Using CPAP for 7 years but still have brain fog

Hi all,
I've been meaning to post here asking for help for several years now, but my brain fog and related memory problems led me to keep forgetting. Basically, my doctors have no idea why I don't sleep well, despite low AHI every night. I'm hoping y'all see something they can't, or can at least help me rule out CPAP as an issue. Did my best to post to take the screenshots per the instructions, apologies if I missed anything.

https://imgur.com/a/4oWJRWI

Your Sleep Apnea appears to be treted pretty good.

Start exploring non-Sleep Apnea reasons.

When we don't feel the good numbers we have to start looking for other potential culprits.

First one to look at is medication side effects.
Do you take any meds and if so, what?

Hi, last year, I was battling similiar situation,for several months, pap therapy stats were outstanding, according to sleep clinic. But, I wasn't sleeping well. After lot's of investigation by primary/specialist, I had super low testosterone. Brain fog and memory was non existent, I was tired everday. Testosterone treatment resolved all symptoms. Thank goodness.

Brain fog/memory example: One evening, I went grocery shopping, filled up an entire cart, got to cash lane, forgot my wallet. I was forgetting to pay bills, etc...

Have you primary care/specialist, investigate deeper then basic work ups. Have your hormones tested. Wish you well.

fijibear wrote: ↑

Tue Jun 14, 2022 1:02 pm

Basically, my doctors have no idea why I don't sleep well, despite low AHI every night.

Can you fully describe "don't sleep well"? Sometimes there can be clues in the minutest of details. Maybe you have other yet unrecognized contributors to how you feel.

Some common sleep disruptors are various types of insomnia, medication side effect, other sleep disorders (like leg movements), medical conditions (like thyroid or mood disorders) and the list goes on. I had reached a point where I told my doctor I didn't want him to stop until he had an answer for why I felt so bad. When my sleep was bad, I assumed that was why. Once I was sleeping better, I found I needed to get more Vitamin D to feel better. Good luck figuring things out.

Pugsy wrote: ↑

Tue Jun 14, 2022 2:08 pm

When we don't feel the good numbers we have to start looking for other potential culprits.

First one to look at is medication side effects.
Do you take any meds and if so, what?

• AM
• Vit D - 10k IU
• Armour Thyroid 60mg for Hypothyroidism
• Xyazal 5mg for allergies
• Vyvanse 30mg for ADHD and energy
• Breo Ellipta 200-25mcg inhaler for Asthma
• Olopatadine nasal spray for allergies
• Fluticasone nasal for allergies
• Vitamin B6 50mg for mood and energy
• Vitamin B1 100mg for energy (I did recently find my blood values were a little low)
  
  PM
• Horizant 900mg for Restless leg syndrome
• Magesium glycinate 400mg for legs and sleep
• Ferrous Fumarate 29mg, every other day for RLS
• Vitamin C 500mg every other day for RLS
• L-Theanine 400mg for sleep

Architect wrote: ↑

Tue Jun 14, 2022 2:12 pm

Testosterone treatment resolved all symptoms.

I haven't had my T tested in some time, I'll suggest it at my PCP appointment next month!

kteague wrote: ↑

Wed Jun 15, 2022 2:43 am

Can you fully describe "don't sleep well"?

Sleep is unrefreshing. I have a fog 24/7. I wake up multiple times in the night, some are significant enough to get me out of bed. I fall asleep quickly if I don't have my CPAP on, but it's much harder to fall asleep with it on. I have a very hard time getting up in the morning, with multiple alarms, to the point where my wife usually has to wake me up. I used to have insomnia which kicked off my brain fog in the first place, after I changed mattresses and started getting shoulder pain. I have much less insomnia now, but am still so fatigued. Thanks for listening, all.

fijibear wrote: ↑

Wed Jun 15, 2022 3:50 pm

I wake up multiple times in the night

Any idea why?

I usually awaken around 3-4 am (going to sleep around 11-midnight). The reasons vary: sometimes I wake up and can go right back to sleep, other times I get hunger pangs and get up and eat (not a great habit), other times I have to pee, and some days (especially after leg workouts), my RLS can wake me up.

How many hours of sleep have you averaged over the years? You could be in a severe sleep deficit.

How much and how hard do you workout? Without good, restorative sleep your body and mind will not respond well.

What exactly does the brain fog feel like? Sleepiness and fatigue, or just memory and concentration issues? How high are you on the daytime sleepiness scale (post cpap)?

I would request your PCP submit a referral to an endocrinologist asap. It might be quite the wait.

I have the same problem as you. I was later diagnosed with REM Sleep Behavior disorder. Read about what it does and see if you exhibit some of those behaviors to get the conversation started. It does show up in the sleep study, but they didn’t see it on mine until they tested me for narcolepsy. It only has one FDA approved treatment which I do not see on your list of current meds.

As for waking up hungry, I would cut the carbs and simple sugars. Add more fat and protein to your diet. Fat and protein keeps you satiated much longer. You may even want to consider full to moderate Keto. Don’t worry, it won’t mess up your gym gains. You may also be sensitive to some of your food choices.

