Can back pain/stiffness cause centrals/PB?

[NotLazyJustTired]

I had a mess of 40 centrals last night with lots of periodic breathing. I've looked at the flow graphs and I would estimate that 70% to 80% of the night I exhibited some level of PB. Most of it minor and most of it was not scored as hypopneas or centrals. This is not a usual pattern for me. I have had high central nights which I documented in another thread: viewtopic.php?f=1&t=88052&st=0&sk=t&sd=a but those have been relatively infrequent (5 out of 35 nights) and did not show this level of periodic breathing.

One pattern I am suspecting is a possible relationship with back pain and/or stiffness. I have had minor back aches and stiffness for a while and it usually results in me turning over several times a night for relief, but it generally does not wake me up all that much. In fact last night I do remember quite a bit of dreaming and thought I was doing pretty well, but alas I awoke with a dreaded headache and brain fog and an AHI of 5.4. Since I am getting my energy back, I am starting to kind of overdo it, weekend warrior stuff. The result has been a bit more back pain than usual. If it's noticeable before bed I take some Tylenol or Ibuprofin. But it's usually worse in the morning than at night. I didn't take anything last night.

I know on two other occasions where I've had many centrals and have woken with more than usual back pain. So my question is, does anyone know if there is a relationship with pain and centrals and specifically periodic breathing? I see my sleep doc on May 8th but would really like to get ahead of this if possible. I have discussed the back pain and a few other minor aches (knees) with my internalist, but he suggested we take care of the sleep apnea, hypothyroidism, and hypertension before delving into these minor symptoms. My next checkup with him is in August. Thoughts?

[JohnBFisher]

I am not aware of a relationship. However, if you have opiate based pain killers, then there could be a connection between the pain killers and the centrals/periodic breathing. Just a thought ...

[NotLazyJustTired]

I am not aware of a relationship. However, if you have opiate based pain killers, then there could be a connection between the pain killers and the centrals/periodic breathing. Just a thought ...

Thanks John, nothing but OTC stuff, Tylenol and generic ibuprofen so far. I know I am fishing, but I've had 5 consecutive previous nights with AHI well below 2 and nary a central and then I have this weird night with more than usual PB and centrals. On one particular occasion it tapered down to normal levels over a 4 night period. I am just trying to find a connection and wondering if the back pain may be the trigger. I appreciate your feedback. I know from other posts centrals are a much bigger deal for you. I hope I don't sound whiny.

[JohnBFisher]

Another possibility is an indirect connection between the back pain/stiffness and the centrals/periodic breathing. It's quite possible / almost a certainty that your back pain / stiffness increased the number of times that you awoke. As a result, you transitioned in and out of sleep more frequently. Central apneas and/or periodic breathing often occur during those transitions. Though they are central in nature, they are considered normal (and thus not counted) when they occur during that transition state. That could account for the increase in you CA/PB values.

Just a possibility.

[NotLazyJustTired]

Another possibility is an indirect connection between the back pain/stiffness and the centrals/periodic breathing. It's quite possible / almost a certainty that your back pain / stiffness increased the number of times that you awoke. As a result, you transitioned in and out of sleep more frequently. Central apneas and/or periodic breathing often occur during those transitions. Though they are central in nature, they are considered normal (and thus not counted) when they occur during that transition state. That could account for the increase in you CA/PB values.

Just a possibility.

That is an interesting thought and gels with what I have previously been told about centrals and PB. It is a possibility, although I do know I hit REM stage at least 3 or 4 times last night, but perhaps they were very short dreams. In times like these I wish I had a Zeo; shame they are going away.

[Kiralynx]

One pattern I am suspecting is a possible relationship with back pain and/or stiffness. I have had minor back aches and stiffness for a while and it usually results in me turning over several times a night for relief, but it generally does not wake me up all that much. In fact last night I do remember quite a bit of dreaming and thought I was doing pretty well, but alas I awoke with a dreaded headache and brain fog and an AHI of 5.4. Since I am getting my energy back, I am starting to kind of overdo it, weekend warrior stuff. The result has been a bit more back pain than usual. If it's noticeable before bed I take some Tylenol or Ibuprofin. But it's usually worse in the morning than at night. I didn't take anything last night.

I know on two other occasions where I've had many centrals and have woken with more than usual back pain. So my question is, does anyone know if there is a relationship with pain and centrals and specifically periodic breathing? I see my sleep doc on May 8th but would really like to get ahead of this if possible. I have discussed the back pain and a few other minor aches (knees) with my internalist, but he suggested we take care of the sleep apnea, hypothyroidism, and hypertension before delving into these minor symptoms. My next checkup with him is in August. Thoughts?

