What is a normal amount of Periodic Breathing?

[Sir NoddinOff]

I'm always happy to see less than 1% of Periodic Breathing, according to Sleepyhead's reports. However my PR sys one 550 rarely shows on it's LED screen any PBs at all, that is, unless I've got a bad cold, a terrible night or whatever. A puzzling situation to which I have no rational answer.

[tbinbny]

Since I have started using Sleepyhead software and the PRS 560, I see one periodic breathing event almost every night, lasting between 1-2 minutes. The % of time in periodic breathing is always under 1%. I have read about what periodic breathing is, but my question is - should I be concerned about it, at this level?

[Todzo]

Since I have started using Sleepyhead software and the PRS 560, I see one periodic breathing event almost every night, lasting between 1-2 minutes. The % of time in periodic breathing is always under 1%. I have read about what periodic breathing is, but my question is - should I be concerned about it, at this level?

Hi tbinbny!

Also look at:

The area around the periodic events - note in particular the "area" of the waveform (the actual volume of air used) and the variation in the periodic event. The more air used and the higher the degree of variability in the flow waveform the more likely it is to cause an arousal. Look at how high the peak is in particular.

Note the response post event - is the air use greater - arousal likely.

Note how you feel - morning - perform during the day - and in the evening.

My unstable breathing is usually related to stress.

Have a great week!

Todzo

[NotLazyJustTired]

Since I have started using Sleepyhead software and the PRS 560, I see one periodic breathing event almost every night, lasting between 1-2 minutes. The % of time in periodic breathing is always under 1%. I have read about what periodic breathing is, but my question is - should I be concerned about it, at this level?

I have been looking into this recently. I have PB almost every night as well, but only on a few occasions has it been noteworthy. Mine typically occurs around the times that I am going to sleep, or in the early morning (probably waking up and going to sleep). I think this is pretty normal for most people. Under 1%, I wouldn't worry about it. However, I will pass on the advice I was recently given...if it does bother you, talk it over with your doc.

[Pugsy]

should I be concerned about it, at this level?

I wouldn't be concerned about it at this level.
Remember the definition...its just a general waxing and waning of the flow.
Zoom in on the PB flow rate...any events associated with the PB flagged time?
Respironics machines are pretty aggressive with the PB flags...often the waxing and waning is very minimal.

Here are some examples of some of mine...none of these are exciting and worth worrying about.







Now this one is as close as I have ever seen to Cheyenne Stokes Respiration but OAs instead of centrals and even still not quite CSR



And here is what CSR looks like. I would only worry about PB if I saw a lot of CSR looking stuff. Less than 1% of the night even if it was true CSR I wouldn't worry...but if it concerns a person....see your doctor.

[pikov22]

In your topmost graph, you have PB with no apneas! So that must be overreporting by the *PAP machine, no?

[Pugsy]

In your topmost graph, you have PB with no apneas! So that must be overreporting by the *PAP machine, no?

Yes and no...depends on how you look at things.
No where in the definition for PB does it say that we have to have an apnea event for it to qualify as Periodic Breathing.
Remember PB definition is a general waxing and waning of the flow for at least 2 minutes and I sure have that on that top report. Barely makes the 2 minute criteria though.

There are multiple forms of PB...like Cheyenne Stokes Respiration which is a type of PB that can point to a problem if there's a lot of it. Cheyenne Stokes Respiration isn't the only sub category for PB.
I really wish Mark had just used PB instead of CSR nomenclature because not all of what we see is CSR (most of what we see isn't CSR) but people see CSR and panic when there's no need to panic.

So the machine isn't really over reporting anything...I meet the criteria for PB but the flow really isn't all that exciting.
Not all PB means something bad is going on.
So the machine reports what it sees meeting the simple definition and criteria for PB...that's all.
Further investigation manually tells us that it really isn't alarming.
Probably 90 % of what little PB I ever see get flagged doesn't have any apneas of any kind or maybe just one show up.

Some PB is normal...awake or asleep. Sometimes we make the official 2 minute criteria and sometimes we don't.
I have never seen a range of % of time in PB that is considered "acceptable" like we have with leaks or AHI or whatever.
So I can't give a "below so and so % is normal"...

[tbinbny]

Once again, thank you Pugsy! You seem to always put things in a way that makes it easy to understand.

I am still very new to this, so I do not have a lot of data to go off of, but it looks like I experience one Periodic Breathing event on 5 out of 6 nights, lasting for between 60-120 seconds, with no other crazy events appearing to be associated with them. So, after reviewing your posts, I am guessing I don't have anything to worry about. I am going to see my doctor for a follow up in a couple of weeks, so I will mention them, just in case, but at least now I feel much more comfortable!

Thanks to all. You are always a great help. Support is a wonderful thing to have when you are confronted with something like this and don't fully understand everything.

