Middle Back Pain with Air Tubing on Top (P30i)

[decker12]

Hello everyone, so glad to see such an active forum for CPAP users!

I've been using my Resmed 11 for about 3 months and doing pretty well with it. Pre-CPAP my AHI was 33 and with it it's less than 3. Pressure ends up being about 6 for the night. Getting regular 100/100 scores on the myAir app. I'm think I've adapted well to it.

However in an effort to maximize my comfort, I've been trying out a few different masks. The one I by far prefer is the hose-on-top nasal pillow P30i. However, using it gives me middle back pain. I have no history of back pain or neck pain.

If I switch to the Airfit P10 (the minimal nose pillow mask), I don't wake up with the back pain. However, I sleep worse because this mask has a tendency to shift all over my face at night unless I really tighten it down, which is both uncomfortable and leaves deep marks on my cheeks that persist for hours after taking it off.

I don't think it's my bed, which is only a year old and pretty comfortable. It's not the "you're getting more air now so muscles are being used more when you sleep so your body may be sore" thing I've read about because it's been months, the pressure remains the same when using the minimal mask, and I don't wake up sore with it.

I've bought one of those elevated arms which the hose clips into in order to keep the hose above my head (and to relieve my body of the weight of the hose), which has made the night's sleep easier, but it hasn't made any difference to my back pain.

I've switched from my P30i to my P10 a couple times in the past three months (for a week at a time) just to verify that yes, P30i = back pain, P10 = no back pain.

Any thoughts or ideas on what else I can try? Thanks in advance!

[lynninnj]

Not sure if I missed it but are you a back or side sleeper? Is it different for each mask?

I don’t have an answer for you but it might be relevant.

[ChicagoGranny]

and to relieve my body of the weight of the hose

When using the P30i, the hose should not touch your body. The correct hose routing is hard to explain, so I am looking for a drawing that someone used before. If I can find it, I will post it.

Safe to assume you are back-sleeping?

[decker12]

No, I am a side sleeper. I'll be on my back for a small amount of time, but mostly just long enough to flip over to the other side. For 20+ years I'm almost always facing to the right when I sleep as well (which is where my CPAP machine is). The hose does not touch my body, it routes out the top of my head and then up towards my contraption that elevates it. It does not pull on me either, I have the elevated contraption setup so there is enough slack for me to switch sides.

I also use a fairly flat and firm pillow, not a big fluffy one. Normally I'd be thrilled to just blame my pillow but as I said, I don't get the middle back pain when using a different type of mask.

[ChicagoGranny]

I don't get the middle back pain when using a different type of mask.

This makes sense only if your body positioning varies with different masks.

Are you using proper side-sleeping posture? Are you in the fetal position? Do you place a small pillow between your knees? Is your pillow of a height such that your entire spine is aligned? https://www.healthline.com/health/side-sleeper#how-to

[decker12]

No, I don't (and honestly, won't) try to rig up a way to use a pillow between my legs when I sleep. My side alignment is fine as far as I can tell and hasn't changed. I don't have any shoulder or neck pain, the pain is located in the middle to lower back. My side sleeping posture has been fine enough my entire life that I haven't had any problems with back pain pre-CPAP. My wife would have definitely told me if I was suddenly sprawled out over the bed instead in the same sleep position I've been using my whole adult life.

If I wake up a couple of hours early (ie 5AM), I can feel the aches before I roll over and go back to sleep. The aches are to the point that it effects my ability to get out of bed, or bending over in the shower, where I'm wincing and moving like an old man (I'm in my 40s). It feels like I was doing heavy lifting the day before. It will go away after several hours, and ibuprofen before going to bed seems to help it, but I don't want to be stuck taking 3 ibuprofen every night who's sole purpose is to pre-emptively deal with the morning back pain. I'm just trading apnea for liver damage at that point.

Again 've tested it already with the same machine, same bed, same pillows, same sleeping situation and pre-sleep habits, same bedtime, and the myAir numbers report the same 100/100, so according to the machine it's working just as well with either mask. It's not like the machine is blasting me with a 15 pressure when wearing the P30i but only giving me 6 when I'm using a different mask. If that was the case I'd have something to go on at least!

