Shoulder pain at high pressure

[Darcys]

Sorry, I should have mentioned that. Before using cpap, I would wake up a lot and switch from my left to my right shoulders. After cpap, I tend to lie on my back, with my left shoulder a bit higher from a pillow. I believe this is causing me to put pressure on my right shoulder blade. Because I don’t wake up like I did, I spend the whole night on it, which is why I think it’s bothered me. As mentioned, I’m not using the cpap right now and I am tossing and turning and that pain has gone away. Now if I could figure out the rib issue!

[chunkyfrog]

Sometimes I hurt, but it gets better once I MOVE AROUND.
Sitting is the new smoking--try to do less of it.

[Darcys]

thanks, not the most helpful, but i will assume good intent. Its not a case of sitting around, or at least no more than I have done in the past. Something is clearly different and wrong. I thought some people
here might have had similar issues and couple provide some insight. Maybe this is not the place for that.

[ChicagoGranny]

Before using cpap, I would wake up a lot and switch from my left to my right shoulders. After cpap, I tend to lie on my back, with my left shoulder a bit higher from a pillow. I believe this is causing me to put pressure on my right shoulder blade.

Are we to conclude from this that CPAP causes shoulder pain?

Or, a change in sleeping position causes shoulder pain?

Is the answer not so simple as "quit sleeping with your left shoulder high on a pillow??"

[Darcys]

thanks for the question. I have tried sleeping in different positions with limited success i.e. struggle to fall asleep. I'm not worried about the shoulder pain to be honest, to your point, either I figure out a different position or I live with it. I only mentioned the shoulder pain to share my experience to the original poster. The bigger concern is the rib pain. Everything I read online implies its some kind of muscle issue ( CPAP related or not) vs something else ie. organs underneath. I'm going to see the Doc to make sure about the organs stuff, but given that it subsides when I am lying flat, I think it is muscle. While it may not be related to Cpap, It did start right when I first started using the machine and has been here to a greater or lesser degree ever since. If, it subsides due to discontinuing using the machine, I am going to reduce the pressure and see if it helps. Most of what I see on this forum related to making those adjustments or reading data I find quite confusing, but I will have to try and figure it out.

thanks again
Darcy

[zonker]

darcy, have you tried sleeping on your stomach?

sorry if you've said and i missed it.

[chunkyfrog]

Usually the only real solution is medical.
So many people use cpap WITHOUT shoulder pain, so it gets ruled out.

[Janknitz]

I think it could be related to CPAP, but muscle soreness from breathing out against pressure shouldn't last more than a day or two, if that. If it is CPAP related, it's more than likely either your sleeping position or aerophagia, even if you are not aware of taking in so much air. I've had some abdominal issues and definitely had referred pain in my shoulders. For me it felt like it was under the shoulder blade, not in the joint. So I'm going to guess your sleeping position and the fact that you are not moving around so much when you are sleeping more deeply might be contributing factors.

You have the perception of exhaling against pressure, but you really don't have to. Once we fall asleep, exhalation is pretty passive. I wrote the following in another thread of someone thinking CPAP was requiring them to forcefully exhale:

For the most part, exhalation during sleep is PASSIVE. "The process of normal expiration is passive, meaning that energy is not required to push air out of the lungs. Instead, the elasticity of the lung tissue causes the lung to recoil, as the diaphragm and intercostal muscles relax following inspiration. In turn, the thoracic cavity and lungs decrease in volume, causing an increase in interpulmonary pressure. The interpulmonary pressure rises above atmospheric pressure, creating a pressure gradient that causes air to leave the lungs." (https://courses.lumenlearning.com/suny- ... o-content/)

***

We can use muscles for forceful exhalation like the intercostals and abdominal muscles. But we don't have to forcefully exhale to expel sufficient air from our lungs. It will happen anyway, when the diaphragm relaxes. It's hard to hold your breath--think about how much work it takes NOT to exhale.

Unless, of course, you suffer from severe lung disease. I'm glad you are following up with your doctor to see if anything else is going on.

If you can find a way to access your data, it would be helpful to see if you are really going to maximum pressure as much as you think you are. If you really need the higher pressure, then you might ask your sleep doctor about a BIPAP which lets you decrease the expiratory pressure even more. Data will also help you see if you can get optimal therapy at a lower pressure and perhaps don't need as much pressure as prescribed.

If you have severe apnea and it's left untreated, you will eventually have a lot more to contend with than shoulder pain, so it bears figuring this all out.

[Darcys]

Zonker : no, I have not tried sleeping on my stomach, not sure I can with my belly, but I could try

Janknitz : thanks, based on what I have read in forums, its consistent with what your saying i.e. should not last more than a couple of days. If it is air in my stomach though, isn't it common to have gas? I do not have that sensation. Also, my assumption is it would not be bothering me a week after being off of it.

