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Been on CPAP for about 9 months now. I'm pretty dialed in, nightly AHI is always under 2.0, usually a 0.8 to 1.2. Comfortable with the mask, everything going well.. except for this back pain that's re-appeared.

When I first started CPAP last summer, I would wake up with bad, aching pain in my mid and lower back. I'd have to gingerly roll myself out of bed, and shuffle around the house for the first hour or so of my day. Then it'd go away and I'd be fine once I got my body moving. This pain almost had me quit CPAP entirely, but then after a few months, it went away. It stayed away for many months. Fast forward to mid April 2023, in the past couple weeks, it's back, and I have no idea why. Exact same type of pain that I had when I had during those first couple of months. Feels like a thoracic spine pain.

Nothing has changed on my end, absolutely nothing, so I'm baffled. Same mask, same bed, same pillow, same sheets, mostly the same amount of sleep. Same sleeping habits as well, going to bed at the same time, but waking up earlier, because the pain gets me up at 6AM and I can't fall back asleep because of the ache. I can look at my SleepHQ data for the past 5 months and see practically no difference in each night other than my usual AHI variation each night.

There is no difference in my weight, my activity levels, anything in my bedroom, or any of my CPAP machine settings.

I'm not waking up any more often or any less than I usually do.

My 14 month old mattress is rotated every couple of months and I'm not in some sort of depression that's formed.

I look at my SleepHQ data from January, Feb, March and even two weeks ago, when I had no back pain, and it looks mostly similar to last night when I could barely shuffle out of bed this morning without biting my lip in pain.

I go to bed pain free, perfectly fine and feeling great, like this morning never happened.. but I'm dreading tomorrow morning.

I have no special pillows, no special wedges or anything in my bed, no pillows between my legs while I sleep, nothing like that. While I'm fine giving something like that a try, I don't see what sense it makes to start using those methods when I've had 7+ solid months of waking up with out pain. I'm a side sleeper for what it's worth.

Taking 4 ibuprofen before bed seems to help when I wake up, but that's kind of a crappy idea to get hooked on ibuprofen to solve this problem.

Here's my chart from a couple of weeks ago when I had no pain:

https://sleephq.com/public/97359554-bb2 ... 35e8c5eb8f

Any ideas on what I should try next? Before you mention it, sorry, I am not going to spend $1500+ on a new mattress as "a shot in the dark" to see if it fixes it, the one I have is only 14 months old and both me and my wife love it.

Thanks in advance. Dreading going to bed tonight.

EDIT: Watched a couple of videos that mentioned my EPR setting of 3 could be causing this. Dunno why it's suddenly causing this when I've been pain free for months, but tonight I'll turn off EPR and see if it helps.

Have you talked to your doctor?
You need to rule out a physical reason--before it gets away from you.
My back became quite painful and debilitating, until my surgery.
I feel like a tadpole again!

Why do you think your back pain has anything to do with CPAP?

Slobber asked a good question. Your back and cpap usage, if possible, should remain separated.

I have had 10 back surgeries in my life, with 6 back surgeries in the last 13 months. Long story-short, I am legally disabled with chronic back pain. As my doctor said, there is nothing much they can do for me, with the exception of a spinal cord stimulator which works great. I had to have it removed because my surgical incision got infected. The plan is to reinstall it next month. My main pain issues are getting up and down outta chairs and walking (I fall a lot). I got an expensive lift chair to get up and down.
I also have a Tempur-Pedic bed. For me, it is a must because it relieves the pressure a conventional mattress puts on my back. As my doctor stated, since there is not much else they can do. I have a walker that I use because of falling. A loud mouth once stopped me in a store parking lot and asked me if I was really disabled. I lifted my shirt and showed her my scars on my back. That shut her up!

The bed, the walker, disabled parking and the lift chair are tools that make my life easier.

Whatever happens, don't stop using cpap. Sometimes, because of the back pain, I can't sleep, so I get up and try to doze in my recliner. My son built a sturdy table that I have behind, but next to the chair. I'm planning on putting my back up cpap machine there, if sleeping in my chair becomes more of a habit.

Sheriff

decker12 wrote: ↑

Thu Apr 20, 2023 5:16 pm

Watched a couple of videos that mentioned my EPR setting of 3 could be causing this.