So yeah, when I use the P30i, I wake up with back pain. Other mask, no back pain, but it has other issues which are just as bad as the back pain but in a different way (and back pain aside, I sleep much more comfortably and prefer using the P30i).

I appreciate your tips! Just not sure what on earth it could be!

[ChicagoGranny]

No, I don't (and honestly, won't) try to rig up a way to use a pillow between my legs when I sleep.

It's not some Rube Goldberg creation. It's a small firm pillow that is simple to place between the knees.

You are the one griping, and it's your spine's health. However, any advice offered in this forum is optional. Carry on as you please.

[robysue1]

Possible crazy idea, but ....

Maybe you are moving around substantially less when you wear the P30i because your brain is somehow more relaxed and is in a deeper sleep. And the fact that you are moving around a whole lot less is what triggers the back pain simply because the back is tired of being in one position for extended lengths of time.

I bring this up because of your own description of sleeping with the AirFit P10:

If I switch to the Airfit P10 (the minimal nose pillow mask), I don't wake up with the back pain. However, I sleep worse because this mask has a tendency to shift all over my face at night unless I really tighten it down, which is both uncomfortable and leaves deep marks on my cheeks that persist for hours after taking it off.

This certainly makes it sound like your sleep itself is much more restless, and hence may involve more movement in bed, when you use the AirFit P10 as compared to the P30i.

[decker12]

Possible crazy idea, but ....

Maybe you are moving around substantially less when you wear the P30i because your brain is somehow more relaxed and is in a deeper sleep. And the fact that you are moving around a whole lot less is what triggers the back pain simply because the back is tired of being in one position for extended lengths of time.

I bring this up because of your own description of sleeping with the AirFit P10:

If I switch to the Airfit P10 (the minimal nose pillow mask), I don't wake up with the back pain. However, I sleep worse because this mask has a tendency to shift all over my face at night unless I really tighten it down, which is both uncomfortable and leaves deep marks on my cheeks that persist for hours after taking it off.

This certainly makes it sound like your sleep itself is much more restless, and hence may involve more movement in bed, when you use the AirFit P10 as compared to the P30i.

Yeah, I was thinking the same thing. I do wear my Apple Watch S7 to bed which has pretty good sleep tracking in it, and it seems to know at which stage of sleep I'm in and for how long. I may just need to start comparing one mask's stats on my watch to the other watch's stats which may tell me how much more or less I'm tossing and turning with the P30i.

[lynninnj]

Possible crazy idea, but ....

Maybe you are moving around substantially less when you wear the P30i because your brain is somehow more relaxed and is in a deeper sleep. And the fact that you are moving around a whole lot less is what triggers the back pain simply because the back is tired of being in one position for extended lengths of time.

I bring this up because of your own description of sleeping with the AirFit P10:

If I switch to the Airfit P10 (the minimal nose pillow mask), I don't wake up with the back pain. However, I sleep worse because this mask has a tendency to shift all over my face at night unless I really tighten it down, which is both uncomfortable and leaves deep marks on my cheeks that persist for hours after taking it off.

This certainly makes it sound like your sleep itself is much more restless, and hence may involve more movement in bed, when you use the AirFit P10 as compared to the P30i.

you are reading my mind and this is why i asked about sleep position

[lynninnj]

Possible crazy idea, but ....

Maybe you are moving around substantially less when you wear the P30i because your brain is somehow more relaxed and is in a deeper sleep. And the fact that you are moving around a whole lot less is what triggers the back pain simply because the back is tired of being in one position for extended lengths of time.

I bring this up because of your own description of sleeping with the AirFit P10:

If I switch to the Airfit P10 (the minimal nose pillow mask), I don't wake up with the back pain. However, I sleep worse because this mask has a tendency to shift all over my face at night unless I really tighten it down, which is both uncomfortable and leaves deep marks on my cheeks that persist for hours after taking it off.

This certainly makes it sound like your sleep itself is much more restless, and hence may involve more movement in bed, when you use the AirFit P10 as compared to the P30i.

Yeah, I was thinking the same thing. I do wear my Apple Watch S7 to bed which has pretty good sleep tracking in it, and it seems to know at which stage of sleep I'm in and for how long. I may just need to start comparing one mask's stats on my watch to the other watch's stats which may tell me how much more or less I'm tossing and turning with the P30i.

