What is the Significance of Periodic Breathing?

[LoQ]

I find periodic breathing in my charts just about every night. Most of it is just waxing and waning breath volumes. One night I did find the kind that has the central apneas between each pair of periods. But I know that at that time, I was moving between stage 1 and being awake, most likely, so it doesn't seem to have an significance as far as I can tell.


But other times I do see periodic breathing, when I am definitely asleep, but without the apneas for the most part. Right now I am not worried about it; I suppose ignorance is bliss. If a person is OK otherwise, is there any reason to be concerned with periodic breathing of this sort, or is it just a natural thing?

[avi123]

Is it the same stuff as this:

viewtopic/t55279/Interpretationperiodic ... vents.html

[LoQ]

Is it the same stuff as this:

viewtopic/t55279/Interpretationperiodic ... vents.html

I don't see how. He has CAs in his periodic breathing. I do not.

[DreamDiver]

Could you post some examples of what you're seeing?

[LoQ]

Could you post some examples of what you're seeing?

Sure. It's just ordinary periodic breathing.

From a couple of nights ago, here, for comparison, is some "normal" breathing:




And a bit later some periodic breathing:



Both of these are at the identical scale. I didn't do anything except page over a few screens.

[greg-g]

Your flow and flow limitation graphs are very different to mine, although I expect I may be the odd one??? I didn’t snore much, no daytime tiredness, just some strange symptoms that I diagnosed as sleep apnea after obtaining an SPO2 meter and finding problems with oxygen desaturations. That’s just a matter of introduction.
I’m using an S9 Autoset in APAP mode with pressure setting of 7 – 20. With these settings my Flow Limitation sits on the baseline with a few spikes occurring which trigger the machine to start increasing pressure.
The other night I limited my maximum pressure to 10 and when my pressure reached the 10 limit the flow limitation curve kicked up likes yours, and the flow flattened out as in your top graph.
You haven’t mentioned what settings you’re using, but from my limited experience you are either in CPAP mode, or your pressures reaching its maximum. Then if you aren’t having problems with apneas or oxygen desaturations it’s probably not an issue. Otherwise I suspect you need more pressure, but I’m just a fellow user.

[DreamDiver]

Sure. It's just ordinary periodic breathing.

[ Graph A ] From a couple of nights ago, here, for comparison, is some "normal" breathing:




[ Graph B ] And a bit later some periodic breathing:



Both of these are at the identical scale. I didn't do anything except page over a few screens.

I'm not a doctor, but my understanding of periodic breathing is that you get the same oscillation in breath volume, but with distinct periodic pauses in breathing activity altogether, similar to this:
Graph C


I have nights similar to your A and B examples - usually, but occasionally B and C. If you have something like C on a continual basis, you may be a candidate for a different machine used to treat either periodic breathing or complex sleep apnea.

Here's an Respironics' idealized example of periodic breathing:


And their idealized example of Complex Sleep Apnea:


From my own experience, I've found the oscillatory breathing from Graph B sometimes manifests because of what I consume. For instance, alcohol (2 drinks, in my case) may cause this in me. Also sometimes I see something that looks like complex sleep apnea (Graph C), but for the most part, my breathing is a little more like your graph A. The stuff in Graph B usually shows up toward the end of the night, while the stuff in Graph A usually shows up at the beginning of the night. (Again, in my case.)

The oscillations are curious, but I'm guessing that if they don't at some point resolve, at least they won't get any worse. It couldn't hurt to watch them, but unless one of our wiser forum members suggest so, I wouldn't be alarmed.

One thing I do notice that's different between you and me is that my flow limitations tend to be dead flat at the bottom of the graph, whereas yours are more or less motile. I'm not exactly sure what that means for you or me. I'm curious - do you smoke or have you been at any time in your life a long-term smoker?

EDIT:

Otherwise I suspect you need more pressure, but I’m just a fellow user.

Same here - if you're on Auto, you may want to increase your pressure or at the very least increase the upper limits of your max pressure to help with flow limitation.

[JohnBFisher]

I am also not a doctor, but it is my understanding that periodic breathing does not have to include a central apnea. Though it generally does include central apneas in the case of advanced heart problems, it does not need to include it.

Though I do not think it is serious (since it is periodic and does not seem to cause any problems), you should certainly ask your doctor about the waxing and waning when you next have the chance. Why? Periodic breathing can be an indication of cardiovascular issues. Not the "can". Some people have periodic breathing with central apneas and have not cardiac issues. Some people have central apneas without the periodic breathing and no cardiac issues.