Well, first of all, you might consider cutting back on the weekend warrior stuff. You know: "Doctor, doctor, it hurts when I do this." "Well, don't DO this, then!"

Second, pain is related to disrupted sleep -- I was diagnosed when the pain from my cancer surgery did not go away. And it was from the pain management doctor that I learned that the hip and knee pain I'd dealt with for 6 years was a result of my apnea. I wasn't tired because the pain in my hips and knees kept waking me up -- I kept waking up with pain because my apnea was causing my oxygen levels to drop and causing the pain.

You may find that treating the apnea also helps with the hypertension, but definitely get a handle on the thyroid.

As you've already noted, when you wake up with pain, it means you had a bad night.

[NotLazyJustTired]

Well, first of all, you might consider cutting back on the weekend warrior stuff. You know: "Doctor, doctor, it hurts when I do this." "Well, don't DO this, then!"

Definitely laughing out loud on this one. You are right, of course. It is just that I have put SO much of my life on hold as a result of this apnea thing and now that my energy is coming back I am running around like a kid in a candy store. Your advice is good and I will show some discretion and cut back.

Second, pain is related to disrupted sleep -- I was diagnosed when the pain from my cancer surgery did not go away. And it was from the pain management doctor that I learned that the hip and knee pain I'd dealt with for 6 years was a result of my apnea. I wasn't tired because the pain in my hips and knees kept waking me up -- I kept waking up with pain because my apnea was causing my oxygen levels to drop and causing the pain.

Yeah, I have noticed that my injuries have taken longer than usual to heal before xPAP. Sort of sounds like a chicken and the egg problem. It probably makes sense to work on both issues together and beat them both down.

You may find that treating the apnea also helps with the hypertension, but definitely get a handle on the thyroid.

As you've already noted, when you wake up with pain, it means you had a bad night.

Last check up my TSH was in normal ranges (I take Synthroid) so I think the thyroid is good for now. Doc put me on meds for BP and those numbers have been looking good lately as well. Yes, he too, is of the opinion that we may be able to discontinue the BP meds when the apnea is under control.

I appreciate your help, it is very kind.

[Pugsy]

Well FWIW...When I have a bad night from back or pelvic pain it definitely shows in the overall reports. Normally I see more centrals...remember maybe a few more awakenings than normal. Like every time I turn over in bed stuff. And when using the PR S1 I will see more PB being flagged. I don't really pour over the S9 flow rate looking for PB like breathing because I already have a pretty good idea what is going on and what I would see anyway.

Also it has been said that we don't really remember our dreams much unless we wake up during them. That seems to be the case for me. Often when I have the "bad" nights I seem to have more dreams and on the good nights much less chance of remembering them.

I don't think the pain itself causes the centrals or the PB. I think what is happening is that the increase in centrals and probably the PB is related more to the awake/semi awake state from the frequent arousals (and if we remember several it's pretty much a given that there are more that aren't remembered) the machine doesn't know if we are awake or not so not only do we have a greater chance of having more sleep onset centrals during the frequent arousals and subsequent transition back to sleep but we have the awake breathing irregularities that the machine will flag because it doesn't know if we are really asleep or not.
So the rather ugly looking stuff is more of a by product of the less than optimal sleep quality.

If I have done a lot of yard work...I usually pay for it with increased pain. Last week I boogered up my left knee and had a hard time laying on my side because it made my knee hurt a lot more. I had a lot of awakenings from the knee pain (even with my usual meds) and the reports were less than stellar. Mainly they just reaffirmed what I already knew...a rather crappy night's sleep because of pain.

So I guess pain can indirectly cause centrals but they really aren't the kind of centrals that we should be alarmed about because they are likely mostly going to be centrals that probably would not be scored in a sleep study because either I wasn't asleep or maybe it was only a sleep onset central and because I had a lot of chances for multiple sleep onsets from all the arousals I then have a greater chance for multiple centrals that might happen during sleep onset.

Oh, one other thing. Two years ago in June I fell and broke my wrist and ended up having to have it pinned.
I was on some heavy duty narcotics for pain for a few nights. I really didn't see the number of centrals materialize that I thought might happen with the opiates. Actually didn't see much of a change in my reports at all. At least not like I thought I would with sleeping totally on my back with Percocet in my system and a good dose at bedtime. I might have had a couple more centrals than I might normally see but they could have just as easily been a byproduct of not the best sleep in the world anyway because of the cast and all that. Pressures didn't really change either, at least no more than what I might have seen anyway. The reports weren't exciting at all considering what was going on and the opiates.