I would also say be brutally honest with yourself and your doctor. Smoking, alcohol, and other drugs (performance enhancers and leisure) can have severe impacts on sleep quality.

Lastly, I am not a doctor. I am merely someone who has dealt with these problems for a very long time with different specialists and also driven to self research. There are a plethora of other medical issues that correlate with sleep disorders. Everything I wrote is from personal experience and medical diagnosis.

One suggestion I have is to get a recording pulse oximeter to see what your O2 sats are doing. Sometimes the data on the CPAP looks OK, but you may still be having desats. It's worth checking to see if that's the case and then maybe changing the pressure.

Armour Thyroid 60mg for Hypothyroidism
Xyazal 5mg for allergies
Breo Ellipta 200-25mcg inhaler for Asthma
Olopatadine nasal spray for allergies
Fluticasone nasal for allergies

Hi friend, when was your last thyroid blood labs? I know for a fact, Thyroid medications can cause undesired symptoms. Armour is combo med T3/T4, as you already know. Hypo/hyper can cause sleep issues. Brain fog is a symptom of both hyper/hypo sleep disturbance. My thyroid was removed 10 years ago. I take Cytomel T3 and have sleep issues occassionally, when T3 levels increase slightly. I cut back dose.

Appears you have severe allergies & Asthma from medication list. Approx 3 years ago, I used Xyazal and Fluticasone, both medications made me very drowsy, including brain fog. Felt like dawn of the dead. I was fighting daytime drowsiness, took naps. So, allergist state to take/use at night. Still felt tired during the day, but active/functional.

I had read an article, written by ENT, allergies can worsen sleep apnea. If your interested, I'll share article pm.

Eating and urinating during the night, could possibly be diabetes.

Wish you well friend, hope your symptoms are resolved soon.

Apologies for ghosting on my thread, but I went and tried many of the suggestions that you all recommended. Unfortunately, my sleep is still unrefreshing, but I'm getting closer to the "why".
An update:

• My testosterone was low, around 220. I have since started injections and my numbers are in range
  
  I started blood pressure meds two months ago. These have had a profound affect on my ability to exercise regularly and not feel terrible during or afterward. I'm still in the process of tweaking the dose/meds with my doctor, but it's great to have some relief and be able to lose a little weight.
  
  I started guanfacine for my ADHD to help with executive dysfunction. My head is much clearer, though I'm still foggy every day.
  
  I discovered that sticking my tongue out while breathing improved respiration, and my fog slightly. I'm not really sure what to make of this info, but I'm seeing an ENT in October
  
  I looked back at an old CPAP titration compared to my diagnostic study, and it showed that I get almost no deep sleep with or without CPAP.

I'm having a hard time getting a respiratory therapist that is knowledgeable enough to work with me. Does anyone here know if there are masks other than my nasal pillows that would do a better job of moving my tongue out of the way / help me get deeper sleep?
Thanks!

Architect wrote: ↑

Fri Jun 17, 2022 10:13 pm

Hi friend, when was your last thyroid blood labs? I know for a fact, Thyroid medications can cause undesired symptoms. Armour is combo med T3/T4, as you already know. Hypo/hyper can cause sleep issues. Brain fog is a symptom of both hyper/hypo sleep disturbance. My thyroid was removed 10 years ago. I take Cytomel T3 and have sleep issues occassionally, when T3 levels increase slightly. I cut back dose.

Appears you have severe allergies & Asthma from medication list. Approx 3 years ago, I used Xyazal and Fluticasone, both medications made me very drowsy, including brain fog. Felt like dawn of the dead. I was fighting daytime drowsiness, took naps. So, allergist state to take/use at night. Still felt tired during the day, but active/functional.

I had read an article, written by ENT, allergies can worsen sleep apnea. If your interested, I'll share article pm.

Eating and urinating during the night, could possibly be diabetes.

Wish you well friend, hope your symptoms are resolved soon.

Thank you for the thoughtful reply, apologies for not answering.

• Thyroid: my values are all in normal range, though my endo is similarly concerned about me taking too high a dose of armour. I tried to split the dose in two to smooth things out, but I became far too tired to function. I might still try that again

• Interestingly, Xyzal is stimulating for me, so I take it during the day. Allegra doesn't seem to affect my fatigue at all

• my glucose has always been just short of pre-diabetes. I have tried a variety of diets over the years, but nothing has helped

Janknitz wrote: ↑

Fri Jun 17, 2022 1:11 pm

One suggestion I have is to get a recording pulse oximeter to see what your O2 sats are doing. Sometimes the data on the CPAP looks OK, but you may still be having desats. It's worth checking to see if that's the case and then maybe changing the pressure.

Thanks for the suggestion. I recently did a sleep study without the CPAP (for insurance purposes). And my desats never went below 92%.

Another option that may not be immediately obvious (it wasn't for me) is anxiety/depression. Check out the list of symptoms. It took me some time to be honest with myself when answering the questionnaires, but treatment has made a notable difference in how I feel.