Periodic Breathing

[Huffer]

What exactly is Periodic Breathing? I'm just trying to understand my readouts.

[JohnBFisher]

Well, first if you see a few events of periodic breathing, don't panic. It's pretty normal. Just as a few events of central apnea. Here's a sight that provides a definition of it:

http://www.medterms.com/script/main/art ... ekey=10902

It notes:

Periodic breathing: Clusters of breaths separated by intervals of apnea (no breathing) or near-apnea. As opposed to normal breathing which is usually regular.

Periodic breathing was originally thought to arise from serious neurologic or cardiovascular disease and therefore to carry a poor outlook. It is now known that periodic breathing tends to occur during sleep, it can occur in healthy persons, and the apnea in periodic breathing is usually central (without respiratory movements) rather than obstructive (caused by upper-airway blockage).

Periodic breathing during sleep occurs typically in patients with congestive heart failure.

It is possible for periodic breathing to NOT be associated with congestive heart failure. The two most common causes beyond that is (1) due to living (and sleeping) at a high altitude and (2) due to some dysregulation of breathing by the central nervous system. Breathing (especially during sleep) is controlled by the Autonomic Nervous System, which is governed by the brain stem. So sometimes neurological problems can trigger periodic breathing.

But the most common cause of periodic breathing is heart problems. And that type of respiration is know as Cheyne-Stokes Respiration (CSR). Here's a picture (with a brief description) that describes it:



But if you see a few events a night, it might just be due to a change of sleep level. Breathing instability often occurs during sleep onset (there's an article about that if you are interested, I can post it in this thread). And that can cause periodic breathing. We've seen a few graphs that seem to indicate that happens to some people, but is not a big deal otherwise.

So, unless you have problems with your sleep, a few throughout the night is not a big issue. The same is usually true with a central apnea as well.

Hope that helps.

[dsm]

Just to add further to John's excellent comments. PB = 'periods of breathing' . In between the periods of breathing are centrals. So PB is essentially a sequence of centrals and periods of breathing. Its that simple.

The CSR (Cheynes Stokes Respiration) pattern is the better known one & it occurs in a rhythmic cycle often referred to as a 'waxing and waning' of respiration in a regular pattern that occurs just under 2 mins per cycle.

The ASV machines (Servo Ventilation) were originally designed to 'normalize' CSR but are capable of normalizing many forms of PB (CSR is just one form & as mentioned, the better known one).

There are 2 ways to deal with PB & Centrals. A central on its own is usually dealt with by a timed bilevel that cycles (between epap & ipap pressures at a set rate) when it detects no, or reduced, flow (ASV machines have this built in otherwise a Bilevel with '(T)imed' mode can do this). PB is dealt with by smoothing out the pattern of waxing and waning (prevent the centrals even occurring). This is achieved by monitoring each breath for either target volume or target av peak flow, and when the target is going to fall short, by instantly ramping up pressure by up to 3 CMs, in that single breath, and for up to 3 breaths if that is needed. Most ASVs normalize respiration within 3 breaths.

Cheers

DSM

[snnnark]

I've heard it likened to a shower where the showerhead is far from the taps.
You turn up the hot... nothing happens, so you turn it up some more.
Then it's too hot so you turn it down, then it's too cold etc etc.

Only instead of temperature, in us it's blood Co2 levels.
You start falling asleep and the brain Co2 level switch changes.
Now you have too much co2 in your blood so the brain tells you lungs to slow/diminish your breathing.
You breath slower and shallower and co2 builds up in your blood.
But because of different factors (most common being heart problems) the blood takes too long to get to the brains receptors and so you build up too much co2. When that co2 rich blood eventually gets there, the brain says "Oops better start breathing fast/deep to blow off the co2." And so the cycle starts.

[dsm]

I've heard it likened to a shower where the showerhead is far from the taps.
You turn up the hot... nothing happens, so you turn it up some more.
Then it's too hot so you turn it down, then it's too cold etc etc.

DSM: Yes I have read that analogy - balancing the hot & cold - that can be fun

Only instead of temperature, in us it's blood Co2 levels.
DSM: Thats the trigger for centrals for sure
You start falling asleep and the brain Co2 level switch changes.
Now you have too much co2 in your blood so the brain tells you lungs to slow/diminish your breathing.
DSM: But this bit is back to front - when the brain detects too much CO2 the signal it sends to the respiratory system is to breathe faster to blow the excess CO2 off.
You breath slower and shallower and co2 builds up in your blood.
DSM: This again is correct - slow your breathing & CO2 builds up
But because of different factors (most common being heart problems) the blood takes too long to get to the brains receptors and so you build up too much co2. When that co2 rich blood eventually gets there, the brain says "Oops better start breathing fast/deep to blow off the co2." And so the cycle starts.
DSM: Again spot on

[Stratman]

But if you see a few events a night, it might just be due to a change of sleep level. Breathing instability often occurs during sleep onset (there's an article about that if you are interested, I can post it in this thread). And that can cause periodic breathing. We've seen a few graphs that seem to indicate that happens to some people, but is not a big deal otherwise.

JOHN, WOULD YOU PLEASE POST THE ARTICLE ABOUT BREATHING INSTABILITY DURING SLEEP ONSET. I SEEM TO HAVE THIS CONDITION. EVERY NIGHT I GET ABOUT 5 OR 6 AI EVENTS ALL WITHIN A FIVE MINUTE PERIOD DURING THE FIRST HALF HOUR WHEN I FALL ASLEEP. AFTER THAT I AM FINE THE REST OF THE NIGHT WITH NO AI EVENTS. ANY INFORMATION OR SUGGESTIONS WOULD BE HELPFUL FOR ME.

