. You have some periods of what looks to be depressed breathing with Flows around 20L/min, or lower. I'm guessing that to be while supine. Not necessarily bad, but it stands out.
Agreed. I think it may have to do with supine position, but hopefully if I can address mask leaks, it won't matter.

Have you a partner that has observed any abnormalities in position or movement while you are asleep? Did your PSG make mention of any significant PLM (Primary Limb Movement)? You might want to do a time lapse video of your sleep. Many laptops have the capability. You can see the links in my signature line for some ideas. I do time lapse at around 20sec intervals and then speed it up to watch. That condenses the night down to a couple of minutes of video. Windows has most of the software needed, probably Mac, too.
Nothing from partner. PSG said no PLMS in either sleep study. I will have to consider time lapse if nothing better by next week.

How about depression? Have you explored that possibility? Often sleep difficulties and depression go hand in hand. Talk therapy, or CBT, seems to be quite effective in treating mild to moderate depression, but many medications have an adverse effect on sleep.
I've considered this. I did go through some traumatic things last year, but I believe I've come out better. I am very open with both my family / friends about sleep apnea, which has helped. Talking definitely helps for everyone. I am thinking I do have some bad days / anxiety, but I am hopeful that it's all attributable to sleep apnea. If not, I should know within a few weeks.

I have been thinking about your situation. From your examples, you seem to lack energy more than suffer from brain fog. Since you have limited energy, it needs to be carefully allotted to your day's activities.
Thanks for dedicating time to my case. This community has been incredible. Most of the time, I do feel like it's mental and fatigue can often feel like it triggers anxiety. It often feels like detachment, or depersonalization as most people describe. You're sleepwalking though things that you should be enjoying.

For example, if you had a poor night's sleep, maybe reschedule your workout to a better day. Or cut back on the intensity/duration of the workout.
I agree, but for the most part, I am automatic at my job and the gym. I've had them as part of my routine for so long, I can almost always get through both. I am aware of some central nervous fatigue from too many days of extreme exercise, so I've been adding in yoga / swimming to give myself some more relaxed exercise.

Alcohol doesn't seem to work for you, so your idea to eliminate/reduce quantities is good. If you want to be sociable cut consumption way back and drink lots of water, before, during and after.
Agreed. I am hopeful that again, alcohol with apnea is a bad look, but it's worse with the fatigue. I had a wedding this past weekend, and I stuck to one thing and stayed hydrated and I was in pretty good shape the next day. Good advice nonetheless.

If you had a poor sleep the night before, when out with friends, head home early, so you don't get panic attacks.
I agree. For the most part, if I am tired, I try to focus on addressing that. I don't believe I've ever had a real panic attack, but I've had what seems to be pretty close to it.

You are young and it seems single so you want to enjoy yourself, which is normal and good. Maybe try to go out when the next day is not a work day.
That has been my strategy. I've tried to avoid alcohol completely on work days and try to get into bed by 9:30-10. Been successful this week.


Do you have a physically active job that is draining your energy. Can you take some time off for vacation and just rest.
No, desk jockey. For the most part, low work stress. I am heading away this weekend with some friends, but not exactly a beach vacation. I did just speak with my boss about all of this, he has been understanding and offered some additional time as needed.


One thing that strikes me is that you are doing everything. Could you be asking too much of yourself?
Definitely a possibility. I am a Type A hard charger but I usually manage to have fun as well. I've been adding in meditation and some deep breathing (plus the aforementioned yoga) so I think I am taking the correct steps.

My memory hasn't been great, and I can be a bit forgetful. My dad has always been that way, but I was obviously concerned. I have been asking him to look into a sleep study as well.


I've read literature saying it can take up to a year of proper CPAP use to recover full brain function, and obviously you need to maintain after that. That being said I've had vast improvements over the last 6 months, but sometimes I'm very grateful that I'm a tester as I was able to test and eliminate many configurations to get to a good one. Even today I'm considering improving it, as my chin strap slipped off partially last night (not enough for me to realize it wasn't working properly), and I woke up several times to mouth sputter, I finally realized the issue, repositioned the strap, and finally fell asleep and was able to dream. So I'm going to try the ultimate chin strap next, because I definitely feel a bit foggy today due to the chin strap issue and I don't want that to ever happen if possible.

