Cheyne Stokes - Should I be concerned?

[Sleeprider]

None of the charts posted so far offer a clue to your settings, and in particular the use of exhale pressure relief (EPR). Best guess is Autoset mode at minimum 6, maximum 12 and EPR 2. I see obstructive apnea that is causing a periodic breathing flow volume, and this is either going to resolve with either EPR or positional aids that prevent chin-tucking. Please read the Organizing Your Oscar Chart wiki linked in my signature links, and get rid of the monthly calendar, pie chart and other unnecessary information. We really need to see your settings and flow limitation chart. Based on what I'm seeing, you have very high flow limitations most of the night, and that is going to be helped by turning on EPR full-time at 3.

[Suzi]

None of the charts posted so far offer a clue to your settings, and in particular the use of exhale pressure relief (EPR).  Best guess is Autoset mode at minimum 6, maximum 12 and EPR 2.   I see obstructive apnea that is causing a periodic breathing flow volume, and this is either going to resolve with either EPR or positional aids that prevent chin-tucking.  Please read the Organizing Your Oscar Chart wiki linked in my signature links, and get rid of the monthly calendar, pie chart and other unnecessary information.  We really need to see  your settings and flow limitation chart.  Based on what I'm seeing, you have very high flow limitations most of the night, and that is going to be helped by turning on EPR full-time at 3.

Thanks Sleeprider. Yes, those settings are correct.  I’ll try the EPR at 3.

[cathyf]

One thing that I'm seeing is that segment from 1:20-3:20 where your respiration rate gyrates wildly around and hits some improbably-high levels.

I see that as well, and have only recently figured out that there is something very bizarre going on when that happens!

To see if what is happening to me is happening to you, you need to zoom in on the flow-rate graphs. The way that you zoom is to click on a graph and drag across for a bit. A little yellow box pops up showing how wide you have selected in time. On that Sep 28 graph, zoom in from like 1:19-1:22. After you zoom, use your right and left arrows to make the graphs scroll sideways across the screen.

Once you get a 3-minute zoom dialed in, look at the flow-rate graph. What I will see is that when the respiration rate is jumping all over the place the graphs have a particular crazy look. The exhales look pretty normal -- a single deep dive. But the inhales are crazy! The curve jumps up and down, and not just a little wiggle, multiple jagged spikes.

Ok, then look at the mask pressure graph. If you have EPR turned on, your mask pressure should be a nice steady even sawtooth pattern, where the top of each tooth is the pressure, and the bottom is the pressure minus the EPR. Now what happens when you are in crazy jaggy breathing is that the machine is completely confused by the wild ups and downs and thinks that they are individual breaths, so it keeps trying to raise and lower the pressure to deliver the EPR, and it can't keep up at all. (I say that lying there I can almost hear my machine mutter "WTF"!)

AND the respiration rate that your machine is reporting -- it's nonsense. The machine is counting all of the crazy jumps as individual breaths. If you just look at the bottom of the exhales, and count them over time, they will not be anything like as high as what the machine reports!

The next thing is your flow limits. I also have crazy wild flow limits -- but I think yours might be even wilder than mine! EPR treats flow limits, but the autoset machine can only go up to an EPR of 3 and that's not going to fix that level of flow limits. You can try 3, and your FLs will probably go down some, but will probably still be pretty bad.

Another quirk with this sort of breathing and how confused the machine gets from it -- flow limits are defined according to subtle little distortions in the inhale curve, but when you see total craziness, the machine doesn't flag that as flow limits. I think it's because the machine algorithm is just completely overwhelmed by the sheer chaos.

[Suzi]

Thanks @Cathyf for all that!  

My personal concern with what I thought "appeared" to be Cheyne Stokes, was the possibility of developing heart failure.  My cardiologist  periodically checks for that as I have mild pulmonary hypertension and also progressive axonal polyneuropathy that also affects my autonomic nervous system.   

However, after doing more online research,  I'm finally beginning to understand why @Gideon keeps pointing out that a true CHS would be marked by many centrals.  I feel much better about my sleep report now. The following article ""Central sleep apnea and Cheyne-Stokes respiration" states"

"Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) is a form of periodic breathing, commonly observed in patients with heart failure (HF), in which central apneas alternate with hyperpneas that have a waxing-waning pattern of tidal volume."PAhttps://news.unboundmedicine.com/medline/citation/18250216/Central_sleep_apnea_and_Cheyne_Stokes_respiration_

As some here and on other Apnea websites have noted, the kind of CSR's that are to be of concern in regards to heart failure, are marked by a very specific regular pattern of alternating CHS and Central apneas - as in lots of them.   I'm attaching one example I found of someone who had heart failure and true CSR.   I've found others that look a little different, but have that same pronounced pattern of CSR alternating with Centrals.  

The following chart is NOT mine, but someone who has heart failure with true CSR.
   

[Sleeprider]

The apnea in your example of CSR is being flagged as obstructive, however there is no doubt that is CSR. I have encountered several people here on the forum with similarly stressed results.  Having seen genuine CSR makes my criteria for periodic breathing with an obstructive origin like yours much higher.