Sounds ridiculous. What is their explanation for how EPR could cause back pain?

A different take.

I saw an increase in my sciatica pain when I started cpap.

Long story short, I wasn't moving around as much. Without cpap, I tossed-turned all night, it didn't matter what position I went to sleep in.

With cpap, I spent long periods of time in one position. Once I figured that out, and started sleeping on my "good" side, pain improved.

Not sure if that applies, as everyone is different. I know what it's like to wake up in pain, and it sucks!!

Good luck!

JimmyStewart wrote: ↑

Fri Apr 21, 2023 11:30 am

A different take.

I saw an increase in my sciatica pain when I started cpap.

Long story short, I wasn't moving around as much. Without cpap, I tossed-turned all night, it didn't matter what position I went to sleep in.

With cpap, I spent long periods of time in one position. Once I figured that out, and started sleeping on my "good" side, pain improved.

Not sure if that applies, as everyone is different. I know what it's like to wake up in pain, and it sucks!!

Good luck!

You are most likely right, I also developed back pain after I started using СPAP. And I agree with your theory that the pain will appear from sleeping better in one position. My pain is felt in the morning and disappears during the day. Of course, the cause is a sore back, not СPAP therapy. A healthy back will not hurt from sleeping in one position. It is necessary to strengthen the back muscles, there is no other solution to this problem. Therefore, I recommend everyone who is worried about their back to find a competent doctor who will select an individual set of exercises and diligently perform them every day.

ChicagoGranny wrote: ↑

Fri Apr 21, 2023 9:10 am

decker12 wrote: ↑

Thu Apr 20, 2023 5:16 pm

Watched a couple of videos that mentioned my EPR setting of 3 could be causing this.

Sounds ridiculous. What is their explanation for how EPR could cause back pain?

I gave it a try and it's been a few days, and back pain has been reduced with EPR turned off. Felt the change in my back pain after the first night and it's gotten better every night since.

Nothing else has changed other than turning that setting off and so far the results have been promising. I'll give it another week and see.

decker12 wrote: ↑

Mon Apr 24, 2023 9:48 am

I gave it a try and it's been a few days, and back pain has been reduced with EPR turned off. Felt the change in my back pain after the first night and it's gotten better every night since.

Nothing else has changed other than turning that setting off and so far the results have been promising. I'll give it another week and see.

I gave it a try and it's been a few days, and back pain has been reduced after sacrificing a few virgins. Felt the change in my back pain after the first night and it's gotten better every night since.

Nothing else has changed other than sacrificing some virgins and so far the results have been promising. I'll give it another week and see.

You can also expect a more bountiful crop this fall.

decker12 wrote: ↑

Mon Apr 24, 2023 9:48 am

I gave it a try and it's been a few days, and back pain has been reduced with EPR turned off. Felt the change in my back pain after the first night and it's gotten better every night since.

Nothing else has changed other than turning that setting off and so far the results have been promising. I'll give it another week and see.

You never understood, your back pain is related to a good sleep. Your sleep is so good that your body is in one position for a long time. Therefore, a sore back makes itself felt. When your sleep is restless, you often move sideways and change your body position, so your back stops bothering you. In my opinion, if the back starts to hurt after SPAP therapy, then this is an indicator of good therapy. And a sore back should be treated with physical exercises and getting rid of excess weight.

There are two ways that CPAP can cause back pain:
1. As already mentioned, not moving as much in bed because you are sleeping so soundly. I had some issues with hip pain for this reason. Adding a 3" memory foam topper to our bed helped this. Joints get stiff and don't get lubricated while we sleep if we are very still.
2. Aerophagia can cause pain you feel in your back--it's "referred" pain from elsewhere. But typically this pain will be higher up around the stomach and back behind the shoulder blades. This may be why adjusting the EPR helps some people--by reducing aerophagia--seems counterintuitive, but whatever works . . .

Also consider that with weather changes increased physical activity might have an impact on your back.

It is a good idea to see a doctor, and perhaps a physical therapist. When I get lower back pain or sciatica I have a home program of some gentle Hatha yoga stretches which really help and also use an infrared sauna. I avoid NSAIDS because I already have bad reflux issues.

