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Another consequence of setting the starting pressure "too low" is that your machine has to "chase" the apneas, since it doesn't respond immediately and quickly. This can result in HIGHER pressures to get the apnea under control, and if your goal is to reduce the pressure you may find that you have accomplished the opposite. This can also lead to more mask leaks.

You could try it to see how your back pain responds, but keep an eye on the other factors, too.

I had the same sort of back pain when first starting to use my CPAP. I would get gas really badly from my machine while lying on my side, so I would try to fall asleep on my back and never roll onto my side throughout the night. I'd end up sleeping for hours on my back which would cause horrible back pain by the morning. Getting my settings better dialed in to minimize the gas so I could lie on my side seemed to alleviate the back pain for the most part.

Good news is that my AHI has not changed that much since dropping it from a minimum of 10 to a minimum of 8.

Bad news is that I have done almost everything in my list to try, short of buying a new mattress (which I won't do, as my current $2k+ king mattress is only 18 months old).

The last thing I'm gonna try is replacing my 12 year old box springs. I bought a steel frame foundation (with steel slats), which hopefully will give me a different type of support with my mattress. Its doubtful it'll make the difference, but I suppose it's possible.

It's just really frustrating because I feel I've gotten my CPAP dialed in. AHI is low, I have no comfort problems with the mask, I'm very much used to it, and I was getting good sleep. But this morning I was up at 4:45AM because of the back pain. I just gave up trying to go back to sleep because no position would relieve it, so I just got up and started getting ready for my day, 3 hours early, in the dark.

As I wrote earlier, I started CPAP in August, then out of the blue I had the exact same type of back pain start in October. I was using the P30i mask back then and had the exact same pain in the same location. I switched to the N30 mask and the pain went away and stayed away all fall and all winter. Then on about April 15th the same pain in the same location came right back, even though I've been using the N30 mask for 6 months. The kicker is that nothing has changed from April 14th, when I had tno pain, to today! No new pillows, no new mattress, no new sleeping position, no new physical activity, no new sleep pattern, no new sheets, no new stress or trouble sleeping, absolutely nothing. The only thing that has changed is that it's been 3 weeks and I'm still experiencing it, whereas in October, it went away after a couple of weeks.

How about seeing a doctor? Just because something is incidental to something else doesn't mean they otherwise are related or that one caused the other.

Doctor had no explanation for when it happened in October, and we were both satisfied when it seemed to just go away after a couple of weeks. When I had my yearly physical a few days after the pain started in April, he had no explanation for it happening now. He would be much more concerned if the back pain persisted throughout the past 10 months, but they don't even persist throughout the day. Instead they are gone after I'm standing up and moving around for a couple hours. As I'm typing this right now there is absolutely no remnant of the pain I was in this morning... but I'll still be awake and in pain at 5AM tomorrow morning and in pain.

Here's hoping the bed frame works out. I'll also try a different mask style, but I have little faith in that because I had this problem in October using a different mask already. I would be absolutely thrilled if this was something, anything, other than my use of CPAP. This pain (the location, the fact it's in the morning, everything about it) is nothing like I've ever experienced in my adult life, and since starting CPAP I've experienced two separate, multi-week long bouts of the pain.

I don't want to give up CPAP therapy but I'll have to consider it if it's the only variable remaining from this extensive (and expensive!) list I've been working down. I could handle the 2 hours worth of pain in the morning (although slowly rolling my legs off the bed, then gingerly limping to the bathroom before gasping with gritted teeth as I slowly inch myself onto the toilet in the morning certainly sucks) but losing 3+ hours of sleep because the pain wakes me up is the bigger issue. Once the pain wakes me up I just can't get comfortable in any position to fall back asleep, it's like the damage for the night has already been done.

Tonight I'm going to try to take 4 ibuprofen before bed to see if that helps, and I honestly hope it does NOT help because I don't want to get hooked on ibuprofen and risk damaging my kidneys.

I'd still ask for a referral to a neurologist, orthopedic MD, physiotherapist, take your pick - your GP may not be the best one to settle on for a definitive answer regardless of the pain's timing.

A few years back, I started having back pain too and used ibuprofen to help, but it only worked for a little while. When the pain came back, I knew I needed a better solution. That's when I thought about trying physiotherapy.

About six months ago, I decided to see a physiotherapist named Humna Aziz. She was really helpful. She showed me some exercises and changed a few things in my daily routine. These changes have made a big difference for me. I've been feeling a lot better since then.

If you're thinking about physiotherapy, it might be a good idea. Here’s a link I found useful: https://www.harbourviewtherapy.com/.

Quick update - it was my abdominal muscles. CPAP actually is to blame.. because I sleep so soundly now that I am not tossing and turning all night! I sleep rock solid and my abs in my back don't like being in that position for 6+ hours so they get sore.

Nothing physically wrong, just needed to strengthen my core. X-rays were clean, except for the fact that I'm older and things don't work the way they used to.

Went to 6 weeks of PT and they immediately identified the problem. Worked out for the past year, lost some weight, and I learned some exercises and techniques and now it's much better, but still bugs me every so often.