Is this periodic breathing?

I've been using my CPAP for a few months now and haven't been feeling much better on it.
I stumbled upon a thread on Periodic Breathing and Cheyne Stokes Breathing and was a bit worried to see that the patterns look really similar to the graphs I see in SleepyHead.

Can someone tell me if these oscillations are normal or if they are an indicator of an issue?
(Sorry I can't post links and have to wait for an admin to OK my account.)

imgur (dot) com/a/qEx21

For what it's worth, Minute Ventilation goes from a max of 8.5 to a min of 4 and then back up again.
This happens during almost all of my time in REM sleep (2ish hours a night or so)

what machine do you use? Mask? What are your pressure settings - so much of the time answers to questions like yours come down to the doctor's having prescribed wide open machine default settings that are too low to be effective, and we need to raise them a bit... but don't do it yet til we know more.

Julie wrote:what machine do you use? Mask? What are your pressure settings - so much of the time answers to questions like yours come down to the doctor's having prescribed wide open machine default settings that are too low to be effective, and we need to raise them a bit... but don't do it yet til we know more.

ResMed A10, My doctor originaly prescribed me something around 6-12cmH20 but I've been adjusting the pressure for the last two months to lower my AHI and currently have it set at between 6-9cmH20 APAP (I also started sleeping on my side which helps a lot).

I use a nasal pillow mask, i've tried other masks that had more leak but the mask I use now has very low amounts of leak and is comfortable.

I'm really just interested in if the pattern in the image I linked to would constitute periodic breathing or if it's normal to have those oscillations in your graphs. Do you need to know my pressure settings for that?

Is there a reason your high pressure is set so low? It may be cutting off events that want to go higher, but download Sleepyhead and post on Imgur, leaving links in this thread so we can see what's what and advise.

First of all...the definition of Periodic Breathing is a waxing and waning of the airflow that lasts at least 2 edited....2 minutes not 2 months which I originally typed...Brain fart example.
Your posted graph meets that definition.
I tried to embed the image but couldn't get it to work.
http://imgur.com/a/qEx21

Second...Cheyne Stokes Respiration is one form of Periodic Breathing but it is NOT the only form of PB.
CSR has a definite more distinct pattern with the waxing and waning with obvious flat lines in between..like this.


Yours looks like what I call "plain PB"...it's just a little gentle waxing and waning which meets the criteria but yours looks nothing like CSR.

Here's one of my own "plain PB"


and here is an example of real CSR


I think you can see the difference easily enough. I don't worry about plain PB at all. Especially if it is just a brief segment.
If it bugs you too much though...verify with your doctor but I doubt he will get all excited about a little plain PB that doesn't even remotely look like CSR.
And even if it did look like real CSR...they don't get excited too much unless it is present in large prolonged segments.

Hey Pugsy, thanks for the reply; you're like a legend around here!

You're right, definitely not CSR. Is plain PB nothing to worry about, or can it impact sleep quality?
The Plain PB that I see lasts almost half the night if not more, and It's present in my sleep data back to the first night.

I don't know all that much about PB in what it might mean in terms of affecting sleep quality.
I know when I would see it that it often was at times where I might have been awake...restless..So mine might have been more of a symptom of restless sleep than it was causing a sleep problem. Awake breathing irregularities that don't mean anything.
But then I never had very much of it so I really didn't dig very deep about plain PB.

If you are consistently seeing large segments (and half the night qualifies as large segment) then I think I would run it by my sleep doctor just for peace of mind. I don't think that it relates to anything alarming but I have never seen that much plain PB.

Maybe related to meds or do you have any sort of lung issues???? I think if you are seeing that much of it, even though it doesn't look like CSR, I would still run it by the doctor. Half the night on a consistent basis would be something I would want to talk to the doctor about. Mainly for peace of mind...just to make sure something weird wasn't going on.
I never had more than 5% of the night in PB and then not every night..more random.

Pugsy wrote:I don't know all that much about PB in what it might mean in terms of affecting sleep quality.
I know when I would see it that it often was at times where I might have been awake...restless..So mine might have been more of a symptom of restless sleep than it was causing a sleep problem. Awake breathing irregularities that don't mean anything.
But then I never had very much of it so I really didn't dig very deep about plain PB.

If you are consistently seeing large segments (and half the night qualifies as large segment) then I think I would run it by my sleep doctor just for peace of mind. I don't think that it relates to anything alarming but I have never seen that much plain PB.

Maybe related to meds or do you have any sort of lung issues???? I think if you are seeing that much of it, even though it doesn't look like CSR, I would still run it by the doctor. Half the night on a consistent basis would be something I would want to talk to the doctor about. Mainly for peace of mind...just to make sure something weird wasn't going on.
I never had more than 5% of the night in PB and then not every night..more random.

I'll bring it up with my doctor the next time I see them.
Thanks for the help!

xxyzx wrote:two months ?

did you mean two minutes ?

did not find any time noted in various dictionary definitions of PB

Yes, I meant 2 minutes. Brain fart...fingers and brain not working together. I will fix that error.

For the purposes of the machine flagged PB this is the definition most commonly used...not the one you pointed out.
This one is from Respironics..and I am not sure exactly what ResMed uses but it is something similar.

defined as a persistent waning and waxing breathing pattrn which repeats itself between 30 and 100 seconds. The nadir of the breathing pattern is characterized by at least a 40% reduction in airflow from an established baseline flow. The pattern must be present for several minutes before it can be identified as periodic breathing. No therapy adjustments are made in response to periodic breathing.

The 2 minute thing was something I got from another source which I can't seem to locate at the moment...doesn't really matter that much though.
It's obvious that the OP here isn't having the CSR type of PB...but the ResMed machine calls it CSR because that is the name it gave to PB.

CSR is NOT the only breathing pattern that can earn a PB flag though and for purpose of evaluation of the data these machines give us...we have to compare real CSR breathing to what the machine is flagging no matter what name it is given.

CSR does indeed point to potential serious issues but people can also have idopathic CSR meaning no known cause.

In this case with this OP...it's not CSR...that much is certain but the duration that he is seeing it does warrant a discussion with his doctor about it. Half the night isn't normal...now is it a sign of some sort of problem...dunno but that's why I said "talk to your doctor".