So....just use some common sense with all the new found energy. If you work muscles that haven't been worked for a while...they will let you know that they don't like it. and one of the ways is with some nighttime pain because they have your full attention in bed.

[NotLazyJustTired]

Pugsy, I am so foggy today I had to read through that twice to make sure I was getting it all.

Your point about remembering dreams is something that I have heard before. I am definitely dreaming more, I can say that. But I have noticed that at the conclusion of every dream (at least those I remember) I am waking up and rolling over. This has been a pattern for a few weeks, even on nights with low centrals. I am reasoning that since I am now realizing more dream states that the APAP is treating my OSA/UARS (i.e. I am not being aroused and thus getting into REM), but my sleep quality has some room for improvement. The fact that I am remembering 3 to 4 dreams a night does not sound like a good thing, especially since I seem to wake up after nearly every REM stage.

The common thread that all three of you have noted is the notion of fragmented sleep and the natural occurrence of PB and centrals during repeated sleep onset. This seems the most plausible explanation and I thank you all.

You know I went back and looked at my overview graph in SleepyHead. This whole business of centrals and PB was not an issue during my first two weeks of therapy. I didn't see anything like this until the 3rd week of my therapy. That is also around the time that I bumped up my minimum pressure from 5cm to 7cm and I have been postulating that it was just an adjustment to that. However, this is also around the time that I had become comfortable with the mask and sleeping "better"...it correlates to my energy increase and the increase in physical activity. It is also around the time, for example, that I no longer felt the need for an afternoon nap. It is really plausible that this whole issue is related to muscle and back pain from my "over doing it" mucking up my sleep quality. Gee it all sounds so simple now.

Just to give you an example of this, I cut down about 15 fir trees last Saturday. This was on a mountain lot which meant having to drag the trees down a fairly steep slope and then climbing back up. Not something I could have even done a month ago, but yeah, I really need to scale back a bit. "Patient, heal thyself!"

[Todzo]

I had a mess of 40 centrals last night with lots of periodic breathing. I've looked at the flow graphs and I would estimate that 70% to 80% of the night I exhibited some level of PB. Most of it minor and most of it was not scored as hypopneas or centrals. This is not a usual pattern for me. I have had high central nights which I documented in another thread: viewtopic.php?f=1&t=88052&st=0&sk=t&sd=a but those have been relatively infrequent (5 out of 35 nights) and did not show this level of periodic breathing.

One pattern I am suspecting is a possible relationship with back pain and/or stiffness. I have had minor back aches and stiffness for a while and it usually results in me turning over several times a night for relief, but it generally does not wake me up all that much. In fact last night I do remember quite a bit of dreaming and thought I was doing pretty well, but alas I awoke with a dreaded headache and brain fog and an AHI of 5.4. Since I am getting my energy back, I am starting to kind of overdo it, weekend warrior stuff. The result has been a bit more back pain than usual. If it's noticeable before bed I take some Tylenol or Ibuprofin. But it's usually worse in the morning than at night. I didn't take anything last night.

I know on two other occasions where I've had many centrals and have woken with more than usual back pain. So my question is, does anyone know if there is a relationship with pain and centrals and specifically periodic breathing? I see my sleep doc on May 8th but would really like to get ahead of this if possible. I have discussed the back pain and a few other minor aches (knees) with my internalist, but he suggested we take care of the sleep apnea, hypothyroidism, and hypertension before delving into these minor symptoms. My next checkup with him is in August. Thoughts?

Hi NotLazyJustTired!

This reminds me of my own experience last winter.

Last fall I found myself having Periodic Breathing (PB) apparently due to high pressure (15 cm/H2O) and a year of weight loss. With no doctors in sight I simply reduced pressure about a cm every seven to ten days watching my data carefully as I went. Some 60 days later I saw some obstructive activity (note: AHI never rose above three!) at 7 cm/H2O and started using 8 cm/H2O. Periodic breathing and all other indications of unstable breathing left at 12 cm/H2O.

But then winter came. Well, in my case “just before winter” is important because mid-November is the anniversary of a time I was exposed to extreme trauma. It sets my nerves on edge. In this case it brought back PB and other indications of unstable breathing even at the very much lower pressure of 8 cm/H2O that was 15 cm/H2O a few months previous.

The “gain” signals in breathing include “central nervous system activation”. What this means for me is that in winter, even at a relatively lower pressure, frayed nerves from experienced trauma bring forth Periodic Breathing. The extra “gain” apparently pushes the breathing system into oscillation (the PB).