I was looking at costochondritis as a possibility, but most of what I read said the pain would be where the ribs attach to the breastbone. Mine is closer to the sides, roughly 6"below the nipple, and about 6" wide on both sides. Im seriously thinking about going to see a bone cracker as well to see if that might help with any of this. Im not a big fan of chiropractics as a regular thing, but if something is out of place and they can fix it, it can help sometimes.

thanks for all the feedback folks, very much appreciated.
Darcy

[ChicagoGranny]

I have not tried sleeping on my stomach, not sure I can with my belly, but I could try

Here is Dr. Falcon's illustrated description of the best position for stomach-sleeping - http://www.uarsrelief.com/sleeppositions.html

Im not a big fan of chiropractics as a regular thing, but if something is out of place and they can fix it, it can help sometimes.

I developed an extreme dislike for chiropractors after a run-in with one of the quacks.

If you do visit a chiropractor, here is an excellent rule of thumb. If you are not better in three visits, you need to quit and move on to a real doctor.

[zonker]

Zonker : no, I have not tried sleeping on my stomach, not sure I can with my belly, but I could try

i see granny has provided a link. it's the method that i've started using within the last few months. i've never slept on my tummy in my 66 years on this earth until i started.

i mention it because of your pain. i have very small measure of pain in my arms if sleeping on my side. more like "discomfort" than pain. sleeping on my tummy takes that out of the equation.

i've also found that i get a longer stretch of uninterrupted sleep this way.

please let us know if you decide to try it and what the results are.

it was hard for me to get used to. i had to break it up and sleep on my sides for a bit. i still don't often make through the night on my tummy.

good luck!

[Darcys]

Thank you both. I sometimes sleep in a modified version of this ( pillow under the raised knee. Not sure if that matters? I like that position, I think I could get used to it. Had some prostate challenges and that position made me get up more during the night, so I abandoned it, but will to give it another shot.

I really appreciate the advice guys, thank you again
Darcy

[zonker]

Thank you both. I sometimes sleep in a modified version of this ( pillow under the raised knee. Not sure if that matters? I like that position, I think I could get used to it. Had some prostate challenges and that position made me get up more during the night, so I abandoned it, but will to give it another shot.

I really appreciate the advice guys, thank you again
Darcy

do keep us apprised.

[Darcys]

hey folks, not sure if the info attached is helpful in evaluating what I might try differently, but here it is.
thanks in advance
Darcy

Compliance Report
Usage 07/09/2020 - 01/04/2021
Usage days 130/180 days (72%)

>= 4 hours 111 days (62%)
< 4 hours 19 days (11%)

Usage hours 815 hours 55 minutes
Average usage (total days) 4 hours 32 minutes
Average usage (days used) 6 hours 17 minutes
Median usage (days used) 6 hours 51 minutes
Total used hours (value since last reset - 01/04/2021) 917 hours

AirSense 10 AutoSet
Serial number 23201322716
Mode AutoSet
Min Pressure 8 cmH2O
Max Pressure 12 cmH2O
EPR Ramp Only
EPR level 2
Response Standard

Therapy
Pressure - cmH2O Median: 9.8 95th percentile: 11.3 Maximum: 11.7
Leaks - L/min Median: 5.1 95th percentile: 27.9 Maximum: 48.2
Events per hour AI: 1.1 HI: 0.7 AHI: 1.8
Apnea Index Central: 0.9 Obstructive: 0.1 Unknown: 0.0
RERA Index 0.1
Cheyne-Stokes respiration (average duration per night) 0 minutes (0%)
Usage - hours

Darcy
07/09/2020 - 01/04/2021
Therapy Report
AirSense 10 AutoSet
Usage (hours)
Usage days 130/180
>= 4 hour days 111 (62%)
< 4 hour days 19 (11%)
Days not used 50 (28%)
Days no data 0 (0%)
Used/day (avg.) 6.3 hrs.
Leak (L/min)
Set threshold 24.0 L/min
Maximum (avg) 48.2
95th % (avg) 27.9
Median (avg) 5.1
Pressure (cmH2O)
Mode AutoSet
Set EPR Ramp Only,
2.0
Set Max Pressure 12.0
Set Min Pressure 8.0
Maximum (avg) 11.7
95th % (avg) 11.3
Median (avg) 9.8
AHI (events/hour)
AHI 1.8
HI 0.7
AI 1.1
CAI 0.9
OAI 0.1
UAI 0.0
RERA 0.1
CSR% (avg) 0.0

[chunkyfrog]

The bullfrog is having shoulder surgery in a couple of weeks.
Near as he can figure, it was hurt during cardiac rehab.
You can guess what he said to rehab for the shoulder.
After, not before. And words I cannot repeat here.