Hey, All You Experimenters! Use Caution

So there I was at 4:00 AM waking up with intense chest pain that radiated up the sides of my neck. Every breath was painful as was any movement. Thinking that the extra weight, poor exercise regimen, and unattended borderline cholesterol had finally caught up with me, I wandered the house for a while checking in with kids’ rooms, took some antacids (just in case). You get the point. When I got a little more analytical (later in the day and after a Dr. visit) I began to put CPAP at the top of the culprit list. Not CPAP itself but my steps or perhaps missteps over the past couple of weeks in addressing some problems.

The first problem (after 6 months of compliant CPAP) was that I started snoring, mainly while using my Swift (as opposed to Activa). I kicked up pressure 1/2 a cm, and after a couple days of lighter snoring another 1/2 that eliminated the snoring. Next, and only on the Swift, I started mouth breathing for the first time. A little tape fixed the mouth breathing and I had a couple of restful, albeit leaky, nights. I tried some other ideas from here on side-sleeping and leaks (vinegar/water spritz and tighter head strap with looser lower strap) with the Swift on the night of the incident (no leaks!).

After tests and eliminating lots of other scary diagnoses, all the Dr. could come up with is in 1 cm extra pressure plus eliminating mouth breathing, plus eliminating any leaks, plus sleeping in a tight ball with my chin on my chest (an unusual position for me – I’m a spraller) may have forced some air into the lining of the lung. It hurts.

I’m much better after backing off the pressure 1cm, ibuprofen, rest, and my Activa for a couple nights.

The moral of the story for me is: if I’m going to experiment by myself I should be more cautious and methodical. For instance, work on the leaks THEN the pressure, if needed. Oh yeah, fear has led to a renewed interest in salad and my bicycle.

Have great weekend and I will do the same!

Chris

Did you take a couple aspirin too (if you are not allergic or have other contraindications)? Use plain aspirin 325 mg. Interferes with the clotting process.

Chris

Thanks for sharing your story. It must have been very worrying and it's great that it wasn't anything more serious. Keep up with the salad and the bicycle

I'm curoius as to why you pushed up your pressure, albeit only a little at a time, because you were snoring. Were there any other factors?

These machines are not so accurate that 1 CM pressure is gonna be a big deal.

I just find this diagnosis suspect. I also sort of think you should have called 911 - I have a certain pattern that I'll take anticids for because it has happened so many times, but then you gotta call 911 - and first time for any sudden chest pain syndrome, you gotta call 911.

Air leaking from the lungs because of overpressure without lung collapse is a common scuba injury (as common as any - that is - extremely rare - I've seen one case in thousands and thousands of observed dives) but it is almost painless as I recall. If there is enough air to displace or collapse the lung (pneumothorax) then it becomes real painful - You are more likely to diagnose it because of things like crackly skin around the neck (where the air tends to pool) You sound more like you had pleurisy which I know from personal experience to be very painful.

If I believed that diagnosis (air leaking into lung cavity because of CPAP) I would not be thinking CPAP any time soon. I would try to see a pulmonary specialist to get cleared for CPAP use.

Did you have an ekg? Chest x-Ray? MRI that showed air in the space around the lung? Test for cardiac enzymes? Any other tests that might make us believe this? I have no idea what you did and did not mention, but if the doctor ruled out a bunch of stuff and came to "air leaked from the overpressure lung into the chest cavity and caused pain", I suspect that is a contraindication to CPAP.

Aerophagia can be extremely painful. Harmless, but painful.

I have to agree with brasshopper. The allowable variance in pressure for your machine to pass calibration checks is plus or minus 1 cmH2O. If 1 cm is going to cause you these problems, then you could be in big trouble if something happens to your machine and the DME provides you with a loaner while yours is being fixed. With the allowable variance, if yours is at the low end of the allowance and the loaner is at the high end of the allowance, you will get a 2 cm increase at the same set pressure. Add to this the allowable error for the manometer used to cal check the units and you are up to 3 cm difference possible on the machines. If it really was the 1cm change that caused the problem, you really need to find out why.

brasshopper wrote:Did you have an ekg? Chest x-Ray? MRI that showed air in the space around the lung? Test for cardiac enzymes? Any other tests that might make us believe this? I have no idea what you did and did not mention, but if the doctor ruled out a bunch of stuff and came to "air leaked from the overpressure lung into the chest cavity and caused pain", I suspect that is a contraindication to CPAP.

Thank you, Brasshopper, for pointing out this latest instance of mis-diagnosis.

BTW, why the moniker Brasshopper? Is there a story there?

