Lately I have Been Getting Costochondritis During sessions

Lately I have Been Getting Bad Costochondritis. I have been using the machine for about a year and only been getting the soreness for a few weeks. I am a side sleeper. I am a newbie when it comes to looking at chart data. All I can tell is that the pain seems to get worse as the pressure gets higher. I have noticed the pressure gets higher with leaks or if I end up on my back. I fixed the major leaks. They were over 30 several times. This was last night for me. I had pretty bad pain and ended up on my back for a little while. I also felt a small mask leak when on was on my right side. Apparently I was drooling and the saliva might have broken the seal. I am very sensitive to high pressures and get palpitations as well when I waken. The charts show shallow breathing. Most nights it is obstructive. My question is can you tell what is causing the Costochondritis? I realize the AHI numbers are very low but the doctor says it because the machine is preventing the apneas. I also constantly wake up and have to take the mask off because I must address the pain and give time for palpitations to calm down. I am at a lost of what to do? Maybe you can look at the charts and give me some pointers. I have never seen my pressure get even close to 14 before.
This is what happened one night when I opened the max pressure to 20.

As to why now that you have some chest wall discomfort at your pressures enough to cause you to wake up after being on cpap for this length of time. Million dollar question that I don't have an answer to. For the most part your pressures are relatively low for the biggest part of the night.

1/22/20 was my first night on the cpap. The machine was set by the doctors at min 5 max 20. On 3/28/20 I changed it too Min 6 Max 12. It pretty much stayed around that range until on 9/24/20 is was changed to min 6.4 max 15 for 8 days. During those 8 days there were massive leaks that directly correlated with the pressure rise which hit a max of 15-20. These high pressures with the massive leaks caused hypopnea or shallow breathing events. I think my body was used to no higher a pressure than 12 and suddenly getting hit with 13-20 pressures caused the Sternum and chest pain. So, I just changed the max back to 12 like it was. The massive leaks are also fixed but I still feel bad but much better than before. I think it has to heal. I also noticed by looking over all the past data that most of the pressure spikes were caused by bad leaks. A few were shallow breathing or central. None of the doctors taught me how to do a proper mask fit test! I learned how to do that here!

If you zoom in on the flow rate and you think you were for sure asleep when it does go quite a bit higher....I would look at the usual suspects....supine sleeping or REM stage sleep causing the OSA to worsen and need more pressure. Also your flow limitations increase a bit at the times of the pressure increases....nasal congestion involvement is a possibility. How's the nasal breathing? Any congestion.

I do get a lot of nasal congestion and my right nostril is partly obstructed. I do end up in a supine position sometimes and that is bad for me. When I have bad dreams or running dreams then that is also an issue.

You might want to consider a tight apap range for a couple of weeks and let the chest wall muscles heal and get back to normal and see how things go.

I tightened it to 6.4-12

It's also possible that we can get costochondritis like symptoms and it simply not be from cpap use. Had any sort of respiratory issue lately while awake? Cold/flu like symptoms?
If it is painful enough that it wakes you up.......need to alert your doctor.

Nope.

I have had real costochondritis in the past and long before I was ever put on cpap. It's extremely uncomfortable I know but it just has to take its time to heal and go away. Every breath hurts and sometimes hurts a lot day and night. The usual anti inflammatory products might help but time is the best thing.

I did research and just got this today in the mail to fix it: https://www.amazon.com/gp/product/B01LY ... UTF8&psc=1

If it were me and I was for sure asleep and I really thought it was the pressures causing the chest wall issues....I would add more EPR to help with exhaling discomfort issues (like set it to 3) and I would maybe limit the max to 12 for a while and see what happens.

It has always been a 1. I will change to 2 and then 3 if needed. Thanks!