I RUN IN CPAP MODE AT 9CM WITH NO EPR OR RAMP. I HAVE TRIED RUNNING IN APAP MODE BUT THE EVENTS COME AND GO SO QUICKLY THE APAP NEVER RISES ABOVE 9.5CM, THEN DROPS BACK DOWN TO 9CM FOR THE REST OF THE NIGHT.

THANKS,

TOM............

[JohnBFisher]

... I've heard it likened to a shower ...

Good analogy and explanation. As I work on my Central Sleep Apnea article, I may incorporate this. In fact, I might just use the Hallmark Style of CPAPtalk ... when you care enough to steal the very best! (with proper attribution, of course!)

[JohnBFisher]

... WOULD YOU PLEASE POST THE ARTICLE ABOUT BREATHING INSTABILITY DURING SLEEP ONSET. I SEEM TO HAVE THIS CONDITION. EVERY NIGHT I GET ABOUT 5 OR 6 AI EVENTS ALL WITHIN A FIVE MINUTE PERIOD DURING THE FIRST HALF HOUR WHEN I FALL ASLEEP. AFTER THAT I AM FINE THE REST OF THE NIGHT WITH NO AI EVENTS. ANY INFORMATION OR SUGGESTIONS WOULD BE HELPFUL FOR ME. ...

As long as it does not awaken you, then there's no need to sweat it. Unfortunately some people are more difficult cases. I found I would stop breathing so long that it woudl awaken me every time I tried to fall asleep. My ASV unit was a Godsend for me.

Here's the article:

Ventilation is unstable during drowsiness before sleep onset
http://jap.physiology.org/cgi/reprint/99/5/2036

There are other articles like that, which show the same results.

And if you are interested, here are Rested Gal's Links to Central Apnea:
viewtopic.php?p=22702

[Stratman]

John,

Thanks for the article. I will read it after dinner.

I guess I am one of the lucky ones. I seem to sleep through my 5 or 6 AI Events at sleep onset. They typically last about 10 to 15 seconds each. Probably just my brain adjusting to the on-set of sleep. My heart is in good shape, resting heart beat runs on the low side about 55 to 60 BPM. I seem to get a good nights sleep and that is the important thing.

Certainly very interresting stuff,

Tom...........

[snnnark]

I've heard it likened to a shower where the showerhead is far from the taps.
You turn up the hot... nothing happens, so you turn it up some more.
Then it's too hot so you turn it down, then it's too cold etc etc.

DSM: Yes I have read that analogy - balancing the hot & cold - that can be fun

Only instead of temperature, in us it's blood Co2 levels.
DSM: Thats the trigger for centrals for sure
You start falling asleep and the brain Co2 level switch changes.
Now you have too much co2 in your blood so the brain tells you lungs to slow/diminish your breathing.
DSM: But this bit is back to front - when the brain detects too much CO2 the signal it sends to the respiratory system is to breathe faster to blow the excess CO2 off.
Ooh, I see what you mean. What I meant to say was that (and again this is my amateur understanding) there is a switch in the brain that when you go to sleep says it expects to see a different level of co2. But after reading the study that John just gave a link to, it seems I may have the wrong end of the stick. So PLEASE IGNORE THE ABOVE STEP
You breathe slower and shallower and co2 builds up in your blood.
DSM: This again is correct - slow your breathing & CO2 builds up
But because of different factors (most common being heart problems) the blood takes too long to get to the brains receptors and so you build up too much co2. When that co2 rich blood eventually gets there, the brain says "Oops better start breathing fast/deep to blow off the co2." And so the cycle starts.
DSM: Again spot on

[Guest]

I suffer from periodic breathing, but its more like I'm holding my breath, and then blow out. My wife complains of puffs of air hitting her. One or two sessions a night for few minutes each. Wierd?

[JohnBFisher]

I suffer from periodic breathing, but its more like I'm holding my breath, and then blow out. My wife complains of puffs of air hitting her. One or two sessions a night for few minutes each. Wierd?

Guest, I've got some questions and a possible idea ... How soon do they happen after you fall asleep? When does the second or third session happen? Is it 90 minutes or 120 minutes between each?

Just wondering. Like I say, we might be able to give you something to discuss with your sleep doctor. Sounds like it's not a big deal for you. But it's always good to understand the odd events.

[snnnark]

I suffer from periodic breathing, but its more like I'm holding my breath, and then blow out. My wife complains of puffs of air hitting her. One or two sessions a night for few minutes each. Wierd?

That sounds more like Obstructive sleep apnea. I've always thought that centrals happen when we don't bother to Inhale

[JohnBFisher]

I suffer from periodic breathing, but its more like I'm holding my breath, and then blow out. My wife complains of puffs of air hitting her. One or two sessions a night for few minutes each. Wierd?

That sounds more like Obstructive sleep apnea. I've always thought that centrals happen when we don't bother to Inhale

I don't disagree. "One or two sessions a night for a few minutes each." It sounds as if it occurs during REM sleep. But without any data, who knows? If it's not bothering "Guest", then it may not be a big issue. "Guest" might actually sleep deeper and more soundly if it is addressed, which is why I suggested "Guest" should speak with his/her sleep specialist about it.

[OutaSync]

I found I would stop breathing so long that it woudl awaken me every time I tried to fall asleep. My ASV unit was a Godsend for me.

Same here.