Is This Cheyenne-Stokes?

[monkeybusiness]

       
Doc has recently put me on 2 new meds for CHF (lowest does of Amiodarone and Metoprolol).  Spent most of last night feeling short of breath.  Normal AHI has been
0.6-2.5 until last night's reading of 7.08.  About 3:00am I changed the MIN EPAP from 8.4 to 9 and kept the MAX IPAP at 20.  That seemed to help long enough to fall asleep again, only to be awakened later by the (what I believe) is a Cheyenne-Stokes breathing pattern around 5:00AM.  Can anyone confirm Cheyenne-Stokes and/or offer advice?  (Feeling quite normal when up and awake).

Thank you.

[Gideon]

IMHO that is CSR

Please contact both your Cardiac and Sleep Doctor advising them that you had a 30 minute episode of CSR last night and ask for their opinion on treating going forward.  Contact them today if at all possible.  Also search other nights for this pattern.

They may choose to modify your meds.  From a treatment point of view, while the VAuto is an awesome machine, it is NOT designed to treat this.

Regarding machine, see the ASV that is enlarged below.
CPAP choice to treat OSA, CA, obstructive or pulmonary restriction
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition.
They should be chosen to treat the specific condition that the user has, Here are the various CPAP machines and what they are designed/intended to treat

This info is from the ResMed Sleep Lab Titration Guide

• CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
  

• AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
  

• AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
  

• VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  

• S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  

• ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
  

[Gideon]

I'm going to suggest reducing your Pressure Support to 2, Possibly even going to no PS in the future to reduce the washing out of CO2 from the bloodstream which is a major cause of Central Apnea.

[Sleeprider]

As Fred notes, the best technology for Cheyne-Stokes Respiration is ASV, but most doctors are reluctant to prescribe it to heart failure patients, particularly with left ventricular ejection fraction less than 45%. This is the result of the SERVE-HF study that found an increased risk of death in patients using ASV with low LVEF%. A newer study is underway, ADVENT-HF, that is showing newer ASV machines, properly titrated do not seem to have this risk. Things are currently in flux, and hopefully your cardiologist is following along and is familiar with the issues.

[monkeybusiness]

A big thank you to you both, Bonjour and Sleeprider.  This apnea board has outstanding contributors for those needing help.

I'll try reducing the PS from 4 to 2 as Bonjour suggested this evening.

Again, thanks!