When beginning, I has some chest soreness from additional effort to exhale--but all over.
Since the pain of costochondritis is in the breastbone area, it would be wise to check with a physician
to rule out a cardiac problem.

chunkyfrog wrote: ↑

Thu Oct 15, 2020 2:04 pm

When beginning, I has some chest soreness from additional effort to exhale--but all over.
Since the pain of costochondritis is in the breastbone area, it would be wise to check with a physician
to rule out a cardiac problem.

It is not just the sternum. It radiates to chest and ribs and even the upper back and gives me bad headaches. It actually can hurt to breath at times. I did have a operation on my aorta but I explained
my surgeon my symptoms and he said they probably are not related.

You've mentioned a few times that the huge leaks are causing pressure spikes.

Leaks don't cause pressure increases, (though they do cause increased flow to compensate) but higher pressure can cause leaks. Especially if the mask isn't fit properly.

The higher pressures and leaks were also not the cause of hypopneas. The Hypopneas (and Flow Limitations) are the cause of the pressure increases, which can then contribute to leaks.

I like Pugsy's advice, limit your maximum pressure and increase your EPR to help breath against the pressure, especially while you're in discomfort. Another consideration could be to switch your Response from Standard to Soft. The pressure increases will be gentler, helping your comfort and maybe the leaks.

Dog Slobber wrote: ↑

Thu Oct 15, 2020 6:47 pm

You've mentioned a few times that the huge leaks are causing pressure spikes.

Leaks don't cause pressure increases, (though they do cause increased flow to compensate) but higher pressure can cause leaks. Especially if the mask isn't fit properly.

The higher pressures and leaks were also not the cause of hypopneas. The Hypopneas (and Flow Limitations) are the cause of the pressure increases, which can then contribute to leaks.

I like Pugsy's advice, limit your maximum pressure and increase your EPR to help breath against the pressure, especially while you're in discomfort. Another consideration could be to switch your Response from Standard to Soft. The pressure increases will be gentler, helping your comfort and maybe the leaks.

The problem was simple. My mask was way too loose. I was never taught how to do a mask fit test while lying down. When I did do it the mask leaked badly in every position. When I ran the mask fit test and tried every position and tightened the mask for every position, the max pressure spikes disappeared.

If it were me and I was for sure asleep and I really thought it was the pressures causing the chest wall issues....I would add more EPR to help with exhaling discomfort issues (like set it to 3) and I would maybe limit the max to 12 for a while and see what happens.

I did as you suggested and here is the result:
I have to say I did not have any Costochondritis symptoms at all but palpitations were bad and my left chest muscle was very tight. I had to get up and stretch it out the muscle in a door frame. I am pretty sure what is happening. Usually within an hour of getting up a bunch of belching occurs and I have a strong urge to use the bathroom. After relief, the palpitations go away. I even lie back down to check and nothing. No palpitations that were hindering me most of the night. What is happening is the weakened LES in my stomach is allowing air into my stomach. I basically have Aerophagia. I know the LES is weak because it lets acid back up.

Aerophagia symptoms

Indeed, although this physiological phenomenon is among the more benign functional disorders, it does induce a sensation of heaviness, bloating, upset stomach, frequent eructation or burping, especially after meals.
Apart from these symptoms, can also be noted: gurgling in the digestive tract, abdominal cramps and nausea, often paired with heart palpitations and vertigo.

All the underlined symptoms I get. Some more than others.

I came off proton pump inhibitors that I was taking for over a year months ago. These weaken your LES. It will take sometime for that to heal. What I need to do is probably lose at least 20-25 lbs to get to 195 lbs @ 5'11 foot tall and get off the cpap for good. Then drop down to 185 lbs and stay there. Since my apnea is obstructive is just because of a fat tongue. Lose the weight and the apnea is gone or at least it won't need to be treated anymore with cpap.

https://www.nature-and-garden.com/healt ... ments.html

If you have suggestions, I would love to heard them.

WakingKnowledge wrote: ↑

Thu Oct 15, 2020 6:53 pm

Dog Slobber wrote: ↑

Thu Oct 15, 2020 6:47 pm

You've mentioned a few times that the huge leaks are causing pressure spikes.

