[Symptoms] Oscar Help! Brain fog, fatigue, anxiety, etc.

[Jackpine]

Background:

I started treatment in 2021 after being diagnosed with mild sleep apnea and an AHI of 24. I started with a Airsense10 and F20 full face mask. Being a complete noob I went off MyAir numbers and what my doctor said to judge how well I was doing. What a mistake... While I felt much better for the first couple years after starting treatment, things started to go down hill quickly in March of 2024. I started to get crazy neck pain and muscle tightness in my neck, traps, shoulders and upper back. This was accompanied by a wide range of symptoms I've never had in my life. Extreme anxiety/panic, blurred vision, dizziness/vertigo, chronic fatigue, extreme brain fog, unable to breath naturally, extremely diminished executive function. Imaging and testing couldn't find anything majorly wrong besides a loss of lordosis in my neck and some minor c1 c2 instability. 

Fast forward to today and I have been able to reduce a lot of the symptoms through various treatments, including improving my cpap setup and settings. I now use a Phillips Dreamwear nasal pillow mask and mouth tape to prevent leaks. I have adjusted my cpap settings as well and the numbers are much better now. The main issues I am still dealing with are chronic fatigue, brain fog, lowered executive function, anxiety, breathing still doesn't feel right, mild dizziness, mild muscle tension in the neck and upper shoulders. I sleep through the night fine, but wake up feeling miserable. 

Oscar Help:

I am newer to Oscar and have watched a lot of youtube content on how to better understand my numbers. It appears I am still having some choppy breathing and maybe exhaling much more than I should be? If you all could take a look at the photos provided from last night's sleep and provide feedback I would greatly appreciate it. I can provide more photos and data as needed. I included my settings below:

Mode: CPAP
Pressure: 8.00 cmH2O
EPR: Full Time
EPR Level: 2 cmH2O
Humidity Level: 5 
Ramp: Off


Thank you!!!

[Deborah K.]

I think we could better help you if you switch to apap mode and set a pressure range of 7 to 15.  Doing this will help us find the pressures that you actually need.  As we sleep our pressure needs change during the night.  If you want to use cpap mode, we will at least be more sure of the correct setting, although apap mode works better for most people.

Raising your EPR to 3 would make your breathing more comfortable and would lower your flow limits, always a good thing to accomplish.

It would help if you changed your Oscar chart some. Remove the calendar, drop the resp. rate and add Pressure. We need to see Pressure on your first page.

Best of luck with improving your therapy and comfort!  

[DaveSkvn]

Hi Jackpine,

Could you include a zoomed in graph of your 'flow rate' around 03:40 so that it shows about one minute's data?

Above the line is the inhalation and below the line is exhalation. We'll look at the bit above the line. If you look when you first switch the machine on (i.e. when you're awake), the inhalation potion above the line looks like half an egg (or a parabola if you wish). It'd be good to see if it still egg-like at 03:40 or if the top has become flattened.

[Jackpine]

Deborah K. pid='541156' dateline='1735061067']

I think we could better help you if you switch to apap mode and set a pressure range of 7 to 15.  Doing this will help us find the pressures that you actually need.  As we sleep our pressure needs change during the night.  If you want to use cpap mode, we will at least be more sure of the correct setting, although apap mode works better for most people.

Raising your EPR to 3 would make your breathing more comfortable and would lower your flow limits, always a good thing to accomplish.

It would help if you changed your Oscar chart some.  Remove the calendar, drop the resp. rate and add Pressure.  We need to see Pressure on your first page.

Best of luck with improving your therapy and comfort!  

I was previously on APAP with a range of 5.6-12 and an EPR of 3. It felt as if I was expiring too quickly and too deeply. It felt as if I would quickly have to take a breath in quickly, where normal breathing I would take a pause. Here is a a screenshot of Oscar with those settings from a few nights ago.

   

Here is a screenshot with pressure added in and settings of CPAP at 8 and EPR 2. Last night was the first night trying these settings.

   

Thank you!

---

Hi Jackpine,

Could you include a zoomed in graph of your 'flow rate' around 03:40 so that it shows about one minute's data?

