Shoulder pain at high pressure

[The_Boaphile]

I asked about this on another thread I have going but thought I'd try putting "Shoulder pain at high pressure" in the subject in hopes of other's possible opinions.

So I am running a PS of 5.0 and 13.0/18.0. The pressure pretty much stays at 18.0 after the 5 minute ramp up. I am 3 1/2 months into this CPAP venture. I'm 60 years old. I started having pain in my lower ribs and sides about a month ago. Then my right shoulder started hurting. I normally sleep like a rock. Always have. But this right shoulder pain is waking me over and over. I am not sleeping in a new position compared to pre-CPAP. I try moving my arm around in different positions to minimize the pain. The CPAP itself and the hardware that goes with it does not cause me issues.

So, I believe this shoulder pain is related to the fact that I am forced to use muscles that are not used to exhaling at this pressure. I feel like my breathing is very different from breathing without the machine in that normal breathing does not require that I entirely fill my lungs on inhaling. The CPAP blows me up to full capacity. Then my exhaling in not a complete evacuation of my lung capacity. So the breathing is more "shallow" than what I am capable of but in a more completely full position. So my chest cavity is blown up fundamentally much larger than without the machine. I think this is stretching something.

The pain feels like it's in the joint. The same pain I used to have after arm wresting 25 years ago. Right at the joint. The pain does come back during the day if I am doing something repetitive with my right arm. It's gone 5 minutes after I get up in the morning. The soreness/tiredness of my lower abdomen is still there all day. That is completely tolerable. The shoulder waking me all night is frustrating.

So, maybe it's just tough luck I have to simply get used to it. I don't know. It's not a lot of fun though. I am still not reaching low levels of events that I think will happen when I can push my pressures a bit higher. I'm determined to make this work. Just perhaps wishing, in vain, it might be a little less painful getting there.

[OkyDoky]

Do you feel bloated or have a lot of gas? You might look up areophagia and see if this could be the problem.

If the pain is constant and not increased with movement it sounds like referred pain.
As crazy as it sounds right shoulder pain can be from the belly. I used to recover laproscopic patients and the gas they would use to inflate the abdomen (even though they attempt to remove most) would cause right shoulder pain until it dissipated.

This link mentions several possible causes. https://www.webmd.com/pain-management/p ... der-pain#1
As you can see heart pain can also be referred so best to check it out.

[OkyDoky]

The pain feels like it's in the joint. The same pain I used to have after arm wresting 25 years ago. Right at the joint. The pain does come back during the day if I am doing something repetitive with my right arm. It's gone 5 minutes after I get up in the morning.

It could also be something degenerative in the shoulder causing the pain if it is with movement. It happens as we get older. May be a coincidence and not related to CPAP.

[Deborah K.]

Do you usually sleep on your right side? If so, it may be that your shoulder just does not respond well to being slept on anymore. Most of my life I slept on both of my sides. Then I taught myself to sleep on my back to help with back pain. Now when I sleep on my sides I wake up quite sore. Sometimes what our bodies used to be comfortable doing is no longer comfortable - changes due to age I suppose.

[The_Boaphile]

Do you feel bloated or have a lot of gas? You might look up areophagia and see if this could be the problem.

If the pain is constant and not increased with movement it sounds like referred pain.
As crazy as it sounds right shoulder pain can be from the belly. I used to recover laproscopic patients and the gas they would use to inflate the abdomen (even though they attempt to remove most) would cause right shoulder pain until it dissipated.

This link mentions several possible causes. https://www.webmd.com/pain-management/p ... der-pain#1
As you can see heart pain can also be referred so best to check it out.

Thank you.

No bloating. No additional gas after I get up or during the night. ;-(

The pain feels like it's in the joint. The same pain I used to have after arm wresting 25 years ago. Right at the joint. The pain does come back during the day if I am doing something repetitive with my right arm. It's gone 5 minutes after I get up in the morning.

It could also be something degenerative in the shoulder causing the pain if it is with movement. It happens as we get older. May be a coincidence and not related to CPAP.

Thank you.

I'm sure the joint is suffering from 60 years of abuse. But I don't have this pain during the daytime except when I am doing a lot of repetitive work with my right arm. I have virtually no movement at night. No stress on the joint. I rarely if ever even roll onto my right side. I'm either on my left side with the shoulder that never complains, or on my back. No question part of this is the old joint. But it seems clear that CPAP aggravates it as it is gone 5 minutes after I stop using the CPAP. This includes if I disconnect the CPAP and go back to sleep. Pain gone. ;-(

Do you usually sleep on your right side? If so, it may be that your shoulder just does not respond well to being slept on anymore. Most of my life I slept on both of my sides. Then I taught myself to sleep on my back to help with back pain. Now when I sleep on my sides I wake up quite sore. Sometimes what our bodies used to be comfortable doing is no longer comfortable - changes due to age I suppose.

Thank you.

No I almost never sleep on my right side where I have the shoulder pain. ;-(

[LSAT]

I'm a lot older than you and have had pain in both shoulders for several years. My pressure is not quite as high as yours, but shoulders wear out....bone on bone. I have had one shoulder replacement and really need another but will wait until after COVID. I really do not see any relationship with CPAP use. These suckers just wear out...Have you had an Xray?

[Julie]

Shoulder 'tip' pain is often related to gallbladder issues - ask your MD directly for a test.

[chunkyfrog]

The only possible connection between shoulder pain and cpap use would be
if it were placed much higher than the bed--and you pulled it down onto your shoulder.
After ten years (+) use, I suppose that my cpap has allowed me to outlast certain parts of my body.
But I am not complaining.
I welcome the minor aches and pains that come with age--as long as they are minor.
Otherwise, I would bellyache a bit more than I do presently.