Leaks don't cause pressure increases, (though they do cause increased flow to compensate) but higher pressure can cause leaks. Especially if the mask isn't fit properly.

The higher pressures and leaks were also not the cause of hypopneas. The Hypopneas (and Flow Limitations) are the cause of the pressure increases, which can then contribute to leaks.

I like Pugsy's advice, limit your maximum pressure and increase your EPR to help breath against the pressure, especially while you're in discomfort. Another consideration could be to switch your Response from Standard to Soft. The pressure increases will be gentler, helping your comfort and maybe the leaks.

The problem was simple. My mask was way too loose. I was never taught how to do a mask fit test while lying down. When I did do it the mask leaked badly in every position. When I ran the mask fit test and tried every position and tightened the mask for every position, the max pressure spikes disappeared.

Leaks do NOT cause pressure increases.

If you take a look at your graphs, including last nights, there is an exact correlation between pressure increases and Flow Limit activity. This is well documented and understood.

On your graphs there simply isn't the same correlation that demonstrates leaks cause pressure increases. There are pressure increases without leaks, and leaks that don't cause pressure increases.

Dog Slobber wrote: ↑

Fri Oct 16, 2020 7:01 am

WakingKnowledge wrote: ↑

Thu Oct 15, 2020 6:53 pm

Dog Slobber wrote: ↑

Thu Oct 15, 2020 6:47 pm

You've mentioned a few times that the huge leaks are causing pressure spikes.

Leaks don't cause pressure increases, (though they do cause increased flow to compensate) but higher pressure can cause leaks. Especially if the mask isn't fit properly.

The higher pressures and leaks were also not the cause of hypopneas. The Hypopneas (and Flow Limitations) are the cause of the pressure increases, which can then contribute to leaks.

I like Pugsy's advice, limit your maximum pressure and increase your EPR to help breath against the pressure, especially while you're in discomfort. Another consideration could be to switch your Response from Standard to Soft. The pressure increases will be gentler, helping your comfort and maybe the leaks.

The problem was simple. My mask was way too loose. I was never taught how to do a mask fit test while lying down. When I did do it the mask leaked badly in every position. When I ran the mask fit test and tried every position and tightened the mask for every position, the max pressure spikes disappeared.

Leaks do NOT cause pressure increases.

If you take a look at your graphs, including last nights, there is an exact correlation between pressure increases and Flow Limit activity. This is well documented and understood.

On your graphs there simply isn't the same correlation that demonstrates leaks cause pressure increases. There are pressure increases without leaks, and leaks that don't cause pressure increases.

Please explain pressure increases and Flow Limit activity. I can show you other charts where clearly the leaks clearly correlated with the pressure increase.

WakingKnowledge wrote: ↑

Fri Oct 16, 2020 7:11 am

Please explain pressure increases and Flow Limit activity.

Flow Limitations are, as the same suggests, a limitation in air flow. Think of it like the air passage has narrowed a bit, and if it continues to narrow then it will close and you will have obstructive apneas.

Auto-adjusting machines are specifically designed to increase pressure upon sensing flow limitations to prevent apneas. Apply some critical thinking and you should recognize that this also makes sense.

WakingKnowledge wrote: ↑

Fri Oct 16, 2020 7:11 am

I can show you other charts where clearly the leaks clearly correlated with the pressure increase.

You've shown charts, where there is no correlation, and you've shown charts and gotten the causation wrong. Higher pressure causes leaks, leaks do not cause higher pressure.

This too, makes sense.

I could show you charts showing a correlation between increased ice cream sales and hot temperatures. You don't draw the conclusion that ice cream sales cause hot temperatures.

In fact, I've seen it mentioned here that continued high leaks may cause some algorithms to lower pressure to address the leaks.

What possible reason would the algorithm respond to leaks, by increasing pressure? That doesn't make sense.