[CPAP] How do I remedy brain fog and headaches after beginning CPAP?

[lessthan200]

After struggling for years with fatigue, brain fog, and not being able to sleep more than 2 hours before waking up I decided to have a sleep study done and was subsequently diagnosed with mild sleep apnea having an overall AHI of 11, REM AHI of 26, and O2 saturation down to 87%. This was followed up with a titration sleep study after which the doctor prescribed me an APAP machine with settings of 10-17 cm of pressure.

I then purchased a Redmed Airsense 10 Autoset with climatelineair tube to use with the Resmed Airfit F20 full face mask I used when I did my titration sleep study. They also gave me an F&P Eson 2.

Here are how my first three nights have been along with the OSCAR screen shots.

My first night using the machine was pretty bad. I decided to try the Eson 2 but was having a lot of anxiety because I could not open my mouth without letting air out. This anxiety kept me in a weird state for an hour or so and it felt like the machine was breathing for me. It felt like I was half asleep half awake laying there with my eyes open and mind racing. When I would close my eyes I would feel claustrophobic and sudden pressure changes as I was beginning to fall asleep would wake me. After waking I had moderate brain fog and fatigue all day.
   

My second night was even worse. I switched to the F20 face mask so that I could open my mouth and take a deep breath when I was feeling claustrophobic which helped a lot but I ended up waking up with even more brain fog, fatigue, and a headache. I recall waking up to use the bathroom and feeling a lot of pressure on my face. I think the headache was due to the mask being too tight because I could feel muscle tightness on the back of my head where the mask strap rests. agnesium before bed.
   

Last night was the best so far. I loosened up the mask quite a bit and only had minor brain fog and headache. I changed the machine response to soft. I was also fatigued throughout the day but it was a different kind of fatigue. I felt a tired mentally but not physically. I also didn't get sleepy after eating lunch. 
   

The OSCAR graphs show more clear airway events than apneas, I'm guessing that's just because I'm not used to the CPAP yet? I only had hypopneas and obstructive apneas during my sleep studies. 

How does the machine treat deep breathes, clearing throat, or swallowing?


Suggestions?

[super7pilot]

You are going through what most do when first starting PAP therapy. Your mind and body has a lot of adapting/getting used to treatment to go through. Our bodies are not made to breathe pressurized air.
A week or so after starting PAP. I swear I felt like an 18 wheeler ran me over. It was nasty. But it slowly got better. Having your mask too tight can hurt and make leaks worse.

The next thing that happens to a lot of new folks is a lot of Clear Airway (CA) events. Two things cause this. First is from dithering back and forth from sleep breathing to wakeful breathing. We call this Sleep Wake Junk (SWJ)

Secondly it is from breathing deeply and our lungs exchange to much Co2 for Oxygen. As our body regulates breathing via our blood Co2 levels. If we off gas too much Co2. Our blood monitoring systems signal this low Co2 to our brain and the brain says. Ok, Low Co2? You don't need to breath until the Co2 is back in range. All these Ca's are called Treatment Emergent Clear Airway events. They tend to lessen as we get used to treatment and make adjustments to our machines.

As you are still having a few OA's. You might try raising your min pressure to 11 or 12. Try that for a night or two. You can up the EPR to 3 and that will make breathing more natural. But can increase CA's. Most of your CA's seem like SWJ. So the EPR3 might make passing through the SWJ zone a bit easier. I know it seems horrible. But you need to stick with it.

Any time the machine detects no breathing for 10 seconds. It is flagged as a CA. So a CA can be from holding your breath while turning over in bed. Coughing clearing your throat can show as a big spike in the flow chart.

[super7pilot]

I want to correct something. A CA is flagged after the machine sends some air pulses to the mask to detect if the airway is open. If it’s open, it’s a CA. If closed it’s an OA.

[ejbpesca]

Getting a mask adjusted is tedious.  The mask fit function on your machine can help find how to adjust straps to give a seal with the least possible strap tension.  I used the F20 for ten years.  It continuously gave me leak problems and soreness due to having to strap it to my face so tightly.  The F40 has been a big improvement for me due to its lightweight, flexibility, and being a hybrid mask that does not go over the top of the nose.

Adapting to PAP therapy is a challenge.  It took me months to accept the headgear and mask.  18 years into it I still have issues with having silicone to my face.

[Deborah K.]

I think you would do well to raise your starting pressure to 10.6. That might help.

You are right; if you didn't have any CAs in your sleep study, they are treatment-emergent and should lessen as time passes.

[lessthan200]

Are the straps on the F40 different than the F20? They look the same in photos.

The F20 mask I was given is a medium so I ordered a large strap for it and some sort of cushion that goes around it to see if it helps. The Amazon reviews on the cushion had people commenting on how it helped with their F20 mask so I figured I'd give it a shot.