I've read the same thing. I know it's a long road, I just hope to see 1% increase per day. I also feel much better now that I am tracking and this forum has helped me understand what I am dealing with. This allows me to hold my doctors accountable and know that I'm not alone. As someone who reads a fair amount about the US Healthcare system, this disease has really opened my eyes even more to how vigilant we need to be with our own health. I went to doctors for years talking about what I was feeling and I guess I just wasn't a "candidate" for sleep apnea. It feels like I am on the road to recovery and provided I prioritize quality sleep, I should come out of this stronger and better. Thanks to all here.

FoggyBrain24 wrote:Thanks Cpapian and Holden4th.

I've been through the brain fog and fatigue and it wasn't until I got onto forums like these that I was able to take control of my therapy. With this, my brain fog vanished, my fatigue levels decreased significantly and my memory, both short and long term, came back.
Can I ask how long it took for you to deal with this? Did any actions speed it up?

A good question.

I used this forum (and another one) to get settings that would work for me. It wasn't instantaneous and I made adjustments. I was told to let myself get used to those changes (two weeks) and then make further changes.The effect was subtle but slow but I remember getting into the car one morning and realised that I felt quite good! It was an epiphany and I've never looked back. I can't remember that dates but I'd say that over three months after getting the settings close to what they should be I knew I was on the right track. Posting my SH data made it easier for the aficionados on this forum to help me with my settings.

Hello All,
I've been using my CPAP with 100% compliance and low AHI each evening. I've begun feeling better but I am still experiencing a bit of brain fog and my mind doesn't seem to be functioning as sharp as it once did. I am curious if anyone has ever made an appointment with a neurologist to evaluate their brain function.

Thanks.

Hi OP, I have definitely been treating myself to a "brain recovery" regimen that seems to be working.
I think a host of things are going on.
1 Energy imbalance (body sets up energy for the night for when it remembers having to deal with apnea)
2 Brain recovery (studies shows it takes about a year of effective cpap therapy for the brain to fully (read mostly) recover
3 possible endocrine issues (adrenal fatigue, aforementioned confused energy metabolism etc

I've done a few things to combat this
Supplements to help with my brain:
Huperzine A, phosphytidylserine, Choline/inositol, MCT oil, Flax, Tumeric, Coffee fruit (found a cheap source via "coffefruit tea"), l-citrulline/L-arginine complex, magnesium (and calcium to balance the magnesium)
Hup A is a acetylcholine reuptake inhibitor, meaning that your body will stop trying to conserve choline, choline is essential in this so that you don't run low
choline is like your brain energy,
flax and phosphytidlyserine provide other fat ingredients for brain recovery (Severe apnea sufferers have been tested to have as much as 30% brain loss)
Tumeric - thins the blood a little, helps clear out waste as it is a potent anti-oxidant
Coffee fruit has been shown to raise BDNF levels (which are typically low in apnea sufferers, probably due to trying to maintain the brain)
l-citrulline/arginine help with cell wall construction and raise Nitrous oxide levels which increases vessel dialation and blood flow (also consequently lowering blood pressure).
Magnesium helps smooth out the heart rate, and apnea sufferers are typically low in this mineral. It also helps with cell generation.

I also take Modafinil which is an awakeness promoter... to try and help balance my awake/asleep cycle, and to retrain myself to stop conserving energy. You mentioned "feeling too tired to go out" I think this is partially just a body habit that gets instituted because your body is trying to conserve energy for the "dieing" that's happening at night. So this helps me get over the feelings of "I just want to stay in" and actually do some stuff.

Edit: Also exercise for BDNF etc., and I also occaisionally supplement with L-lysine and L-tyrosine for various reasons

Also I have to say I was having huge exercise issues before taking magnesium. If I ever "over-excercised" I would feel flat for a few days. Magnesium seems to have eliminated that. I can go as hard core as I want and it just ups my general energy levels. It's supposed to smooth out the heart rate (prevents many kinds of arrythmias,) and since apnea sufferers in general are more likely to suffer from a deficiency it's probably the #1 supplement that apnea sufferers should be taking (or making sure it shows up in the diet (I actually do both))

Thanks Nicholas, this is all very helpful. Did you put together this regiment with the help of a doctor or through your own research?

I've always been able to get to the gym and get exercise in, however, I've noticed that my body is not progressing commensurate with my workout partner.

I currently do not take any multi-vitamin or supplement beyond creatine/whey protein. My sleep doctor did offer the prescription for modafinil, however I was apprehensive about taking anything (I am very caffeine sensitive). Do you have a recommendation for magnesium? I try to derive as much as I can from whole foods, but it seems like my brain just isn't grasping difficult concepts or retaining information (these were not problems when I was younger).

Would love to hear a bit more - I will take a look at some of the other items you list below.

Thanks.