Central sleep apnea periodic breathing

[swwalden1]

Is this what Cheyne Stokes periodic breathing looks like?

sleepyhead screen shot

[Crimson Nape]

Based off the a sleep disorder website definition (listed below), then Yes!

Patterns of cheyne-stokes respiration:

Cheyne-stokes respiration has alternate periods of no breathing changing smoothly into periods of hyper breathing, which smoothly change back into no breathing. This type of breathing is abnormal and can occur during sleep or wakefulness. If it occurs in wakefulness, it is a sign of more advanced disease.

If a person who is sleeping has cheyne-stokes respiration, the apnea durations are ten seconds or larger, and if there are more than five such apneas per hour of sleep, then the person has central sleep apnea.

I hope this may help.

[richb]

[quote='swwalden1' pid='118163' dateline='1434578989']
Is this what Cheyne Stokes periodic breathing looks like?

I have a similar breathing pattern. It sure looks like Cheyne Stokes breathing but mine seems to be a result of the machine itself. I did not have this pattern during sleep study or titration. I am postulating that the cause might be CO2 washout.

[swwalden1]

[quote='swwalden1' pid='118163' dateline='1434578989']
Is this what Cheyne Stokes periodic breathing looks like?

I have a similar breathing pattern. It sure looks like Cheyne Stokes breathing but mine seems to be a result of the machine itself. I did not have this pattern during sleep study or titration. I am postulating that the cause might be CO2 washout.

I have a follow up visit with my pulmonologist next week. i'll let you know what he thinks.

Steve

[richb]

Is this what Cheyne Stokes periodic breathing looks like?

sleepyhead screen shot

I don't think you can be diagnosed with true Cheyne Stokes respiration with just the graphs on Sleepyhead. The machine can elicit the Cheyne Stokes breathing pattern in the course of correcting OA and HA. If you had the pattern during your sleep study that is a different story. The machine can cause symptoms of hyperventilation. Specifically the machine can cause Hypocapnea (low CO2 levels in the blood). The low CO2 level fool the body into sensing that you have been breathing enough and you stop breathing until your blood CO2 raises and breathing resumes. The machine can washout enough CO2 to cause this abnormal breathing pattern.

[richb]

[quote='swwalden1' pid='118163' dateline='1434578989']
Is this what Cheyne Stokes periodic breathing looks like?



I don't think you can be diagnosed with true Cheyne Stokes respiration with just the graphs on Sleepyhead. The machine can elicit the Cheyne Stokes breathing pattern in the course of correcting OA and HA.

It seems that some sleep Pros refer to Periodic Breathing as a distinct form of Hypopnea. I believe that is what was observed during my PSG. I was put on Bi-pap but the result is what looks like Cheyne Stokes breathing. I believe that the machine aggravated the Periodic Breathing and converted it to Cheyne Stokes breathing. CO2 washout is the probable cause. Now my question is: What is the best course of treatment for periodic breathing? That may be a question that you are also asking.

[swwalden1]

Rich,

I'm a long time PAP user--over twenty years. The last couple of years the quality of my therapy has diminished. My recent 6-month average theated AHI was about 27. I had a Resmed S8 machine with limited data capabilities so my Dr, suggested a 5-night home study using an auto CPAP. it's a long story but the trial was not successful. The Dr then prescribed a Resmed Aircurve 10 Vauto and sent me home to see if I could figure out what was going on with my sleep.

I have some preliminary conclusions.
1) I needed to switch to a FFM just to get the machine to collect data
2) My obstructive sleep apnea is highly positional--it is much worse in the supine position.
3) If I stay off my back, my treated OAs are now in the acceptable range, however most of my apnea events are now categorized as CAs
4) Most, but not all, CA events exhibit the pattern shown in the sleepyhead screenshot.

I don't know what percentage of the 6-month average AHI of 27 were attributable to CAs and I don't know if they are caused by the machine or not. I hope to get some insights into this next week during my follow up DR Visit.

Steve

[richb]

[attachment=1558][attachment=1559][attachment=1560]

Rich,
I have some preliminary conclusions.
1) I needed to switch to a FFM just to get the machine to collect data
2) My obstructive sleep apnea is highly positional--it is much worse in the supine position.
3) If I stay off my back, my treated OAs are now in the acceptable range, however most of my apnea events are now categorized as CAs
4) Most, but not all, CA events exhibit the pattern shown in the sleepyhead screenshot.

I don't know what percentage of the 6-month average AHI of 27 were attributable to CAs and I don't know if they are caused by the machine or not. I hope to get some insights into this next week during my follow up DR Visit.

Steve

I hope your Dr is familiar with Complex Sleep Apnea. It seems that most Docs focus on OA and figure that everything is OA related. If looks like if you sleeping on your side you don't have many OAs. Does your graph show HA in the form of Periodic Breathing? Do your CAs look like Cheyne Stokes Breathing? If so your machine might be aggravating the Periodic Breathing and actually causing the CAs. You may have developed Periodic Breathing over the years.
Here are some samples from one of my recent nights. Note that during Periodic Breathing I do not stop breathing completely but the rise and fall resembles Cheyne Stokes Breathing.

[swwalden1]

I hope to get some insights into this next week during my follow up Dr. visit.

Steve

Met with my sleep doc (Pulmonologist/Internist) yesterday. He said this breathing pattern is not Cheyne-Stokes. He said they see it all the time in the sleep lab when they "over titrate" a patient. He was very clear that he thinks the the VPAP machine is causing this breathing pattern.

He sent me home to try lower max pressures and less pressure support--which, as you know, is consistent with a lot of the advice given on this board.

I hesitate to even mention this because 1) it's only one night of data and 2) I have a lot of night-to-night variation.

Having said that, I switched to CPAP mode, 10 cmH2O with EPR of 1 and my reported events were 7 OAs, 12 CAs, 12Hs over almost 7 hours of usage. Not great, but OK, and only one episodes of two back-to-back CAs.

Steve

[richb]

I hope to get some insights into this next week during my follow up Dr. visit.

Steve

Met with my sleep doc (Pulmonologist/Internist) yesterday. He said this breathing pattern is not Cheyne-Stokes. He said they see it all the time in the sleep lab when they "over titrate" a patient. He was very clear that he thinks the the VPAP machine is causing this breathing pattern.

Steve

The pattern we are referring to mimics Cheyne Stokes breathing but the period peak to peak is usually not as long as Cheyne Stokes. Cheyne Stokes is usually associated with congestive heart failure and the peak to peak is usually about a minute or more. However, the mechanism is very similar in that hyperventilation and CO2 washout is involved. My problem seems to be that I have Periodic Breathing without full apnea when not on CPAP. The machine just aggravates this condition. Last night I spent over an hour in apnea. I have an appointment at the Sleep Center on Tuesday.

Rich