Why is pressure changing by 1.5 cm H2O? - Asking because my spinal joints hurt

[PaulaO2]

Why would using APAP mode cause you spinal and rib cage pain?

[DariaVader]

Thanks Daria,
I notice that on my stats, SH will list me as using ramp, which I don't use, also says my humidifier is disconnected, which it's not.
But it said the same on the prior version of SH too.

I do know that Mark has done recent work on the PRS1 importer - it has it's own category on the bug tracker - but I don't know if it's fixed in the compiled version. You could pm me a screenshot of the settings you mean and I have some of my son's data from before he went to bilevel - he was using ramp=off and a humidifier with a heated hose - does that match your setting?

[vsheline]

I believe the idea I had yesterday was that I'd put the machine in auto mode and then gradually increase the upper pressure limit and see if my body tolerated that better than letting the pressure go from, say, 9.0-15.0 all at once.

I'm not sure that actually makes any sense, though.

Makes perfect sense to me. Raising the pressure very slowly in CPAP mode also makes perfect sense.

Perhaps you have some dislocated ribs or vertebrae? I would work toward trying to see several chiropractors for a consultation and choosing one, perhaps getting spinal X-rays taken and starting a treatment plan, if spinal dislocations are found to be the issue.

An upgraded bed to sleep on often helps lower back pain, but sounds like that's not your problem.

Good luck in finding the root cause of the pain, and getting it fixed. I suggest working toward fixing the root problem which is causing the pain.

It is not normal to have the pain you have from a moderate pressure like 14 cmH2O, or from the pressure periodically varying within a 1.5 cmH2O window. Lots of our fellow members who use bilevel machines use inhale pressures above 20.

For example, many nights my inhale pressures reach 24 or 25, and my inhale versus exhale pressure difference is always at least 5 and ranges up to 10. At first I had some sore muscles and stiffness, but it went away in a couple weeks as my muscles grew stronger.

[green wings]

Thanks, Vaughan. I am guessing that my pain threshold is maybe a lot lower than yours. I suspect I'd be visiting the ER if I had something dislocated. I'm fairly wimpy.

I got a new mattress last summer. It's a Serta memory foam - not top of the line, but it's fairly decent. That doesn't mean it couldn't be the problem. I feel like I'm sleeping on my back a lot more than I used to since I started CPAP therapy in the winter.

Your idea about finding a chiropractor actually sounds like an excellent one. I'm probably going to have to be hurting more before I'll do it, though, because I absolutely hate going to a new doctor for an undiagnosed problem.

Again, thanks for your reply. It seems to be generally agreed that those 1.5 cm set pressure changes aren't likely to be what's aggravating my spinal joint pain.

I believe the idea I had yesterday was that I'd put the machine in auto mode and then gradually increase the upper pressure limit and see if my body tolerated that better than letting the pressure go from, say, 9.0-15.0 all at once.

I'm not sure that actually makes any sense, though.

Makes perfect sense to me. Raising the pressure very slowly in CPAP mode also makes perfect sense.

Perhaps you have some dislocated ribs or vertebrae? I would work toward trying to see several chiropractors for a consultation and choosing one, perhaps getting spinal X-rays taken and starting a treatment plan, if spinal dislocations are found to be the issue.

An upgraded bed to sleep on often helps lower back pain, but sounds like that's not your problem.

Good luck in finding the root cause of the pain, and getting it fixed. I suggest working toward fixing the root problem which is causing the pain.

It is not normal to have the pain you have from a moderate pressure like 14 cmH2O, or from the pressure periodically varying within a 1.5 cmH2O window. Lots of our fellow members who use bilevel machines use inhale pressures above 20.

For example, many nights my inhale pressures reach 24 or 25, and my inhale versus exhale pressure difference is always at least 5 and ranges up to 10. At first I had some sore muscles and stiffness, but it went away in a couple weeks as my muscles grew stronger.

[green wings]

No idea really. It's a case of "I did X and Y happened" and this is the second time, so I thought I'd ask to see what people's opinions are.

After I started this thread, I did a web search on "CPAP APAP auto arthritis spine pain" and found dozens of people complaining that CPAP therapy made their arthritis worse.

Then I noticed that there were also dozens of people claiming that CPAP therapy made their awful arthritis pains go away.

Why would using APAP mode cause you spinal and rib cage pain?

[AshSF]

No idea really. It's a case of "I did X and Y happened" and this is the second time, so I thought I'd ask to see what people's opinions are.

After I started this thread, I did a web search on "CPAP APAP auto arthritis spine pain" and found dozens of people complaining that CPAP therapy made their arthritis worse.

Then I noticed that there were also dozens of people claiming that CPAP therapy made their awful arthritis pains go away.

There are multiple things at work here:
1) As Vaughan said, early on in PAP therapy, your diaphragm muscles are working harder. They may make your rib cage sore. That pain may somehow radiate/contribute to your spinal issues.
2) For some people, with Therapy, they move around much less in bed. Lying in one position can make some muscles sore.
3) for some people, if you are having microarousals (knocked from a deeper sleep stage to shallower one), you may be moving about too much and may be causing pain in some joints. Pressure changes in APAP mode causes microarousals in about 18% of people.

