New to CPAP - chest soreness after therapy?

[PNW-Adam]

Hello,

First off, I want to thank everyone for this forum. It's been a huge help as I move into this new phase of life. I'm 39 and just diagnosed with severe apnea with an AHI of 115 when I did the lab study. No wonder I've felt like crap for years. I was able to manage it because I work at home and was able to get away with napping every day and made up the work hours well into the early AM. So far, I've been on therapy for two weeks, and I'm feeling great. I haven't had a nap since I brought my equipment home. AHI hasn't been above 1.7 since I started. Lifechanging, to say the least.

The only issue that I'm having is a soreness in my chest when I wake up. It's painful for a few hours and then dulls down for the rest of the day. Like an elephant has been sitting on me all night. My Dr. set the pressure at a fixed 15, so I'm assuming the soreness is from the extra effort that it takes to exhale all night. I expected my muscles to have grown accustomed to it by now, but every day is the same cycle again. Is this a common sensation? My follow-up appointment isn't until January, so I'm wondering if this is something that I should bring up now and try and get seen earlier, or just wait it out and see if I adjust.

[esel]

you will adjust. The soreness is normal, the breathing muscles are not used to quickly build up or down.

If you have exhale pressure release (EPR) you could try to set it to 2 and see if it helps.

[Pugsy]

Welcome to the forum.

First of all...we always get a bit nervous when people start complaining about any chest discomfort because we don't have any way to know for sure it's not heart related. So do at least call your doctor and alert him/her to the symptoms because he's in the best position to know if you have any history of anything that might be cause for concern. We have zero way to know anything in that regard and would hate to tell you to ignore something that might be a big problem.

Now to your question...is the chest wall discomfort related to exhaling against the pressure?? Probably it is related. Very definitely a common complaint for some people even at relatively low pressures and your 15 cm fixed pressure is certainly no where near the low side of things.
The chest wall muscles aren't used to the extra work load of exhaling against the pressure. They get sore like any muscle would when put through a new unknown work out routine.
I don't know if you know what costochrondritis is (google it) but that's sort of the way it feels when we get chest wall muscle discomfort from pretty much the extra exercise/work of breathing against the pressure.
How long can it last...unknown really but I have seen people say that it took 2 to 3 months for it to gradually fade away.
I myself had a small taste of it at the beginning of my therapy but it went away fairly quickly but I was using pressures half of what yours are. I have also had real costrochondritis in the past which is how I knew what to compare it to.

If your doctor isn't alarmed...treat it like you would any sore muscle if its really uncomfortable...maybe even some anti inflammatory meds if you can't take those sort of OTC meds without a problem. I couldn't because of GI issues so I was stuck with plain old aspirin and it did help a little and it wasn't too long before it was a non issue.

Adding in some exhale relief (called EPR on your machine) might also help a bit if you aren't already using it. Lessens the work out a bit.

Do at least call your doctor and alert him/her to the symptoms though...we never want to totally ignore any new sort of chest discomfort on the off chance that it might be cardiac related.
But to answer your question....it's a common complaint associated with new to cpap therapy. It will usually take some time to fade away and how long is unknown but I have known of people saying it took several weeks even at low pressures.

[Muse-Inc]

I was using CPAP and after hmmm, 20-21 months developed severe low ribcage pain, esp in back. So awful, even a mildly deep breath had me wincing. Peers here suggested I might need APAP. Talked to sleep doc, he gave me a loaner APAP over a holiday weekend. Wow, after 3 nights, much less pain. Then the fight with insurance, no surprise they won. Bought my own machine. Doc & I decided on range of 8-16 initially. Learned how to read my numbers and tweak settings. For past 9 years, annual AHI has been 0.1.

[nicholasjh1]

ALso if it is the muscle thing, studies have shown that apnea sufferers (especially untreated ones) have low magnesium... presumably due to compensating for the apnea. ... So magnesium allows your muscles to relax more, taking a supplement or eating plenty of veggies high in magnesium may make a huge difference in the muscles soreness and or cramps.

[PNW-Adam]

Just getting around to following up on this. Thanks everyone for the advice so far.

I have my follow up appointment coming up and wanted to get some thoughts on my graphs. Still suffering from a bit of chest soreness in the morning. The problem I'm now having is that I'm consistently running out of water in my humidifier around 4am. This wakes me up with a dry mouth. My Dr. has me on a fixed 15cm pressure, and I seem to have a lot of leakage, (but my API seems low and I'm not waking from leaks.) and I'm guessing that both the high pressure and high leak rate are contributing to the humidifier running dry. I've settled on no heat in the hose (I like the cool air) and a humidity setting of 2. Generally, I feel like I'm getting a good sleep each night.

So here are my questions:
Is it possible to tell from the graphs if I'd be better served by an auto-adjusting pressure?

Is the constant high pressure I'm on contributing to the high leak rate? Do the masks have an upper limit to how much pressure they can reasonably hold? My sense is that soft silicone of the full face mask has gotten a little slack over the past two months and I'm getting more instances of a "blowout" between the mask and my cheek (often with a loud farting noise that my wife thinks is hilarious.)

During my sleep study, they used a nasal pillow instead of the full face mask. I did have to use a chin strap, which I found claustrophobic, but I'm wondering if I should try switching to that arrangement and see if the leaks subside. Thoughts?

I've realized that when I've gone a few days without shaving, my large leaks are way up (see Dec 30). After shaving the large leaks go away (see Jan 1) but there doesn't seem to be much improvement in the "time over leak redline." I would have expected those two measurements to be more directly related. Is there a good explanation of why they're not?

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[Pugsy]

The high leaks are likely a significant factor in the water consumption problem.

No way to tell if going to auto mode would be of benefit to you from the data shown in fixed mode especially in the face of so much large leak.

Now while your leaks are big...they aren't as bad in terms of time over the red line as the statistics are saying.
SleepyHead defaults to the ResMed red line threshold of 24 L/min and that's not what a Respironics machine uses as a red line.

Go to Preferences/CPAP tab and change the default 24 L/min number to something more suitable for a Respironics machine at your pressure and your mask....which we are never given an exact red line because it actually varies...but somewhere aroun 75 or 80 L/min would be more in line with what you need..might even be a bit higher at your pressure but 75 is a nice conservative number.

Your large leaks are bad...maybe 60% of the night...but for sure not the 94% statistic.
So setting a more appropriate red line will make the statistics look a little less ugly.
The gray large leak areas...those are the machine doing the flagging...those are real.
The statistic thing...that's a SleepyHead calculation statistic and you need a more appropriate red line to base the statistic on...or just turn off that feature.