YANMD: Always foggy, but my mornings rival London
April 25, 2016 9:39 AM   Subscribe

I wake up every single morning feeling like absolute garbage, mentally. I have considerable brain fog, struggle to move, and everything I do feels like a Sisyphean quest. When I take an almost-exactly 2 hour nap, almost exactly 2-3 hours after waking, I don't exactly feel normal, but things definitely feel lighter. I feel more rested, anyway. What could this be, and what can I do?

The situation:
26 year old male, history of what I think is mistakenly diagnosed as depression
I feel like I'm wading through fog every day. It takes me forever to plan written communication and things just generally seem incredibly difficult in proportion to the size of the task at hand.

Some snowflakes:
- I wake up after 8 hours sleep, but always by a need to urinate. Some days more urgently than others. After I do this, I feel as though I've been relieved of an irritating tension. I feel exhausted, but am unable to go back to sleep. This isn't a UTI, because urinalysis and blood tests are all normal. All other urination during the day feels normal ( normal frequency, no special urgency, no pain, etc).
- I"m not able to go right back to sleep. If I am, it doesn't do much for me.
- The ONLY thing that works is a 90-120 minute nap around 2 to 3 hours after I first wake up, usually after eating. Before that, I'm too tense. The time in between is torture, as is the entire day if I don't get this nap.
- Blood sugar, VIT D, thyroid and all others are okay
- No conclusive findings of sleep apnea, though I do snore (deviated septum, nasal polyps and whatnot)
- MRI of brain is normal
- Tried all SS and SNRIs with no change in this pattern, though some help with mood
- Sometimes need another nap during the day

I've tried not sleeping all day, getting up at the same time every day, tried cutting out caffeine ( which has no effect on me in the AM but helps a little in the PM, though not with cognition). Why does this seem to have a temporality to it? What can I do to be a functioning human being? Even writing this has me feeling like I need my bed.
posted by marsbar77 to Health & Fitness (20 answers total) 8 users marked this as a favorite
Provigil may give you short term relief, but I'd keep pursuing this. I'd have that annoying sleep study redone, because it really does sound a lot like sleep apnea or related disorder.
posted by praemunire at 9:41 AM on April 25, 2016 [1 favorite]

Exercise? Have you tried it already?
posted by amtho at 9:49 AM on April 25, 2016

You may be waking up at a wrong point in your sleep cycle. Inevitably if I wake up at 6 am for my 7:30 wake up, pee and go back to sleep my morning is hell. Wake up at 5:00 or getting close to 5:30 pee and return to sleep my morning is good. Try getting up at slightly different times to see if it makes a difference.
posted by AlexiaSky at 9:49 AM on April 25, 2016 [4 favorites]

I have tried (limited) exercise. I have cerebral palsy so it's hard, but when I do it does help me fall asleep, but never with the morning foginess. I've suspected a sleep cycle abnormality, but I'm not sure how to pinpoint what would work for me... Is there a scientific way to find this out? It's also not just the fogginess.. my body feels super heavy, almost like there's some psychomotor retardation going on
posted by marsbar77 at 9:53 AM on April 25, 2016

This is exactly how I felt coming off caffeine (a mild soda addiction dropped for sugar not caffeine but still had withdrawal effects). It took about two months to start feeling normal again. You don't say how long you tried going without but maybe that is it? I found that the OTC migraine medication to be very helpful for that as each one contains about 30 mg of caffeine. So maybe try taking them and see if that clears you up to make sure it isn't caffeine?

Also is it possible there is something else you are regularly taking/eating that has a stimulant effect on you that is leaving you feeling withdrawn? I also find eating a large breakfast but a light evening meal has great benefits to how I feel when I wake up.

My wife thought she had an unending series of bladder infections but in reality got finally diagnosed with a irritable bladder that is controlled through diet (the big offenders for her are highly acidic foods-especially tomato, yogurt and sugar).
posted by bartonlong at 10:15 AM on April 25, 2016

Your symptoms could be related to your cerebral palsy. Sleep and cognition are two of the known areas of difficulty in people who have this condition. What have your specialists said about this?
posted by cartoonella at 10:20 AM on April 25, 2016 [2 favorites]

Snoring + morning foggies = strong possibility of sleep apnea. GET THAT SLEEP TEST. I found it hard to get going in the morning, and then I got my CPAP, and now I wake up ready to take on the day.
posted by Rosie M. Banks at 10:25 AM on April 25, 2016 [1 favorite]

Just to clarify : I had the sleep study done. They couldn't say conclusively because I couldn't get much sleep with all those wires, but it didn't look like SA.
posted by marsbar77 at 10:48 AM on April 25, 2016

Also, if there's SA there, what would account for how time sensitive all of this is? That's what I'm really curious about..
posted by marsbar77 at 10:58 AM on April 25, 2016

Our brains make chemicals that paralyze us during sleep. You might make more of them than another person does. You might ask a neurologist about the dynamic of sleep chemistry as it applies to you, and see if there is an "anti sleep narcosis" med to take upon awakening. With cerebral palsy depending on the severity you might have difficulty exercising out those chemicals. So starting with a bang, in spite of feeling like, it might be one answer. Some breathing exercises, like breath of fire, it is an exercise in Kundalini yoga; it consists of rapid short breaths that give you a lot of oxygen to work with first thing in the AM. I often stagger around upon immediate waking, especially if I am driven out of bed by an obligation. You can do some exercises in bed before arising that will get your metabolism up, and the fog cleared out.
posted by Oyéah at 11:02 AM on April 25, 2016

You sleep in order to clean the brain. The lymphatic system for the rest of the body is powered by muscle motion. Walking is one of the best ways to fuel it. When you are active, lymph is returned to the blood at many times the usual resting rate. The brain has a separate system. It dumps lymph at night.