All that being said, I would not worry overly much. This could just be a normal pattern for you. If you have no other indication of issues, it's probably nothing to worry about.

[brain_cloud]

Could you post some examples of what you're seeing?

Sure. It's just ordinary periodic breathing.

From a couple of nights ago, here, for comparison, is some "normal" breathing:




And a bit later some periodic breathing:



Both of these are at the identical scale. I didn't do anything except page over a few screens.

Hi LoQ, I have tons of B through the night also, extremely similar to yours except generally with somewhat longer peak-to-peak interval, more like 1.5-2.0 minutes, whereas yours looks just slightly less than a minute, although maybe that varies. Anyway, you are not alone.

[DreamOn]

I also see periods each night that look like Flow Graph B. They seem to be associated with flow limitations in my case, and I suspect they may be sleep-stage related. I'd like to learn more about this, as I've been curious about it for some time.

[Bright Choice]

Is it advisable to treat everyone who has periodic breathing ie cheyne stokes? My 82 year old mother died in the middle of the night with a heart event of some sort. This was in the 80's and I was very aware of her csr prior to this event. I was nurse then and it was just attributed to old age.

My brothers wife describes his nighttime breathing like it is csr. He has heard me talk about my insomnia/apnea and he dismisses the conversation with "I do not have any trouble sleeping". He is really healthy and is 69. I'd like some ammunition for my conversation with him. Any suggestions?

[DreamDiver]

Is it advisable to treat everyone who has periodic breathing ie cheyne stokes? My 82 year old mother died in the middle of the night with a heart event of some sort. This was in the 80's and I was very aware of her csr prior to this event. I was nurse then and it was just attributed to old age.

My brothers wife describes his nighttime breathing like it is csr. He has heard me talk about my insomnia/apnea and he dismisses the conversation with "I do not have any trouble sleeping". He is really healthy and is 69. I'd like some ammunition for my conversation with him. Any suggestions?

I did little more looking around:
http://en.wikipedia.org/wiki/Cheyne-Stokes_respiration

The slightly periodic breathing posted in the second graph by LoQ is not technically Cheynes Stokes Breathing. There are no apneas at the bottom of each volume oscillation.

If your brother has CSR, try asking him to use an oximeter for a night or two. It's easier to convince someone when they can see their oxygen levels aren't at peak.

[Bright Choice]

Thanks. Good suggestion. I have just ordered an oximeter and can ship that off to him when the time is right.

[LoQ]

The other night I limited my maximum pressure to 10 and when my pressure reached the 10 limit the flow limitation curve kicked up likes yours

I would be keenly interested to understand what you mean by this. I don't know what "kicked up" means, and I don't know which graph you are talking about. Could you also verify that you meant to say "flow limitation" and not "flow" or some other line?

and the flow flattened out as in your top graph.

I would also be keenly interested to understand what you mean by this. What does "flattened out" mean? I don't see how you can tell whether the flow in the top graph "flattened out," so I realize I must not know what you mean by that.


I think one of the issues here is that I can't see any of your charts, so I don't have a basis to compare my flow or FL to yours, which might illuminate your comments.

I suspect you need more pressure, but I’m just a fellow user.

Well, I think you are pretty smart. I probably do need more pressure. My settings were 10 - 20 auto for that, but the pressure stays between 19 and 20 during the REM cycles. Sometimes it will come down between REM cycles, but not always. I wish the algorithm were quicker to come back down.

[LoQ]

And their idealized example of Complex Sleep Apnea:

I am confused by this. What benefits would the person with CSR get from improving their flow to that chart that someone like me, who does not have the apneas between the cycles, NOT get? All that shows is that the oscillation of breathing leveled out.....nothing happened to the apneas! What does that do for them that it wouldn't do for me?

From my own experience, I've found the oscillatory breathing from Graph B sometimes manifests because of what I consume. For instance, alcohol (2 drinks, in my case) may cause this in me.

Interesting. I don't drink, some something else causes mine.

One thing I do notice that's different between you and me is that my flow limitations tend to be dead flat at the bottom of the graph, whereas yours are more or less motile. I'm not exactly sure what that means for you or me. I'm curious - do you smoke or have you been at any time in your life a long-term smoker?

I do not smoke, and I have never smoked, not even a single cigarette just to see what it is like.

What do you mean by "dead flat at the bottom"?

Same here - if you're on Auto, you may want to increase your pressure or at the very least increase the upper limits of your max pressure to help with flow limitation.

I wish I could. My poor little machine is working its heart out, but the engineers decided, for whatever reason, that people don't need more then 20 cm.