Is sizing the same on the F40 as the F20?

Why should I raise my starting pressure to 10.6?

Yesterdays report
   

[super7pilot]

You should favor setting your minimum to your average pressure as that is the pressure you were breathing most of the night.

That will also lesson the pressure changes that can wake you.

[SarcasticDave94]

You might do better on standard response versus soft. It appeared the higher flow limits occurred just before the group of CA in the last chart. Maybe the setting edits others suggest will help the flow limits get under control better.

[ejbpesca]

A. Are the straps on the F40 different than the F20? They look the same in photos.

B. The F20 mask I was given is a medium so I ordered a large strap for it and some sort of cushion that goes around it to see if it helps. The Amazon reviews on the cushion had people commenting on how it helped with their F20 mask so I figured I'd give it a shot.

C. Is sizing the same on the F40 as the F20?

D. Why should I raise my starting pressure to 10.6?

Yesterdays report

A. The straps for the F40 are a bit different than the F20s I have.  They look like they maybe could be interchangeable but I have not tried that.

B. You may be referring to a mask liner that fits over the mask cushion.  I tried the Snugz brand but found it to leak air too much...on me.  I use a liner with my F40 with success though.

C. No.  My experience was the F20 mask cushions come in different dimensions from S to L.  From what I understand the F40 mask is the same size for S M and W cushions.  It is the nostril ports that are different for each size.  ResMed has videos explaining the sizing process.

D.  If you do not use Ramp then you do not have a starting pressure.  What may be suggested is minimum pressure.  The reason to raise min pressure on an APAP machine is to give better delivery of therapy.  If 10.6 is the most effective pressure for therapy then setting the min to 10.6 keeps that pressure available continuously, not allowing the machine to lower the pressure and then rise to it again.  What was your sleep study prescription min pressure?  Those can be wrong.  

For example:  My sleep study prescription min pressure is 8 max 20.  That is not correct for me.  My min effective pressure is 12 and 20 works well for the max. 8-20 is a common setting clinicians use for its flexibility.  It gives the machine the scope to auto-adjust pressure. But, this does not produce the most effective therapy.  The APAP machine is not fast enough to jump from min 8 to the 12 I need for therapy.  I need continuous 12 min to prevent my apneas and the max 20 for when Flow Limitations and apneas get worse.  Here's why someone may have suggested to raise your Min pressure to 10.6:

What is often suggested for a min setting is the Med figure next to Pressure under Statistics in OSCAR.  Your Med or Median pressure is 10.48.  You have set your min pressure to 10.  If your Med pressure under Statistics continues to be higher than your Min setting you may want to raise the Min to the Med pressure.  What you find here for settings are suggestions from experiences and research but not always what may work best for you.  Adjusting your machine is an experiment.  Look over several OSCAR reports to check for the Med (median) Pressure under Statistics.  If that figure amount is regularly above the Min pressure setting then it is suggested to raise Min to that figure.

Yesterdays report:

Looking Good!  AHI is low.  CA apneas are low and may be part of getting used to PAP therapy.  A few apneas here and there are normal. Some people get an AHI of 0.00 sometimes and consistently under 1.00.  I have no such luck.  If I get < 1.00 I celebrate.  Last night was rough for me with AHI 4.40.  Under 5.00 is supposed to be okay, but for me, it takes < 2.00 for me to feel the benefits of the therapy.

Zero Large Leaks! great!

The Leak Rate went up a bit for a while but stayed under the acceptable limit of 24.

Flow Limitations are not remarkable.  As you get accustomed to PAP a closer look can be made to check if Flow Limitations are remaining low. 

The other things I check are Events and total time in apnea.  Some dive into all aspects of the OSCAR data graphs and statistics but what I mentioned above gives a good idea of how well therapy is going.

Your OSCAR report looks really good.  I'm 18 years into PAP therapy and would be very happy if most of my OSCAR reports were similar to that one.  I think your CAs will go down as you adapt but a few may come and go without being understood why.

Brain fog and headaches are common complaints from those with sleep apnea.  They also can occur during the process of adapting to CPAP/APAP therapy.  Hopefully, you will be feeling better as you adapt.

[lessthan200]

B. I was talking about the blue microfiber like material that wraps around the headgear straps. I didn't like it. It cushioned the straps but then it started to make my head hot. 

D. Yes, I was talking about the minimum pressure. I ended up raising it to 10.6 and lowering the max pressure to 12.8. I ended up with a lot more CAs, see screenshot below.
My sleep study prescription was for an APAP set to 10-17cm.

My med pressure was always higher than my minimum setting on previous nights.

4/15 report showed a lot more CAs and AHI for the night was 7.75. Most of the CAs were very close to one another. I think I remember waking up in the middle of the night to use the bathroom and taking off the mask and not putting it back on.