What is the Significance of Periodic Breathing?

[rested gal]

I thought that maybe some of you would be interested in how EncorePro 2.2.14.0 presents Periodic Breathing episodes.

That was really interesting. They make it a lot easier to find PB. I wonder why they report it at all? That sort of reinforces the idea that PB isn't completely normal.

My guess as to why Respironics chose to report PB at all is that they are giving the clinician an easier way (as you mentioned, LoQ) to notice CSR (Cheyne-Stokes Respiration) IF CSR was present in the person. They don't expect CPAP users to be looking at our own data, much less be digging into what Periodic Breathing might mean.

They expect a doctor or RT to look at the downloaded data (maybe...slim chance of that happening in most cases) and have provided a tool that might make massive amounts of PB, if accompanied by possible central apneas in CSR's waning phase, jump out at the doc/RT and practically yell, "Switch this person to an ASV machine...and check the heart while you're at it."

Other than that, my further guess is that Respironics would agree with what others have said here -- that some PB isn't a problem. Well, actually they'd probably just say, "Ask your doctor."

[avi123]

oops, it seems to veer into neurology to include the brain's respiration control. I better stop commenting.

[LoQ]

on those "periodic breathing" graphs the main waves (not the oscillations) are at a minute apart which correlates with a heart rate. So John Fisher might have a point with the possible connection to the cardiac issues.

Huh? My heart rate is never 1 beat a minute.

I read your comment about 60 BPM. I don't think my lungs know that there are 60 seconds in a minute and that my heart is beating at that rate. Is there something magical about 1 minute that I don't yet understand?

Could you elaborate on the significance of "main waves" (and what are those, exactly?) being 1 minute apart, coupled with a heart rate of 60 BPM?

[LoQ]

They don't expect CPAP users to be looking at our own data, much less be digging into what Periodic Breathing might mean.

Heh. I keep forgetting that.

Just some editorializing here, in the current environment of the practice of medicine, there simply is no model that allows doctors or even RTs to spend the kind of time necessary to discover these problems. It seems to me that patients MUST become familiar with whatever diseases they have, especially if they have SDB or something related to that. If you are waiting for your doctor to find something on your data, that's most likely not going to happen, even if he requests you to bring the card in for a download. All he is looking for is that your AHI is under 5. If that means you have four 3-minute apneas each hour, he could really care less. It's up to you to find those things. If you have one of those machines that reports "average time in apnea" in the summary data, you might be a little better off. But there are still things you can find that your doctor won't, and that you need to act upon.

[avi123]

Just some editorializing here, in the current environment of the practice of medicine, there simply is no model that allows doctors or even RTs to spend the kind of time necessary to discover these problems. It seems to me that patients MUST become familiar with whatever diseases they have, especially if they have SDB or something related to that.

I agree

If you are waiting for your doctor to find something on your data, that's most likely not going to happen, even if he requests you to bring the card in for a download.

I agree that the info that is supplied to your Doc does not suppose to expect the Doc to diagnose your respiration ailments other then related to CPAPs capabilities. These machines are not made to check your other ailments than simple sleep related apneas. Even in the set-up in a Sleep Study clinic costing hundreds of thousands of dollars they are not capable to diagnose respiratory diseases such as Cheyne- Stokes, Biot's, etc.


All he is looking for is that your AHI is under 5.

My Doc put the emphasis on the Sleep Architecture and Oxygen level more than the AHI and the rest

If that means you have four 3-minute apneas each hour, he could really care less. It's up to you to find those things. If you have one of those machines that reports "average time in apnea" in the summary data, you might be a little better off. But there are still things you can find that your doctor won't, and that you need to act upon.

I don't agree with you that you should become your own Doctor.

[LoQ]

If that means you have four 3-minute apneas each hour, he could really care less. It's up to you to find those things. If you have one of those machines that reports "average time in apnea" in the summary data, you might be a little better off. But there are still things you can find that your doctor won't, and that you need to act upon.

I don't agree with you that you should become your own Doctor.

I did not assert that you SHOULD become your own doctor, so you can't really disagree with me.

It's like with anything, you can't just go to the doctor and say "I don't feel good." You have to take some factual information with you.

I routinely take my blood pressure. My doctor expects me to monitor the numbers myself and if I see something that looks like a problem, to let him know before the next scheduled appointment. Does that equate to becoming my own doctor, in your mind? If not, how is it different from flagging data from your PAP machine that seems wrong and bringing it to the doctor's attention? I think we are in basic agreement, and perhaps my previous post didn't communicate as well as it should.

[avi123]

[quote="LoQ
It's like with anything, you can't just go to the doctor and say "I don't feel good." You have to take some factual information with you.

I routinely take my blood pressure. My doctor expects me to monitor the numbers myself and if I see something that looks like a problem, to let him know before the next scheduled appointment. Does that equate to becoming my own doctor, in your mind? If not, how is it different from flagging data from your PAP machine that seems wrong and bringing it to the doctor's attention? I think we are in basic agreement, and perhaps my previous post didn't communicate as well as it should.[/quote]

Reply:

No, to diagnose Periodic Breathing abnormalities it's not like taking blood pressure. You need special EEG and EKG equipment that you and I know very little about. You also need to monitor blood Pco2 and pH on a Blood Gas Analyzer . Do you know how and where to do it? So what will you be taking to your doctor?

[LoQ]

[quote="LoQ
It's like with anything, you can't just go to the doctor and say "I don't feel good." You have to take some factual information with you.

I routinely take my blood pressure. My doctor expects me to monitor the numbers myself and if I see something that looks like a problem, to let him know before the next scheduled appointment. Does that equate to becoming my own doctor, in your mind? If not, how is it different from flagging data from your PAP machine that seems wrong and bringing it to the doctor's attention? I think we are in basic agreement, and perhaps my previous post didn't communicate as well as it should.

Reply:

No, to diagnose Periodic Breathing abnormalities it's not like taking blood pressure. You need special EEG and EKG equipment that you and I know very little about. You also need to monitor blood Pco2 and pH on a Blood Gas Analyzer . Do you know how and where to do it? So what will you be taking to your doctor?[/quote]

I fear I must bow out of the conversation. You seem intent on attributing to me thoughts I don't have and responding as though I have not said other things that would make a difference in your response if you took them into consideration. Dialog is not possible under those circumstances, but I thank you for your thoughts nevertheless.