Cheyne-Stokes Breathing

Hi all,

Just thought I should start a new thread, because I installed the Mac version of Sleepyhead v0.9.8-1, in which Mark identifies the below breathing pattern as Cheyne-Stokes, which has been called Periodic Breathing, which was not alarming to me because I have always breathed "periodically" and so think it is normal. But seeing this called Cheyne-Stokes made me look it up in Wikipedia and it now seems pretty alarming. That may be a good thing. Maybe I'm getting closer to understanding my pathology.

Any Cheyne-Stokes people out there? What am I to think of this?

Thanks for any help,
Suenyo



PS: Mark, I LOVE this edition of Sleepyhead! But why does F8 not get rid of the right-hand shortcut pane anymore?

Please see my request for additional images in the other thread you posted this same image and question.
You can continue it here though in this thread as this is a better place for it. That way not to get lost in someone else's thread.

Pugsy,

Yes, thanks. We are now on the same thread. Here is the 7am:

7 AM just looks like the general waxing and waning definition of PB...nothing like CSR.
Do you ever have green PB flagged time with many CAs/Centrals mixed in?

SleepyHead defaults to calling PB as CSR but it isn't always CSR...it's PB. I think you can change it in Preferences.
Real CSR (the kind that we start worrying about) is usually associated with a large number of centrals and has a much more dramatic waxing and waning of the breaths with centrals flagged.

If the bulk of your PB flagged time looks like the air flow from the 7 AM time frame....no where near what CSR looks like.
Of course if you are concerned talk it over with your doctor but I don't see it yet on what you have shown so far.

Looks more like crappy sleep to me and I guess you know that the leaks are kinda ugly and need work.

Thanks Pugsy,

I actually do have tons of centrals and much more dramatic breathing flows all the time so I am going to investigate this. Imgur did cut off the right a bit. There is a flagged central there. I guess I may as well upload another pic. Funny thing is that since I started with the Quattro over a month ago my data has changed dramatically. It may be because I have so much leak though. I can't figure out the leaks, but I have resorted to just cranking down the mask so tight I wake up with its outline on my face. Last nights data is much better (clearer) for that, but I'm very confused about the LL. Last night my "normal" breathing areas were very attenuated long before it was flagged LL. The machine ramped up a cm several times to see if it could help, but it did not have any effect. I had a bunch of incipient CAs I think (really thin red vertical lines with a shorter than -is it 10 seconds?- one set included a full CA. Let me see...



Notice that the breathing is sorta wavey periodic, but its the same on the left with lowish leaks as on the right with leaks of 80.

That CA at 6:52 looks more like a post arousal CA than anything else....see that big spike in the breath right before the flat line...that looks more like a big gulp of air....doesn't look like CSR to me....looks like you took a deep breath and held it for a few seconds.

Let me get someone to show you what real CSR looks like.

Here's another with tons of Hypopneas and what is a Pressure Pulse? I think thats what I saw in the last pic and thought they were incipient CAs. I'm going to upload a pic of time on my Wisp which has more centrals.

Here is a graph of a nasal mask, probably Wisp from before my Quattro days. Notice the difference between the pie graph and the one above with the Quattro. Why the diff?

Pugsy asked me to post an example of true cheyne stokes breathing, she asked me to zoom in more, but I don't have the original files anymore.
(click for zoomies)


you can, however see that the breath goes to nothing in between the waxing and waning of the breathing, and it's not just one or two episodes.

most of the night was like this, to varying amounts.

ALSO! remember that the respironics machines don't even claim to detect cheyne stokes breathing, sleepyhead has that mislabled, and you can change it in the preferences.

Pressure pulses are nothing more than little puffs of air that the machine uses to help it decide if what it is sensing is central in nature or obstructive in nature.

Let me see if I can find a better CSR image.

The pie chart...it's useless..it's whole pie and each event section is just a % of the whole pie so if you don't have many of one thing then it looks like you had a whole lot of something else.
If all you had was one hyponea all night...the whole pie would be hyponea.

Thanks PaleRider,

That's impressive. No, I'm not in that category, thank you.

Great Pugsy,

and I'll look more into the Hypopnea/CA/OA ratio. It is true that the Centrals and Oas have gone way down and the Hs way up since going to full face mask, so my question is

What does this mean? The AHI isn't any better. It may be worse. I'm wondering if I need an actual sleep study. I'm sure tired of being tired.

Catch you later, gotta go to work....

This is not CSR despite the PB flagging...the waxing and waning doesn't match up with true CSR and there weren't any centrals. It's just weird breathing...barely met the 2 minute duration minimum requirement.



This one isn't CSR despite the large cluster of centrals

http://s1081.photobucket.com/user/Onesh ... rt=3&o=322

This is below...iffy for CSR and this one has centrals

Suenyo wrote:Thanks PaleRider,

That's impressive. No, I'm not in that category, thank you.

that person is now on a vpap adapt (asv) and supplemental oxygen.... and doing much better.

yeah, you're nowhere near that.

and, like I said, remember that the respironics machines flag periodic breathing.... not just CSR. and PB is often nothing at all to worry about.

Suenyo wrote:It is true that the Centrals and Oas have gone way down and the Hs way up since going to full face mask, so my question is

What does this mean? The AHI isn't any better. It may be worse. I'm wondering if I need an actual sleep study. I'm sure tired of being tired.

You went to a full face mask?...from what mask?
Right now the leaks look so bad we really can't evaluate things accurately. With leaks of that magnitude it is possible the leaks are causing arousals and a lot of what you see is SWJ (Sleep/wake/junk).
If you went from a nasal mask to a full face mask maybe you just need a small pressure adjustment (not unusual to need a little more when going to full face mask).

Right now the main thing I would be concerned about is the leaks. Fix them or get them under better control and see what happens.
They need to be fixed anyway. I am not a perfectionist when it comes to the leak line and will let a little bit of ugly slide but yours is way more than a little bit unless this report is just a really bad fluke.