[OkyDoky]

Need to determine if it is joint or referred pain so a talk with your doctor is a good idea. I wondered what was the reason for the pressure support of 5 cm? Do you have a restrictive lung problem or have difficulty taking a deep breath prior to CPAP? Did you have a titration and the doctor gave you these settings? Do you monitor your therapy with OSCAR and is it controlled?

If it is referred pain from the belly whether it is gas, gall bladder or several other problems the shoulder pain from these are due to diaphragm irritation so along with the soreness of your abdominal muscles and the deep breaths you report it is possible. Talk with your doctor to find out where this is coming from.

[The_Boaphile]

So I had a CT scan. My gallbladder is good. Shoulder pain caused by gallbladder issues is in the shoulder blade area. The inflamed gallbladder irritates the phrenic nerve after a fatty meal causing the pain on the right side normally ending up in the right shoulder blade area. Not joint pain as I described.

My pain is and has been like an arthritic joint pain that is not intermittent after a fatty meal. It happens during use of the joint working, or late into the night. It's when I use the shoulder to work and when what I describe as "blowing up balloons" all night long due to the exhale pressure on my machine. I haven't yet, but I am considering having an injection of cortisone in my shoulder to take down the inflammation.

[ChicagoGranny]

I feel like my breathing is very different from breathing without the machine in that normal breathing does not require that I entirely fill my lungs on inhaling.

When a CPAP user falls asleep, the autonomic nervous system takes control of breathing. The user breathes gently and rhythmically.

It's unclear what you mean by "entirely fill my lungs." While asleep, a CPAP user does not breathe any deeper than a non-user. CPAP pressure is so low that expansion of the lungs is negligible. A CPAP pressure of 20 cmh20 is less than typical day-to-day changes in atmospheric pressure. Fortunately, even low pressures are enough to increase the surface area of the alveoli.

I couldn't explain a connection between CPAP pressure and shoulder pain.

[The_Boaphile]

I feel like my breathing is very different from breathing without the machine in that normal breathing does not require that I entirely fill my lungs on inhaling.

When a CPAP user falls asleep, the autonomic nervous system takes control of breathing. The user breathes gently and rhythmically.

It's unclear what you mean by "entirely fill my lungs." While asleep, a CPAP user does not breathe any deeper than a non-user. CPAP pressure is so low that expansion of the lungs is negligible. A CPAP pressure of 20 cmh20 is less than typical day-to-day changes in atmospheric pressure. Fortunately, even low pressures are enough to increase the surface area of the alveoli.

I couldn't explain a connection between CPAP pressure and shoulder pain.

The pain in the shoulder did not start till I was weeks into this journey. The only after using the machine at pressures near and above 20cm, I started to have the soreness in the lower ribs that many other have also had. That pain is known to be associated with the extra effort involved in exhaling.

The pressure of the machine is intended to "keep the airway" open. The idea that this does not also open the other airways, such as the lungs, doesn't really make sense to me. At lower pressures, while awake I can feel the air leave my lungs quite naturally without any of the associated rib or shoulder pain. At the higher pressure, I can feel the necessary effort there is to exhale. Regardless if my body does this while I am awake or asleep it is going to require a certain amount of effort to accomplish.

The variance of atmospheric pressure is a non factor in this. Atmospheric pressure variation has no impact upon us because it is equalized. Artificial pressure internally without the accompanying equal external pressure is by design different which is exactly how CPAP works to open the airway.

This shoulder issue seems to be unique to me and my irritated tissues around that joint. I do plan on just working through it. I made the post simply wondering if others had experienced the same thing.

Thanks for everyones input. It is appreciated.

[a_cpaper]

@The_Boaphile, do you mind sharing how this was fixed for you? I have the exact same pain in addition to some pain in the armpit muscles. I started using the CPAP in May 2020 and pain in my lower ribs started early July. It spread over to my shoulder blades now and across the ribs. The difference though is that this pain is felt during the day now causing disruptions I did meet my primary care doctor and my sleep specialist but both think that CPAP did not cause this. They do not believe it is related to the heart and feel perhaps it is stress. I know COVID has made things stressful for everyone but it is does feel tied to the CPAP.
Please let me know if something helped with this. Thanks in advance.

[Darcys]

Hi everyone, first time poster.
I can relate to both the shoulder pain and the last post about ribs. I started using my cpap in the spring. I gave up on it after a month or so because I felt like I had been punched in. The ribs everyday ( both sides). After looking at some forums where people said it was common, but short lived I gave it another shot in the fall. Well, it’s been 4 months and it has no subsided. It lasts all day and is about a 3 on the discomfort level. Bothers me way more when I am sitting. I also have had the shoulder pain, but more in the shoulder blade area, like a knot. It comes and goes, seems to bother me more sitting as well . My cpap guy and doc. Think none of this is tied to cpap.

I stopped using my cpap 8 days ago. My shoulder pain is completely gone. I absolutely believe the shoulder is becaus I move less when I sleep with the cpap and that lack of movement is putting a new strain on my shoulder.

As for the ribs, pain is still there, subsided a bit maybe , but not a lot. Gonna give it another week before I head to the doc. Definitely feels like muscle pain, but pretty dam uncomfortable. I’m hoping there is someone on. The forum that has had similar occurrences and has some advice. If it subsides soon, my plan will be to go back on the cpap at a reduced pressure to see if that helps. It’s one of those auto adjusting ones, so not sure if it will help , but worth trying I guess?

Thanks as good luck everyone !
Darcy

[ChicagoGranny]

I absolutely believe the shoulder is becaus I move less when I sleep with the cpap and that lack of movement is putting a new strain on my shoulder.

It seems odd that you don't mention which position(s) you sleep in. Shoulder problems are often associated with sleeping on the sides.

Which position(s) do you sleep in? Do you use a different position when using CPAP?