[jsbarb]

This is a back door approach, maybe some insight about the "controls" on Table 3. Found web searching for "What is the normal percentage of periodic breathing for a male"

Periodic breathing during sleep in patients affected by fibromyalgia syndrome.
http://www.ersj.org.uk/content/14/1/203.full.pdf

[Sir NoddinOff]

Ah, an old old post. About a year and a half ago, when I was using my PR S1 APAP (see my old post above), I'd usually stay under 1% periodic breathing, ie. classic CS variety, typically defined by the distinctive cessation of breathing between the periodic cycles. (as reported by my Sleepyhead software). Notably, I usually felt fine the next day if I managed to get enough sleep in spite of the PBs. However, every now and then, I'd get into the 3% to 5% range.(5% only happened a few times).. seemingly out of nowhere. Leaks didn't seem to be a factor. On the mornings after these high PB nights, I would feel terrible and sometimes my diaphragm would even feel sort of lethargic, for lack of a better term.

I've now been using ASV for 8 months and haven't seen a single PB waveform show up yet. Not one single snore either. Please consult with to your sleep doctor BEFORE you take the ASV plunge, should you be motivated to give it a try. Other medical conditions need to be taken into consideration.

[icipher]

From a year and a half ago, when I was using my PR S1 APAP, I'd usually stay under 1% periodic breathing, ie. classic CS variety, typically defined by the distinctive cessation of breathing between the periodic cycles. (as reported by my Sleepyhead software). Notably, I usually felt fine the next day if I managed to get enough sleep in spite of the PBs. However, every now and then, I'd get into the 3% to 5% range.(5% only happened a few times).. seemingly out of nowhere. Leaks didn't seem to be a factor. On the mornings after these high PB nights, I would feel terrible and sometimes my diaphragm would even feel sort of lethargic, for lack of a better term.

I've now been using ASV for 8 months and haven't seen a single PB waveform show up yet. Not one single snore either. Please consult with to your sleep doctor BEFORE you take the ASV plunge, should you be motivated to give it a try. Other medical conditions need to be taken into consideration.

What are the medical conditions you speak of?

[Sir NoddinOff]

From a year and a half ago, when I was using my PR S1 APAP, I'd usually stay under 1% periodic breathing, ie. classic CS variety, typically defined by the distinctive cessation of breathing between the periodic cycles. (as reported by my Sleepyhead software). Notably, I usually felt fine the next day if I managed to get enough sleep in spite of the PBs. However, every now and then, I'd get into the 3% to 5% range.(5% only happened a few times).. seemingly out of nowhere. Leaks didn't seem to be a factor. On the mornings after these high PB nights, I would feel terrible and sometimes my diaphragm would even feel sort of lethargic, for lack of a better term.

I've now been using ASV for 8 months and haven't seen a single PB waveform show up yet. Not one single snore either. Please consult with to your sleep doctor BEFORE you take the ASV plunge, should you be motivated to give it a try. Other medical conditions need to be taken into consideration.

What are the medical conditions you speak of?

A reactivated old old post... I guess periodic breathing is still around

I used to have a complete list, but as I recall post heart attack recovery, chronic obstructive heart disease, impending myocardial infarction - serious heart stuff, in other words. The second and third categories were certain pulmonary and neuro-based disorders... I remember COPD was at the top of the pulmonary list. People with diabetes have to be checked for a condition called neuropathic rebreathing. Anyway, if you have any doubts you'll need to speak to a doctor who's well versed in CPAP and especially ASV (rare as hen's teeth).

[Madqdog]

This is a most interesting thread. I believe a bit more comment is in order:

First, the AHI is a measure of OSA (Obstructive Sleep Apnea) and not PB (Periodic Breathing) which is a reflection of CSA (Central Sleep Apnea). Thus to infer that an AHI <5 means that one can ignore a higher PB is not correct (and yes, the two conditions may be seen in the same person). Likely, a normal AHI stimulates less concern among clinicians when the patient reports a PB that is small but increasing.

While significant CHF (Congestive Heart Failure) is typically seen as a cause of CSA, one must recall that any factor that influences the brain (hence, "Central") may result in CSA. We typically think of stroke, TIA's (Transient Ischemic Attacks) and Subdural Hematomas as resulting in CSA, but any factor that influences the brain may do so; this is certainly true in the case of a myriad of drugs that have central effects. Thus, any sedative medication can do so, and this includes many sleep aids. When I take melatonin alone for sleep, I see no effect as reflected in the PB my Dream Station reports; when I add Ambien or Benadryl, especially over several nights, PB will rise (although never greater than 3%).

I, too, have asked many Pulmonary/Sleep Specialists what a "normal" PB is. I have never received a straightforward answer. Rather, because my AHI (typically less than 1.5 against a formal sleep study revealing an AHI of 123... yes, 123!) is normal on CPAP, I've been told to ignore the PB. Terrific, but curious minds want to know, and if there are no norms, why does ones CPAP machine report PB?

[breatherguy]

If CPAP pressure is too high, your brain doesn't tell your muscles of breathing to take a breath. You will have fewer events with an auto adjust CPAP.

[D.H.]

From what I was able to find out, periodic breathing is not harmful in and of itself. However, it could be an indicator of serious issues. I will speak to my sleep doctor about this next time I go.