Thanks for your tips everyone. Quick update on this, in case anyone has any thoughts.

I've tried to scientifically try one thing at a time in an effort to solve this problem, so far without luck. I change one thing, and one thing only, and try it for two nights to see if it makes any difference to my back pain. What I've tried:

• Switching to a thin but firm pillow (about 2" thick)
  Switching to a thicker but still firm pillow (about 4" thick)
  Reducing EPR to 0 (sadly only worked for one night so it was a false positive)
  Rolled up towel between thighs while sleeping
  One of those contoured H-shaped firm leg pillows specifically designed to be between my thighs while sleeping
  Sleeping with my heated mattress pad turned on even though it's relatively warm out

One thing I have not put on my "things to try" list is reducing my minimum pressure. I regularly load my data into SleepHQ and I see that I'm consistently at a 10.2 to 17 pressure range throughout the night, with a typical AHI of less than 1.8, so I have my Minimum set to 10 and my Maximum set to 18.

So my question is, if I'm not using EPR, is there any reason to not set my Minimum to a 5? What are the disadvantages of having my minimum too low?

As far as other things to try, I still need to try removing the heating mattress pad, rotating the mattress, putting on Bengay / menthol type lotion on my back before bed, using two pillows, removing the clamp/stand that elevates my CPAP hose above my head, and simply taking 3x ibuprofen before bed so I don't wake up sore (least desirable choice!).

Again, I've been perfectly fine for 8 months using the heated mattress pad, a regularly rotated mattress, the elevated CPAP hose device, the same pillows, the same activity level and exercises, the same settings on my machine, basically everything I can think of. If you gave me a million dollars to figure out what has changed since October to March 1st when I had no back pain to April 15th when it started, I wouldn't be able to tell you a thing. Absolutely nothing stands out as having changed. My AHI is great, I have no mask leaks, I'm comfortable with my mask, I feel rested in the morning (but I'm in pain), I would say my CPAP therapy is going absolutely excellent with the exception of this back pain!

The only reason I'm blaming CPAP is because when I first started CPAP in August, I had this exact same back pain in the exact same places, for 6 weeks until it just went away. Back then, it also went away after I got up and walked around for a couple of hours but it was absolute misery for the first 45 minutes of my day. It's the exact same thing now. To the point that the pain wakes me up a good 60 minutes early, and then I'm limping into the bathroom and gingerly lowering myself with gritted teeth when I sit down on the toilet. It's awful but it goes away by 10AM.

Thanks again for any tips or conversation about this!

decker12 wrote: ↑

Thu May 04, 2023 3:05 pm

So my question is, if I'm not using EPR, is there any reason to not set my Minimum to a 5? What are the disadvantages of having my minimum too low?

On the one chart you posted, your pressure is increasing at times to 12, 13, and 14. The machine is increasing the pressure gradually because the sensors say the airway is about to collapse. If you set the minimum too low, the machine will not increase the pressure quickly enough to prevent apneas.(The big pressure swings might also interfere with your sleep.)

ChicagoGranny wrote: ↑

Thu May 04, 2023 4:13 pm

decker12 wrote: ↑

Thu May 04, 2023 3:05 pm

So my question is, if I'm not using EPR, is there any reason to not set my Minimum to a 5? What are the disadvantages of having my minimum too low?

On the one chart you posted, your pressure is increasing at times to 12, 13, and 14. The machine is increasing the pressure gradually because the sensors say the airway is about to collapse. If you set the minimum too low, the machine will not increase the pressure quickly enough to prevent apneas.(The big pressure swings might also interfere with your sleep.)

Yeah, that's what I figured and I was under the same understanding about why you just don't set the machine from 5 to 20 and be done with it. Was just shooting in the dark hoping to find some way to correlate my back pain with my pressure settings.

Do you have any idea about what is "too much" of a pressure jump to prevent the event? With my SleepHQ data for the past 8 months, I think I'm pretty well dialed in with my 10 - 18 setting. I may try setting the minimum to an 8 just to see if it helps with my back pain and/or effects my AHI.

decker12 wrote: ↑

Thu May 04, 2023 4:19 pm

I may try setting the minimum to an 8 just to see if it helps with my back pain

Yep. If you have too many events, you can change it back the next night.