Lymph is essentially blood fluid with blood components removed. It also gets called interstitial fluid. Urinating is about dumping junk the kidneys filtered out of the blood.

So the uncomfortable urination in the morning is very likely related to dumping lymph from your brain and this may be related to the fact that you have cerebal palsy.

Let me suggest you walk more, eat clean and consider nutritional supplements to support brain health, like b vitamins.
posted by Michele in California at 11:16 AM on April 25, 2016 [1 favorite]

Did they test you for anything other than sleep apnea? Are you able to get a CPAP (with heated humidifier) on a trial basis? Because it seems to me as if you are not getting good quality sleep. It's not normal to stumble around in a fog every morning, day after day. It's not normal to need a nap when you first wake up. It's not normal to be so low-energy you can't live the life you want.

Ideally a sleep test will look for things like narcolepsy (I had a daytime sleep latency test for that after my overnight sleep test), restless leg syndrome, hypersomnia, etc. Maybe you need a new and better sleep test? Or a trial of a CPAP machine? In any case, if at all possible, don't let your doctor(s) shrug their shoulders and say "Try taking more naps" or anything to that effect.
posted by Rosie M. Banks at 11:28 AM on April 25, 2016

What time do you typically wake up in the morning? Does it matter whether you wake up later in the day?

I feel like this when I get up in the morning too. Brain foggy, moving is difficult and painful, any amount of physical exertion makes me feel like I've been hit by a truck. If I need to do something active for work before 12 pm, I need a nap to recover.

However, if I wake up after 12 pm, I don't feel like this. (Well, I still need half an hour to let my brain fully wake up, but after that I feel okay.) Getting up even a little later, like 2 pm, makes me feel even better.

I've realized that I just have a sleep cycle where my body wants to sleep from about 6 am to 2 pm. Maybe you want to experiment with going to sleep and waking up at different times.

Also, do you have any allergies or sinus congestion? When my allergies act up, I end up feeling exceedingly foggy and exhausted all day. I haven't had a sleep study, but I'm pretty sure the whole not being able to breathe through my nose is disrupting my sleep. Sinus rinses + flonase + mucinex has helped with this a lot.
posted by litera scripta manet at 11:30 AM on April 25, 2016 [1 favorite]

- Tried all SS and SNRIs with no change in this pattern, though some help with mood

Oh, also, did you try Wellbutrin? It's not an SSRI or an SNRI, but rather a norepinephrine dopamine reuptake inhibitor. Compared to SSRIs and SNRIs, it's more likely to improve things like energy level and focus. (IANAD, but I have taken Wellbutrin in the past.)
posted by litera scripta manet at 11:33 AM on April 25, 2016

I had 2 sleep studies. I knew I didn't sleep, but they said I did, and that I didn't have sleep apnea. On the 3rd study I did sleep, and I DID have sleep apnea. So, if you didn't sleep, don't believe them that you did. I'd say get another sleep study. Your symptoms sound exactly like sleep apnea. Also, there are other sleep problems they can diagnose with a sleep study.
posted by H21 at 12:07 PM on April 25, 2016 [1 favorite]

I discovered that my morning fogginess was much improved if I ate a breakfast of mostly protein, rather than carbs. Although if I wake up at the wrong point in my sleep cycle, all bets are off and I tend to remain foggy for a good part of the day.
posted by telophase at 1:29 PM on April 25, 2016

Brain fog is a symptom of ADHD. What you describe seems significantly more severe than brain fog, but I felt that it was worth mentioning, since you have ruled out thyroid issues.
posted by sparklemotion at 1:38 PM on April 25, 2016

Things that have helped me:

1) Get a wake up light alarm: http://www.amazon.com/Philips-Morning-Wake-Up-Simulation-HF3520/dp/B0093162RM

2) Drink a big glass of water as soon as you wake up. Have it next to your bed waiting for you. Sometimes a little flavor, e.g. lemon juice and Stevia, makes it easier to guzzle that much water in one go.

3) Eat 30 grams of protein within 30 minutes of waking. Six scrambled eggs will cover this and are easy to make even when you're brain dead.
posted by Jacqueline at 9:02 PM on April 25, 2016

I echo the comment about Wellbutrin -- I was on it for quite some time and took it for my ADD as well as my depression, and it definitely had a great improvement on my mental acuity.
posted by gloraelin at 6:39 AM on April 26, 2016

I can't take either Wellbutrin or ADHD meds, unfortunately. Wellbutrin makes me anxious and adds to my muscle tension, and any ADD meds, even NRIs, send my already high blood pressure to dangerous levels :(
posted by marsbar77 at 6:48 AM on April 26, 2016

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