Above the line is the inhalation and below the line is exhalation. We'll look at the bit above the line. If you look when you first switch the machine on (i.e. when you're awake), the inhalation potion above the line looks like half an egg (or a parabola if you wish). It'd be good to see if it still egg-like at 03:40 or if the top has become flattened.

Here is the screenshot around 3:40. Definitely looks like flatter tops to me.

   

[Dormeo]

Are you typically in bed for only 7 hours? Most people need 7-9 hours of actual sleep, which means at least 7.5 hours in bed.

Sometimes people with sleep apnea also have something else going on that affects their daytime functioning in some of the ways you've described. You might ask your doctor to check the following: thyroid, testosterone, iron, vitamin D, B vitamins, Lyme disease, autoimmune disease (especially in the connective-tissue-disease family). And any chance you have long Covid?

[Jackpine]

I usually have my cpap on for 8-9 hours. Last night we had a holiday party and got slightly less sleep than normal.

I had Covid twice. The last time was July 2022. Had a little bit of lingering brain fog, but that resolved before all of these symptoms came on strong and abruptly in March of 2024. I’ve seen multiple ENT’s, a neurologist, had blood work done. No blood work to rule out thyroid, autoimmune, Lyme, etc. though as you mentioned. I’ll speak with my primary care to see if he can order that.

Are you asking this because my Oscar data wouldn’t indicate a major issue?

[Dormeo]

It's well worth tweaking your settings to see whether that helps. I've mentioned these other avenues largely because of the recent and fairly sudden onset of your symptoms. Also, my own experience with autoimmune disease makes me wonder whether you may have some form of myositis. It would be good to rule it out.

[SeePak]

Hi Jack.

Anxiety.....that is the order of the day!

So many people are having these issues, Stress, Anxiety, Depression.

Sore neck muscles and upper back and shoulders!?

cPAP wont fix that!

You have, for the most part, a very stable chart for CPAP.  At least it looks that way to me.

What is not to like about 0.04 Flow Limit?

However, you have a HIGH respiratory rate and low tidal volume.

Short, shallow breathing, and you must have that all day?

Will be worsened with CPAP therapy.

Your Youtube searching can help you, by finding Breathwork and breathing exercises.
This should be almost mandated here.
Check out Patrick McKeown.

I too have had anxiety issues and i can stop any stress/anxiety dead in its tracks by concentrating on BREATHING exercises.
I honestly dont know how anyone could challenge that!

And also, if I were to make a suggestion to try something in your CPAP settings, i would say.

CPAP mode      7 cm,  EPR=0      ( in your own words the EPR made breathing quick, almost guaranteed due to your already high Respiration rate. )

I am suggesting to try for a week, along with exercises.

Peace.

[Jackpine]

Hi Jack.

Anxiety.....that is the order of the day!

So many people are having these issues, Stress, Anxiety, Depression.

Sore neck muscles and upper back and shoulders!?

cPAP wont fix that!

You have, for the most part, a very stable chart for CPAP.  At least it looks that way to me.

What is not to like about 0.04 Flow Limit?

However, you have a HIGH respiratory rate and low tidal volume.

Short, shallow breathing, and you must have that all day?

Will be worsened with CPAP therapy.

Your Youtube searching can help you, by finding Breathwork and breathing exercises.
This should be almost mandated here.
Check out Patrick McKeown.

I too have had anxiety issues and i can stop any stress/anxiety dead in its tracks by concentrating on BREATHING exercises.
I honestly dont know how anyone could challenge that!

And also, if I were to make a suggestion to try something in your CPAP settings, i would say.

CPAP mode      7 cm,  EPR=0      ( in your own words the EPR made breathing quick, almost guaranteed due to your already high Respiration rate. )

I am suggesting to try for a week, along with exercises.

Peace.

Thank you for the recommendations! I have started doing breathing exercises and meditation and they have been helping during the day. When I wake up in the morning all the symptoms come roaring back. It is almost like my body is still having to work hard to breathe while I am asleep. Could UARS be a possibility?

[SeePak]

Give those breathing exercises and the proper ones especially for anxiety a lot of them with breathing into cupped hands.
Especially do when you wake up in the morning when you're having those symptoms.
And with other exercises you can get into the rest and digest state balancing your vagal nerves.
Hang in there you can do it!