This newbie is a problem child

Pugsy is female.
Your mistake happens all the time.
Pugsy is a good sport.

JPB

Central apneas can be harmful if they are numerous enough or prolonged enough to caused oxygen level drops...or they can cause a sleep disruption.
Awake flagged centrals...not a problem except they point to not being asleep. A few centrals here or there not usually a problem.

Your obstructive apneas are your worse problem though. Obviously a lot more of them and in dense clusters so likely happening frequently and back to back.

You know you need a higher EPAP/IPAP but then you are having difficulty with the chest wall muscle soreness and apparently it seems to radiate to your shoulder as well.
There is no way to know how long it is going to take your body to get used to the extra work for those muscles to get used to feel like you have been blowing up balloons all night. It's like going to the gym and starting a new routine that works different muscles in a manner they aren't used to and you have to deal with the muscle soreness until the muscles are more accustomed to the new exercise routine.

I know of people that get past it in 3 or 4 days and others it takes 3 or 4 weeks. Just another one of those YMMV things that comes with all this cpap stuff.

We have to sleep first and foremost though and having so much pain we simply can't sleep isn't good either and I would rather see you have sub optimal OA therapy and sleep without pain than no therapy at all. It's not ideal obviously but with the goal that once your chest muscles don't cause so much pain you can then address the need for more EPAP minimum and maximum.
Baby steps with the increases in pressure and time and you will eventually get there but it won't be an overnight solution.

And I don't mind being referred to as a he. Happens all the time. We used to have a gender selection available in the profile so people could know M or F but there was a forum update done a couple of years ago and we lost that feature in the profile. It is not a big deal to me.

Lmao tell me why I read this title and got worried for a sec

Pugsy wrote: ↑

Sat Oct 31, 2020 6:15 pm

Central apneas can be harmful if they are numerous enough or prolonged enough to caused oxygen level drops...or they can cause a sleep disruption.
Awake flagged centrals...not a problem except they point to not being asleep. A few centrals here or there not usually a problem.

Your obstructive apneas are your worse problem though. Obviously a lot more of them and in dense clusters so likely happening frequently and back to back.

Obviously you know you need a higher EPAP but then obviously you are having difficulty with the chest wall muscle soreness and apparently it seems to radiate to your shoulder as well.
There is no way to know how long it is going to take your body to get used to the extra work for those muscles to get used to feel like you have been blowing up balloons all night. It's like going to the gym and starting a new routine that works different muscles in a manner they aren't used to and you have to deal with the muscle soreness until the muscles are more accustomed to the new exercise routine.

I know of people that get past it in 3 or 4 days and others it takes 3 or 4 weeks. Just another one of those YMMV things.

We have to sleep first and foremost though and having so much pain we simply can't sleep isn't good either and I would rather see you have sub optimal OA therapy and sleep without pain than no therapy at all. It's not ideal obviously but with the goal that once your chest muscles don't cause so much pain you can then address the need for more EPAP minimum and maximum.
Baby steps with the increases in pressure and time and you will eventually get there but it won't be an overnight solution.

3-4 weeks sounds better to me than I would have guessed. I'm going to stick with where I am for a couple nights and creep up every 3-5 days one notch at a time.

The Pug pic looked like a male Pug to me. Not a flattering pic. Cute for a Pug but... I'm digging myself deeper huh? We had a black Pug when I was a kid. Her name was Nee Nee. Very sweet little dog. No offense meant at all. Really happy you are here to help. I appreciate it.

jimbud wrote: ↑

Sat Oct 31, 2020 5:50 pm

Pugsy is female.
Your mistake happens all the time.
Pugsy is a good sport.

JPB

Thanks for the heads up. Makes sense though right? Women are more empathetic than men generally and she has certainly been very helpful to me. I generally have a higher opinion of most women than I do men. Not at all unrelated to the fact that I am one. I know that my wife is a LOT better at being nice than I am.

Wanna see something scary? It's Halloween right?

So my daughters started nagging me about my snoring about 6 months ago. They were concerned i might have sleep apnea. I bought a finger oxygen meter. This is what I saw when I decided I had to do something.

Scary huh?
This is a more typical night since I started CPAP.

Your lowest oxygen level beat mine by 3%. Mine went to 73% during my sleep study.

My little black pug avatar. That is Sarge and indeed a male. He crossed the Rainbow Bridge from sudden onset heart problems at the ripe old age of barely 9 yrs old not quite 2 years ago. He was my little buddy because I saved him from an abusive situation at about 5 months of age.
I couldn't go pee without him following me to the bathroom. When I went to town he sat on the back of the couch looking out the window for me until I got home.
So to honor him I changed my avatar to a picture I had of him when he was young and I hadn't had him too long.
And yes...I know that pretty much only Pug lovers can see the beauty in the breed. He wasn't the smartest knife in the drawer.
We used to call him our Down Syndrome Dog. You know how people with Down Syndrome typically are....always happy and smiling and with hearts as big as the universe. Love everyone unconditionally.

Big empty spot when he left me. I was pugless for the first time in over 30 years.
Anyway...God sent Lucy to me a few months later. Another rescue...age 6 from a breeder and she couldn't have any more babies so they didn't want her. I don't know who rescued who with her. I think she rescued me more.

