Visual appearance of Cheyne Stokes Respiration in SleepyHead

Last night was a good one for me, with an overall AHI of 0.67, marked only by four hypopnea and two RERA events, but there was also a Cheyne Stokes flag that is mystifying me.

SleepyHead reports that the CSR event occurred for 1 min 8 sec shortly after 1 am. Below is the display of the Flow Rate row, zoomed in to a couple of minutes on either side of the event (which I gather is the segment SleepyHead highlighted in blue).

I thought that CSR meant that you stopped breathing for a period -- thus I expected to see a flatline across some portion of this. But I'm not seeing it. The breathing does look somewhat irregular just before and during parts of the blue segment -- the shape changes, then at the beginning of the blue period it's shallower than normal, and then in the middle it looks somewhat deeper than average. (The right part of the screen from about 01:11:40 on is how my respiration typically looks for 99.9% of the night.)

Is this how CSR looks? Not what I expected -- I thought there'd be a very distinctive period where I was clearly not breathing at all.

No, that is not what CSR looks like.
Actually the Respironics machines don't flag CSR...they flag Periodic Breathing and PB is just a general waxing and waning of the air flow. Now CSR is a type of Periodic Breathing but it is not the only type of PB.
I wish Mark hadn't chosen to use CSR term for this event in the Respironics machine because Respironics doesn't call it CSR...if you were using Encore software it would just flag it as PB.

This is what real CSR looks like and yours is no where near real CSR and even if it was...unless a lot of it is seen it wouldn't be a big deal.

Great, thanks, very good to know.

So for the other events (hypopnea and RERA in particular), is my Respironics machine flagging these, or are they SleepyHead's interpretation of what it's seeing in the flow rate data?

SleepyHead is only reporting what the machine is reporting.
If you were to use Respironics Encore software the data reported and events flagged will be the same except for minor rounding of the numbers up or down. Encore goes to one decimal point and SleepyHead goes to two decimal points.

Only possible exception would be if someone wants to play around with the user flag stuff which Encore doesn't offer.
For the main items that both software products report...it's the machine that does the evaluation and flagging and the software is only reporting what the machine has flagged.
Encore would show you the same flagged green area but call it PB. Air flow graphs would be the same though. It's the machine that is sensing the waxing and waning and flagging. SleepyHead isn't making that evaluation.

Okay, thanks. So if I understand this correctly, if I brought my SD card to my sleep clinic where they use Encore software, and we looked at my data from last night in Encore and SleepyHead, the tick marks in the Event Flags row would be exactly the same -- same four hypopnea events, same two RERA -- except that the shaded area that SleepyHead calls "CSR" would be labeled "PB" in Encore.

I renamed Cheyne Stokes Respiration on my Events Preferences to Periodic Breathing (PB). No one sees it but me, but I don't like the default label, so I changed it.

Dyssomniac wrote:Okay, thanks. So if I understand this correctly, if I brought my SD card to my sleep clinic where they use Encore software, and we looked at my data from last night in Encore and SleepyHead, the tick marks in the Event Flags row would be exactly the same -- same four hypopnea events, same two RERA -- except that the shaded area that SleepyHead calls "CSR" would be labeled "PB" in Encor

Correct.

If you want Encore just send me a private message but it is strictly Windows only software and the only way to run on a Mac is with some sort of virtual Windows on the Mac.
It shows the same data but visually a little differently.
EncoreGuide link this will show you examples of what you will see. For a different machine than yours but the basics are the same.
http://www.healthcare.philips.com/pwc_h ... _Guide.pdf

Dyssomniac wrote:Is this how CSR looks? Not what I expected -- I thought there'd be a very distinctive period where I was clearly not breathing at all.

respironcs machines don't detect CSR, that trace is mislabeled, you can fix it in the preferences/events tab, and change the label to 'periodic breathing'.

Perfect, thanks!

Here is a screenshot of my Cheyne-Stokes. I see a lot of this on my data. Should I be concerned? Is it possibly this which causes me to feel so tired all the time?



Thanks in advance...

Suenyo wrote:Here is a screenshot of my Cheyne-Stokes. I see a lot of this on my data. Should I be concerned? Is it possibly this which causes me to feel so tired all the time?

Can you get an image that isn't zoomed in quite so much so that we can see more than 1 breath in the image?
Like maybe the entire green shaded area? Need to see more breaths.
Also...an image of the second green PB area that doesn't seem to have events flagged in the middle of it?

To Pugsy: You mean the 7am green section?

Also, I uploaded this twice to Imgur thinking that Imgur was shortening it, but you have to expand the window rightward. (I'm pretty sure you already know this, sorry).

Suenyo wrote:To Pugsy: You mean the 7am green section?

Yes..the 7 AM section and let's continue the discussion in your other thread.

CSR is a form of Periodic Breathing but it isn't the only form of Periodic Breathing. If this is all you are seeing I wouldn't be worried.