[0rangebear]

Green Wings
In the quote below, AshSF talks about "making your rib cage sore".
Maybe my experience can help, I did not have any back, spine, or rib cage pain when I went into the emergency room in November 2015.

Because of my injury and the fact that I could not breath on my back, they put me on a ventilator. They put me in an induced coma for 4 days and when they woke me up I had spine, back, and neck pain, that kept me awake, I then had my second sleep study and they sent me home with a APAP. My Dr. told me told me needed to learn to sleep and breath on my back.

The back pain got worse during the first six weeks. I would almost pass out when I got up to go to the bathroom. The pain along with the dehydration was almost unbearable. Therefore,I went to see an orthopedic spine specialist and he told me something very similar to AshSF's and Vaughan's comments below.

He said: When I was on the respirator the Ventilator and my muscles fought for control, injuring my diaphragm and the connective tissues between my ribs. He also said, it happens to everyone on a ventilator, and the longer you on it, the greater the injury.

He told me the positive airway therapy can cause similar injury when first applied although not everyone experiences it.

This is why some people say the Therapy made their pain worse!

It my case the APAP was aggravating the damage cause by the ventilator. His estimate was 4 to 6 months for the pain to go away, but he also noted that it is like training for any sport. Once the muscles adapt to the Positive Air Pressure expanding you lungs more that you did before you were on ventilation or PAP therapy. The initial pain should go away and the stronger muscles may reduce other joint pain you have in you respiratory system.

This I why some people find the therapy "over time" reduces their arthritic pain.

It has been 5 months since I was on the ventilator and 103 days on the APAP, my rib, spine, neck, and back pain has improved significantly in the last month, as my body continues to heal.

Therefore, give the therapy some time, we all acclimate differently to this therapy.

No idea really. It's a case of "I did X and Y happened" and this is the second time, so I thought I'd ask to see what people's opinions are.

After I started this thread, I did a web search on "CPAP APAP auto arthritis spine pain" and found dozens of people complaining that CPAP therapy made their arthritis worse.

Then I noticed that there were also dozens of people claiming that CPAP therapy made their awful arthritis pains go away.

There are multiple things at work here:
1) As Vaughan said, early on in PAP therapy, your diaphragm muscles are working harder. They may make your rib cage sore. That pain may somehow radiate/contribute to your spinal issues.
2) For some people, with Therapy, they move around much less in bed. Lying in one position can make some muscles sore.
3) for some people, if you are having microarousals (knocked from a deeper sleep stage to shallower one), you may be moving about too much and may be causing pain in some joints. Pressure changes in APAP mode causes microarousals in about 18% of people.

[palerider]

1) As Vaughan said, early on in PAP therapy, your diaphragm muscles are working harder.

your Diaphram is only used for inhalation, it relaxes for exhalation. so your diaphram is actually working *less*

[green wings]

Thanks for the input, Ash, Orangebear, and Palerider.

I slept without the CPAP last night and woke up on my side this morning with lots less spinal joint pain. It's still there, along with pain in the connective tissue along the bottom of my ribcage when I inhale, but it hurts lots less than it did yesterday.

I have fairly decent breathing "form", but my ribcage does still move some.

Since I'm prone to having problems with pain in certain areas the the points where tendons and ligaments attach to bones (enthesitis), that may be what's going on.

I am going to figure out some way to do something that will keep me from sleeping on my back for a while. I haven't tried that so far, because sleeping on one side all the time seems like it will cause problems as much as sleeping on my back will, but I may need to use something every other night to make sure I stay off my back.

Another good thing, I think, would be to get myself back to yoga classes, because I feel sure that part of this problem is coming from the fact that my core is de-conditioned.

I've been telling myself that I'll start doing more exercise when I start having more energy from using the CPAP therapy, but that hasn't really happened yet.

I'm keeping the chiropractor idea in reserve in case this problem doesn't go away. I just can't deal with the idea of any more new doctors at the moment.

Again, thanks for all the replies. It has helped me to sort through this problem in my head.

[0rangebear]

1) As Vaughan said, early on in PAP therapy, your diaphragm muscles are working harder.

your Diaphram is only used for inhalation, it relaxes for exhalation. so your diaphram is actually working *less*

FYI
Muscles of exhalation

During quiet breathing is simply driven by the elastic recoil of the thoracic wall. When forceful exhalation is required, because the elasticity of the lungs is reduced, or the thoracic wall is increased beyond it normal function through respiratory distress. Active exhalation is achieved by contraction of the abdominal wall muscles (rectus abdominus, transverse abdominus, external oblique muscle and internal oblique muscle). These press the abdominal organs cranially (upward) hyperextending the diaphragm, reducing the volume of the thoracic cavity.

The internal intercostal muscles have fibres that are angled obliquely downward and backward from rib to rib.These muscles therefore assist in lowering the rib cage, adding force to exhalation. During respiratory distress,

"Mechanics of respiratory muscles". Respiratory Physiology and Neurobiology 2008