I just got an apple watch 7 and I like the sleep tracking function. I’m not sure if it will tell you if you were laying on one side with the other. I wish it would.

tightening the mask down drastically is not gonna help the fit of the mask all that much nor will it help your face. But I can’t help but feel like you need to change one variable to test whatever hypothesis you come up with as far as trying something different.

[lynninnj]

have you looked at your data on sleep HQ or oscar yet? have you figured out which mask actually has the leaks? And what degree are the leaks?

If you could get to where you had fewer ahi with the P10 which equals less back pain that would work? (or get used to some leaking?)

somewhere there is a good combination for you.

Hopefully soon you will be able to lower your AHI as well.

[lynninnj]

OK I’m coming back to this again and I wrap my brain around it.

I have a mask that leaks just about all the time-N30. It’s not necessarily that it leaks a lot, but it does leak often. I still managed to get a really good sleep with it with low a H I.

Sleep apnea can increase your inflammatory response within your body, at least that’s what I’m reading. It is those hypoxic events that create the inflammatory flare ups.

It seems entirely possible to me that you aren’t actually getting a better nights sleep with the P30i. it may seem like it fits better or stays put better, but it may not actually be giving you as good of a sleep.

My back up is the P 10 that you mention. I don’t like it because it pokes up my nose, but that’s just me. It’s possible that like my N30 it still gets the air in there good despite the leak levels.

I am not saying any of this as an authority. I’m just posing it as a possible mechanism for your difficulty.

if it were me, I would be starting to look at the data number one. Look at it for each mask. It doesn’t have to be a week trial with each. You’ve already established that it’s one way with one mask and another way with another mask.

a second step from there after determining what your leak levels are might be to work on creating a better seal with each mask. In fact, you can do that anyway just by using a little smear of lanolin before you put the mask on. Lanolin= lansinoh nipple cream for nursing is excellent product found near breast feeding supplies. Don’t be put off by the name and a little tiny bit goes a very very long way.

Just a thought.

[decker12]

Hopefully soon you will be able to lower your AHI as well.

Out of curiosity, what AHI should I be shooting for? I'm pretty happy with having 33 AHI during my initial sleep study, to being reduced to less than 3 a night with my CPAP machine. Note that my AHI remains under 5 regardless of which mask I wear.

With the P10, even though the myAir app doesn't show it (myAir always thinks I have a 5/5 mask seal), I know I definitely have mask leakage especially when I roll over and the thing rolls up along my face and comes out of one nostril. I can hear it, and then of course I have air blowing all over my face until I mentally wake up a bit and fix it. That's why I have to tighten the thing so much, to keep it in place when I switch positions during sleep. I don't consider myself a vain person but waking up with red bands along my cheekbones which persist for hours, like I've been wearing a diving mask, just doesn't look or feel right. But the cream sounds like a good idea.

[lynninnj]

Hopefully soon you will be able to lower your AHI as well.

Out of curiosity, what AHI should I be shooting for? I'm pretty happy with having 33 AHI during my initial sleep study, to being reduced to less than 3 a night with my CPAP machine. Note that my AHI remains under 5 regardless of which mask I wear.

With the P10, even though the myAir app doesn't show it (myAir always thinks I have a 5/5 mask seal), I know I definitely have mask leakage especially when I roll over and the thing rolls up along my face and comes out of one nostril. I can hear it, and then of course I have air blowing all over my face until I mentally wake up a bit and fix it. That's why I have to tighten the thing so much, to keep it in place when I switch positions during sleep. I don't consider myself a vain person but waking up with red bands along my cheekbones which persist for hours, like I've been wearing a diving mask, just doesn't look or feel right. But the cream sounds like a good idea.

Myair app tells you basically next to nothing compared to an SD card read by either oscar or sleephq.

I wouldn’t be happy with more than 1 ahi. Call me a fusspot but more than 10 rude awakenings in a night makes me cranky. Math it out. If you get 3 x 8 hours that’s 24 times your body lacked oxygen. Yes, 3 is way better than 33 (99x a night). I wager most posters who have been here a while are below 1. (my machine says .4 but sleephq will probably tell me it’s .46)

Figuring out the mask is just one part of it though.

Have you put an sd card in there yet?
(sorry if I missed that-will reread)