Worried: Lung irritation after PAP

Dear members: I am new to this forum and PAP therapy and I need your advice. I tried CPAP (then BIPAP) in 8-10 pressure range and after a just a few days of use, I feel irritation in my lungs (not nose or throat, but lungs). It is not pain, but irritation. I am using a humidifier and my System One with DreamWear nasal mask are clean. I read that some people experience lung muscle discomfort/pain which goes away after some time. But in my case, it is a sense of irritation in my lungs and I am worried about it. Also, when asleep in the morning and the PAP machine going, I heard a woozing sound as if coming from my lungs. Anyone experienced such symptoms? What can it be and how to deal with it?

Irritation - can you be any more specific please?

TeddyBear777 wrote:Dear members: I am new to this forum and PAP therapy and I need your advice. I tried CPAP (then BIPAP) in 8-10 pressure range and after a just a few days of use, I feel irritation in my lungs (not nose or throat, but lungs). It is not pain, but irritation. I am using a humidifier and my System One with DreamWear nasal mask are clean. I read that some people experience lung muscle discomfort/pain which goes away after some time. But in my case, it is a sense of irritation in my lungs and I am worried about it. Also, when asleep in the morning and the PAP machine going, I heard a woozing sound as if coming from my lungs. Anyone experienced such symptoms? What can it be and how to deal with it?

Probably NOT your lungs but your esophagus. You are probably having an asthma like reaction to the dryness or wetness of the air plus the fact that you breathing muscles are protesting. Unless of course you have CPOD in which case go and see your doctor.
The woozing sound is you breathing through the mask.

You don't say how old you are, or if you've ever had asthma, or if you have it now. (There is a thing called 'late onset asthma' - so called because its first appearance or 'onset' is later in life - typically 45+.)

With asthma of any kind, the epithelial cells - those are the ones that line the bronchi - can become 'twitchy' - that is, extra sensitive to various substances or stimuli - even stimuli which are not normally regarded as irritating, or are not irritating to most people.

Conditions which bring about this extra senstivity, apart from the usual suspects, include: stress, hyper-ventilation, prolongued bouts of laughter, and positively ionised air.

The first question to ask is: whatever the cause of the sensitivity, does the epilthelium layer respond by producing mucus (or phlegm)? And if, so, is it clear? Or does it have a colour? (Colour usually means infection.)

Even if it is clear, is it being produced in sufficient volume to reduce lung capacity.? Ie, make you short of breath?

It doesn't sound like you have anything seriously wrong with your lungs. But to be on the safe side, you might visit your PCP. He or she can listen to your chest, ask you to blow into a peak-flow meter, produce some phlegm for testing, etc. You might benefit from a low-dose steroid inhaler.

Please note: I am not a doctor, just a former medical journalist.

Thank you for your feedback - every bit helps!
I am 55 and I had pre-astma as a child which never developed. I have no mucus or anything coming out if I try to cough. My lungs feel clear when I take breaths, but irritated and with an inclination to cough.
Is it normal? Do most PAP beginners experience such irritation?

What humidity setting are you using on the humidifier?
Are you using a heated hose? If you aren't sure the heated hose for the SystemOne has a black coupling on the end that attaches to the humidifier. If you are using a heated hose what is the temperature setting?
Do you take any medications? If so what? Particularly any blood pressure medications?

Thank you for your comments and questions!
I am using System One with a Humidifier set at 2 but no heated hose. (Should I get one?) My room temp is comfy now at around 70F and may go down to 50's in the winter. I take no meds and I am generally healthy except for sleep apnea which I had for decades but never treated it till now. I also have trouble sleeping now as I used to sleep on my stomach and now trying hard to learn to sleep on my back and sides. Since I am not a PAP therapy, I figured that I can try change to a better sleeping position, but changing habits is causing me to struggle to fall asleep for hours. The machine is telling me some pretty high AHI's which I verified by looking at software and seeing mostly centrals. Anyway, that's a different struggle altogether...I do not want to hurt myself on PAP and my irritation, deep in my chest-lung area, is a bit of a concern since I read nobody having it yet on any forum.