Regards,
Bill

I woke up a few nights ago...felt like a huge nail had been driven in my sternum. I turned my machine off, massaged my chest while I was waking up,
then drank some Mylanta. Cardiologist recommended that. After a few minutes it still hurt real bad and I used the Nitrolingual. Two squirts and the
pain went away. If it had not, I would have dialed 911. My cardiologist said he did not recommend anti-acid tablets because there are so many on the market it is difficult to estimate their dosages, so he told me to use Mylanta if I have a choice. Food for thought Snoozing Gonzo.

I have warned everyone who will listen...be very careful of "dry mouth". My asthma medications cause me to have it every day. I went to the ER with three nitro pills under my tongue. I had dry mouth. The EMT was sharp, found them and squirted Nitrolingual in my mouth. By the time the ER people had signed me in I was ready to go home. In my dreams......they had a $500 aspirin they had to give me and a $600 drink of water. I was scared they might open a box of kleenex or something...sending my insurance company into Chapter Eleven.

Good Luck with it.....

I am not 100% clear here that we have a bad diagnosis - I suspect that it is more a partial tale told by someone who has spent the day in the hospital and was too tired to give us the details.

Honestly, I want the rest of the symptoms and disgnosis since, as presented, I'd worry.

Look, I've been married three times but I only am on my second CPAP (they don't argue - or drive their own cars). I'm wedded to it more thoroughly than I am to many other things - I'm somewhat surprised that I was able to change masks recently.

I've used nasal masks through a bunch of stuffed up noses....

And I would be worrled about spontaneous pneumothorax given the diagnosis and symptoms.

Aerophagia (eating air) can be very painful. I don't think we are talking about that - that is usually why anticids are recommended, since simethicone allows that air to be broken up and expelled (that is more likely my problem.

I am shocked the doctor did not put you on asprin therapy. One half of a asprin per day or 1 baby asprin per day. Please take the asprin therapy no matter what your doctor thinks he is ruling out. At our ages and on CPAP therapy, we should ALL be on asprin therapy. Even women. One baby asprin per day after a meal will do no harm and prevent so much harm that everyone over 40 should be put on it if they are more than 30 lbs over average weight. That is my opinion and I am not a doctor, but I am a well read person and this is what experts have been saying for the last 12 years. At very least, ask your doctor about it.

about the only part of any of this diagnosing, especially the initial one by the doctor, that sounds like a safe bet is the salad and bicycle....and maybe use sunscreen.

Gonzo,

Don't be so hard on yourself. Seems to nothing you did regarding your cpap therapy had anything to do with what happened. As has been said, 1cm would not have any perceptable effect. It sounds to me like you probably emphasized your concern about the possible affects of your self-adjusting and just gave you a diagnosis that would satisfy your concern.

Thank you all for your concern and advice. Sorry not to reply sooner but I really did take the weekend off. Over that time other folks that I visited with were much more blunt than you. They basically said I was no less that an idiot for accepting the Dr. story and not going to the ER.

-- Good idea on the aspirin therapy, I'm already there... Mylanta - better liquid than tablet, sounds good... its nice to hear my minor fiddling with pressure + elimination of leaks probably didn't bring this on and I better look elsewhere for answers.

-- There really isn't much more to the story. I didn't spend much time at the hospital. My pulmonologist/sleep Dr. had me come in for a chest x-ray and that was it. He called a few hours later after the picture got to him through the radiologist to say they couldn't find anything and came up with the above story. Perhaps, as Littlebaddow and Brasshopper suggest, the Dr.'s story was just a rearranged version of what I told him because he didn't know what else to say, and didn't want to keep looking. The pain gradually went away over two days and hasn't returned.

I have searched my memory for other symptoms and clues. The only other symptoms I didn't mention was that it hurt a lot to bend over - like to tie shoes and my blood pressure was up a bit. The only CPAP related occurrence is that my heated hose stopped working last week and I discovered that the day after my incident. I had the humidity fairly high (Remstar Pro setting 4) which doesn't work at all without the hose (mask full of condensate).

I know I have to cut 20 - 30 pounds but your concerns have overcome my simple acceptance of the Dr.'s opinion on basically a phone + x-ray diagnosis (I'm usually more skeptical - I guess he told me what I wanted to hear.) I have made an appointment for an ekg at a lab that is separate from the medical group that includes my pulmonologist/sleep guy- a little late but it may show any ongoing or left over signs. I'll turn that in to both my regular Dr. and CPAP Dr. to see if there is any more action.

Thanks for the past and continued help and support!

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