So as I think about what you asked it occurs to me that pain activates the central nervous system so I believe that I would expect it to cause PB and other forms of unstable breathing.

Have a great week!

Todzo

[NotLazyJustTired]

Hi NotLazyJustTired!

This reminds me of my own experience last winter.

Last fall I found myself having Periodic Breathing (PB) apparently due to high pressure (15 cm/H2O) and a year of weight loss. With no doctors in sight I simply reduced pressure about a cm every seven to ten days watching my data carefully as I went. Some 60 days later I saw some obstructive activity (note: AHI never rose above three!) at 7 cm/H2O and started using 8 cm/H2O. Periodic breathing and all other indications of unstable breathing left at 12 cm/H2O.

But then winter came. Well, in my case “just before winter” is important because mid-November is the anniversary of a time I was exposed to extreme trauma. It sets my nerves on edge. In this case it brought back PB and other indications of unstable breathing even at the very much lower pressure of 8 cm/H2O that was 15 cm/H2O a few months previous.

The “gain” signals in breathing include “central nervous system activation”. What this means for me is that in winter, even at a relatively lower pressure, frayed nerves from experienced trauma bring forth Periodic Breathing. The extra “gain” apparently pushes the breathing system into oscillation (the PB).

So as I think about what you asked it occurs to me that pain activates the central nervous system so I believe that I would expect it to cause PB and other forms of unstable breathing.

Have a great week!

Todzo

Thanks for the post! The prevailing theory I am hearing is that the pain may be causing sleep fragmentation and it is the normal PB/centrals that most everyone experiences during sleep onset. If your sleep is being fragmented quite a bit, it makes sense that you would have more sleep stage transitions and thus more sleep onset activity. In your case, it may be the stress of your anniversary that is causing disruptions to your sleep architecture. It is one theory anyway. But I am keeping an open mind and what you say may be plausible as well. It is why I asked the question, to get opinions.

Either way you look at it, it seems that alleviating the pain should produce better sleep quality. I am going to pace myself a little bit better and start taking Aleve before I retire even if the pain is minor and see how that goes.

It may be too personal a question to ask here, but are you finding that the stress from your trauma is diminishing with passing years? PM me if you don't feel comfortable answering in a post. Or just ignore it altogether; I don't mean to pry, just curious if you are getting better.

[Kiralynx]

Definitely laughing out loud on this one. You are right, of course. It is just that I have put SO much of my life on hold as a result of this apnea thing and now that my energy is coming back I am running around like a kid in a candy store. Your advice is good and I will show some discretion and cut back.

Check -- you notice, I didn't say anything about STOPPING. Just cutting back until you regain your strength. There's a saying in the dietary Forum I rum, "Two steps forward, and one step back...."

Yeah, I have noticed that my injuries have taken longer than usual to heal before xPAP. Sort of sounds like a chicken and the egg problem. It probably makes sense to work on both issues together and beat them both down.

Oh, believe me, it does. When you finally catch up on your sleep debt, and start having energy, it's like climbing out of a pot of glue. All of a sudden, you can MOVE.

Last check up my TSH was in normal ranges (I take Synthroid) so I think the thyroid is good for now. Doc put me on meds for BP and those numbers have been looking good lately as well. Yes, he too, is of the opinion that we may be able to discontinue the BP meds when the apnea is under control.

Website of interest: Stop the Thyroid Madness. TSH does not necessarily show valid thyroid levels, and Synthroid doesn't necessarily take care of everything. Kind of like your DME doesn't necessarily take care of teaching you what you need to know about CPAP.

I appreciate your help, it is very kind.

Ye be welcome!

[archangle]

There's some risk of heart problems causing pain/stiffness and PB.

Probably nothing to panic over, but don't fall into the trap of blaming everything on apnea/CPAP.

[NotLazyJustTired]

Website of interest: Stop the Thyroid Madness. TSH does not necessarily show valid thyroid levels, and Synthroid doesn't necessarily take care of everything. Kind of like your DME doesn't necessarily take care of teaching you what you need to know about CPAP.

Yes, I have read some about that. I can't remember off the top of my head but there are other levels that need to be checked. I also recall the differences had something to do with a non-functioning thyroid vs. having part or all removed. But alas, I will repeat that research and discuss it with my internalist. I appreciate you pulling me out of my fog and highlighting this for me.

[pbb]

Here's a naive/nubie question: How does one get/find the PB data? I use SleepyHead... Thanks for the help. p