Some blood pressure meds can cause the urge to cough. That's why I asked but since you aren't taking any meds we can't blame meds.

Look on the bottom of the blower unit for a 3 digit model number and tell us that 3 digit number.
It may have DS or REF or P in front or behind the 3 digits.
Just how high is that AHI and how much of the AHI is central/clear airway?

Lung irritation or feeling like one needs to cough isn't a common complaint from cpap usage. The only thing I can think of that might be factor is that the humidity setting of 2 isn't all that much in terms of humidity and maybe the air is a bit dry and causing the cilia in the lungs to be a bit dry and thus the urge to cough.
It's a stretch but increasing the humidity setting to see if it helps is easy to do. That setting of 2 without the heated hose being used really doesn't add very much moisture to the air at all. It's going to be very minimal added moisture.
I would increase the humidity setting to around 4 and see if that helps at all.

It is System One 750P (Bi-level Auto with Bi-flex) - got it used and trying it on my own.
There is so much going on with me interacting with the machine, so may surprises - all unpleasant so far and I learned that many new users on various forums have similar struggles. But the irritation in my chest is the unknown and hopefully the humidifier setting increase will help (although the person who sold me the machine did not even use a humidifier, so I am only cautiously optimistic). Thank you for a recommendation!

Ahhh...DIYing it.

What are your other settings?
Which mode?
EPAP and IPAP?
PS (Pressure support)?

We really need to know what the AHI is and what it is composed of.
Are you using SleepyHead or Encore?

I am familiar with the 750...I used to have one. That's part of the reason I know about the humidification system on it.

Thanks for asking.
I am just starting out, experimenting with pressures and humidity. Started one night with Bipap in Auto with E=6 min, I=8 nominal, I=16 max, PS=8, Biflex at 3 and Humidity at 2. Sleepyhead showed that the machine auto-ranged to 10 max, so next night, I went to a straight Bi-level mode with E=4 and I=10. Qualitative results: AHI is 48 (mostly Clear Airway) with peaks at 60! and its real, but most of the numerous centrals last about 20 seconds max, so that's the good news, and during those 20 secs, it does not look like the breath is completely flat-lining but barely pulsing which still qualifies as a reduction for central. I may be shallow breathing and/or fighting the pressure.
I learned that can't use the machine/software to make an accurate diagnosis so I am not panicking. Will be going to 10/6 tonight to see if I need more support at the min level...Feeling-wise, I am sleeping worse than when I slept on my stomach with no machine for years, but this can't go on forever, so I will keep at it.
The real concerns besides (lung?) irritation is air bubbles forming in the mouth which I have to consciously vent out. I am working on my tongue to help the inner leakage but ordered a chin strap as a back up.

Reduce your PS so that it is no more than 4 maximum.
See if the clear airway events reduce. With the high PS you have been using you may have been causing the body to blow off too much carbon dioxide which in turn causes the centrals because the brain looks for a higher level of carbon dioxide before it triggers the breathing.

So your plan for 6/10 tonight should work out better if it was the high PS that was the trigger for the CAs.

Will do. Was starting with PS=8 because of an old and questionable UARS diagnosis which often requires higher support as well as higher pressures. Based on the earlier results, it looks like I have an apnea and not UARS. I am end up re-doing the sleep study, but the first one left me with an impression that the sleep study folks were not competent then. They gave me a cpap which did not do a thing and I gave up. Now, a decade later, I hope there is more knowledge in this field. Heck, I know a lot more based on reading expert reviews and comments on various forums including yours. Thanks!

Further to Pugsy's excellent remarks, if you are blowing off CO2, then that will change the acid/ alkaline balance of the blood - in your case, most noticeably in the lungs. And that alone can bring the sensation of irritation. This is the process which results from the cause I listed above as 'hyper-ventilation'.

Here's a quick study:

https://medictests.com/acid-base-balance/

Lung irritation, don't see it. It does force your chest to work past the range it does at normal are pressures, it will get used to it after a week.

When I started XPAP ten years ago, my O2 levels were 92 on good days, now they are 95, I like the way my XPAP abuses me. Beat me down some more. Jim