I can't bear to change avatar's yet though. That big hole isn't entirely healed up yet.
Anyway...Meet Lucy.
This was when I first got her last year...a little thin. Not thin now and on a diet because she is a couch potato. Typical pug though and even melted my husband's heart because she loves to take naps in his lap and none of our other dogs have ever done that.
I live in the country on 40 acres. 2 horses, 3 dogs now and 2 cats inside and 4 to 6 outside. And a multitude of whatever creature waddles by....possums, coons, deer and an occasional armadillo.

Pugsy wrote: ↑

Sat Oct 31, 2020 7:19 pm

Your lowest oxygen level beat mine by 3%. Mine went to 73% during my sleep study.

My little black pug avatar. That is Sarge and indeed a male. He crossed the Rainbow Bridge from sudden onset heart problems at the ripe old age of barely 9 yrs old not quite 2 years ago. He was my little buddy because I saved him from an abusive situation at about 5 months of age.
I couldn't go pee without him following me to the bathroom. When I went to town he sat on the back of the couch looking out the window for me until I got home.
So to honor him I changed my avatar to a picture I had of him when he was young and I hadn't had him too long.
And yes...I know that pretty much only Pug lovers can see the beauty in the breed. He wasn't the smartest knife in the drawer.
We used to call him our Down Syndrome Dog. You know how people with Down Syndrome typically are....always happy and smiling and with hearts as big as the universe. Love everyone unconditionally.

Big empty spot when he left me. I was pugless for the first time in over 30 years.
Anyway...God sent Lucy to me a few months later. Another rescue...age 6 from a breeder and she couldn't have any more babies so they didn't want her. I don't know who rescued who with her. I think she rescued me more.

I can't bear to change avatar's yet though. That big hole isn't entirely healed up yet.
Anyway...Meet Lucy.
This was when I first got her last year...a little thin. Not thin now and on a diet because she is a couch potato. Typical pug though and even melted my husband's heart because she loves to take naps in his lap and none of our other dogs have ever done that.
I live in the country on 40 acres. 2 horses, 3 dogs now and 2 cats inside and 4 to 6 outside. And a multitude of whatever creature waddles by....possums, coons, deer and an occasional armadillo.

Very sweet puppy tales. Thanks for sharing that.

Well. I continue to be perplexed I guess.

My shoulder pain has persisted. My thought was my body just needs to get used to the CPAP and that needs to happen over some period of time. Two weeks ago I had dropped my pressures to PS 5.0 13.0/18.0. It was at this setting for 12 nights. I figured out if I elevated my right arm while on my left side, where I usually am when I sleep, that the pain was less an issue. The pain overall gets worse the longer I am on the CPAP overnight. Over these 12 days the pain became progressively worse. This pain and irritation I now started to feel more during the day than before. Saturday night was a particularly painful night.

So Sunday night I dropped the pressures back to PS 5.0 11.0/16.00. The pain was not any better.

So here is a puzzler; Last night I slashed the pressures down to a PS of 4.0 and 8.0/12.0 hoping to avoid the pain. That worked. Last night was the first night in about a month without pain. I anticipate a high AHI reading this morning. My AHI was 5.15! This is one of the best results I have ever had.

I wear a finger oxygen meter which records my oxygen levels as well as my heart rate. My average heart rate was 55. Most of the nights in the past month it has been more like 60. I felt like I had the best night sleep I have had in a long time.

A week ago I switched to a nasal pillow mask. That has resulted in less leakage but nothing else really changed till I slashed the pressure last night.

Any ideas?

Some parts of the night the 8/12 does a good job. Some parts it doesn't...either maybe REM related or supine related.
How about allowing the machine to increase just a little which I am sure it would want to do to prevent those clusters?

So how about 8 minimum PS 4 and maybe IPAP max of 15 and see if the machine wants to go up and if it does will those OA clusters be prevented.
It's better than using higher pressures all night.

I still am not sure your shoulder issues are pressure related. I still think you need to see a doctor about it.

The saga continues...

So I had a CT scan. My gallbladder is good. Shoulder pain caused by gallbladder issues is in the shoulder blade area. The inflamed gallbladder irritates the phrenic nerve after a fatty meal causing the pain on the right side normally ending up in the right shoulder blade area. Not joint pain as I described.

My pain is and has been like an arthritic joint pain that is not intermittent after a fatty meal. It happens during use of the joint working, or late into the night. It's when I use the shoulder to work and when what I describe as "blowing up balloons" all night long due to the exhale pressure on my machine. I haven't yet, but I am considering having an injection of cortisone in my shoulder to take down the inflammation.

So to avoid pain I have left the pressure relatively low. I did take Pugsy's advice and bumped it up one night higher IPAP max of 14. Events were not lower.
The number of events does range a bit. Prior to the onset of this shoulder pain, the higher pressures would wake me over and over all night long. My number of events was still mostly about 10 per hour.

I have struggled to keep a good seal with a nasal pillow/ORACLE mask combo I have been using. I think I have that mostly worked out now.

I believe the periods of time when I have the most significant number of of events are happening when I am on my back. I am experimenting with a section of foam "floaty" I have tied around my waist on my back tying to train myself to stay off my back. Rolling over is a bit of a process but I'm working through it.

I get what feels like a really good nights sleep at this lower pressure. I'd like to figure out how to stay off my back 100% of the time and then see how my numbers work out. This was last night. This is in my top 5 best nights since starting this journey nearly 4 months ago.