Please help, frightened Bipap user with chest pain

[Fourkidletts]

Thank you all. I'm trying to soak it all in, it's a lot of info. This is the first time I'm reading people say I have central and obstructive apnea. I have a lot to learn about reading my charts. There was a time I woke up and the air was coming out of my mouth. This is when I felt chest pain. Does my chart account for the mouth open? how does that show up? As a leak? I have no idea how long I was like that for. Does my chart show I had my mouth closed most of the night then?

I have been tested for everything under the sun, including GI issues. All have been ruled out, except for anemia and apnea. It's distressing to hear that chest pain isn't common. I've written cardiologist again, as well as patient advocacy to file a complaint. 3 months of chest pain is long enough!!!!

[staceyburke]

If you look at the leak chart, it will show a longer period with a flat top. You can zoom in to a breath by breath look (click the point you want to zoom in and then press and hold the up key). A normal breath will have a round top, mouth breathing will be flattened.

The only chart I was in your post you do not have a problem with leaks.

[OpalRose]

You can actually tell a lot by looking at the leak rate graph.  

There are areas where you can see spikes, which usually means mask movement, sometimes caused from simply turning over.  But if you notice flat tops on the graph, this signifies mouth breathing.

Waking up with air coming out of your mouth isn't a pleasant feeling, and can cause a very dry mouth.  It can register as a leak if it lasts a significant amount of time.  You can try a Cervical collar to help keep your mouth closed, and/or use the "Tongue Suck Technique."

 
Tongue Suck Technique:
Place your tongue to the roof of your mouth with tip of tongue behind front teeth.  Slowly suck upwards and back.
This places the tongue in a natural position, with the back of tongue sealing the back of the throat so that if you open your mouth/jaw while sleeping, no air will escape.

This takes practice and many people don't have the patience to master it, but for those of us that did, it was worth it.  

Your leak rate isn't that bad, but it is something to watch.

[Fourkidletts]

Thank you.  Maybe I'm keeping my mouth closed better than I thought I was.  I'm finally seeing where on the Oscar to see where my central events are vs obstructive.  I will try the minor change Sleeprider mentioned.  This is a lot to take in.   Thank you again to everyone for the help.  I just really need this chest pain to go away so I can stop being so afraid of sleeping with this!  It's obviously needed.

[Fourkidletts]

Please talk to me about this AHI graph.  Why does it steadily climb (mostly) from 5:20-7:15?  This is the point where I woke up with chest pain and took it off.  Does it seem my "good night" lasted for a few hours, then was kind of awful for a bit?  No chest pain when I went to the bathroom (where the break happens around 4:45).  I'm really trying to find a correlation to my chest pain.  


   
   

[Sleeprider]

Good morning kidletts. The AHI graph is a running average of apnea events. It is not a very useful graph, and I never use it. Your AHI is 3 per hour, but much of that is focused on the period between 6:00 and 7:00 AM. Since all of those events are non-obstructive (classified central), it is likely to be sleep disruption or movement where you simply hold your breath for more than 10 seconds as your shift position.

I was thinking about your complaint of chest pain, and it sounds to me like you might have ingested some air. This is called aerophagia and is a common problem with new users. The air pressure can be sufficient to overcome a "gate" called the lower esophageal sphincter (LES), which separates the stomach from the esophagus. This is a bigger problem in individuals with a history of gastric reflux, but can happen to anyone. Basically with you bipap pressure, you just swallow more air. This can give the same symptoms as heartburn or the pressure you felt in your chest. The problem usually self-resolves, but if it continues we can give you some ideas on how to deal with it or even prevent it.

I'd still like to see you try a slightly lower pressure support setting. This will help to avoid the conditions that result in aerophagia.

[OpalRose]

Fourkidletts,
The above chart is the same one you've posted previously, from Nov. 9th.   Do you have a current chart?

I've also been thinking about your chest pain...

Did you experience this before Cpap or did it specifically start after you started Cpap? I just went back to read your first post.  So you experienced this pain prior, but Cpap could be aggravating it...

It may very well be Aerophagia, but there is "thing" that some folk experience when new to using Cpap.  
You may be focusing too much on your breathing, almost like putting extra effort into breathing.... which can cause your chest muscles to hurt or ache.

If you are anxious about using Cpap, you may be relating it to causing you pain.  Putting extra effort into the natural act of breathing can cause your chest muscles to ache.  

I experienced this somewhat when I started and got to the point that I had to try some calming breathing exercises almost to learn how to breathe again.  Trust your machine and the advice you are getting, relax and breathe naturally.  

I agree with lowering your pressure, at least until you can adapt.

[SarcasticDave94]

That suggestion to reduce the PS setting makes sense to me. The bit of aerophagia/air swallowing I suffered from at the beginning of PAP therapy was due in part to the higher pressures I needed for successful therapy. I know I have GERD/acid reflux that is caused by a recurring hiatal hernia. The point is that the lower pressures Sleeprider is suggesting is a good idea. Try it and see what happens. Maybe it surprises and makes this better. Do keep at this PAP therapy. Unfortunate some have more difficult cases for us to crack, but our success rate of self advocacy is near perfect. And of course there's AB rule 22, never quit. We're here to help in whatever way we can.

[Bobaloo]

Fourkidletts, what is the cause of your anemia?

[Fourkidletts]

Thanks so much for the thoughtful replies to my answers!  Really glad I’ve found you guys.  

Let’s see, to answer the anemia question, it’s due to heavy periods and fibroids.  I’m supposed to have a surgery but it’s being put off until I can resolve my chest pain and sleep issues.  Kaiser is taking way to dammed long for my iron infusions and talking to an actual sleep doctor so I filed a complaint yesterday to get an expedited review of my case due to the 3 months now of chest pains.

Thank you for the info on the swallowing air issue.  I have to say that I’m about 90 percent sure I’m having the same pain I was having before the machine.  Perhaps I could be swallowing a little and making it worse, but I slept really well last night and still woke up with a little bit of pain, but not like before.  Hopefully I’m at least on the right track.  I have a college zoom class I have to attend but will be posting my last night’s sleep for feedback.  I got over 7 hours with my machine!  Only issues were itchy nose and I woke with a sore nose.  Maybe had it too tight?  My new chin strap seems much better than the one I had before.  

Thanks all, I’ll post charts soon.  : Hoping my iron infusions will happen ASAP so I can take one more thing off the table.   

Cyndi