Periodic breathing concern

HI all. I have a concern -

I have been on ASV therapy for a little over a year and I have never used any software with it; however, I do check my stats on the LCD screen. The entire time I have been using the ASV therapy, I have never had any percentage of sleep time show numbers for periodic breathing; however, I apparently had an episode of it last night as it showed 3%. Should I be worried if this continues?

More stats and tidbits on my health :

- AHI is showing as 1.6 (up a little from my average of <.

- 90% EPAP is showing as 10.5

- No HX of CHF/HF, diabetes, renal failure, fibromyalgia (sp?), or heart disease.

- Recent (2/2018) echo showed very minor trace regurgitation in the tricuspid and mitral valves. NO evidence of pulmonary hypertension, effusion, or stenosis. Mild left atrial dilation. Normal EKG.

- Just discontinued Effexor XR as of Thursday, 4.12.2018.

- No abnormal stressors at home or at work.

- Was put on 2L/minute oxygen at night due to hypoxia due to a very nasty bout of pneumonia which required hospitalization. This has been in use at night since December of 2016. Going in for a study to see if I still need it, hopefully sometime in the next couple of months depending on when the sleep lab can schedule me.

Can someone help me start putting these pieces together to see if i need to be overly concerned about the periodic breathing thing? I'm going to my doctor next month anyhoo so I intend to bring it up with her but in the mean time, is it futile to get excited about that "jump" from a solid year of 0% PB to 3%? This is the first incidence of it I have ever noticed being in my stats so it kinda freaked me out.

Any thoughts?

-

My first thought would be that going off the Effexor, especially if you did not taper over a long time as most of the antidepressants need to be, could have caused the blip. Second is that the 90% gauge is about your result (10.5) being at or below 90%, not AT that level for the time, so don't imagine it was there all the time by any means. I can't talk about periodic breathing as others are more famiiiar with it, but I'd wait another week or so til the Effexor's really gone down in your system before jumping to any conclusions. BTW if you've gained even a very little weight recently that can make a surprising difference sometimes.

Julie wrote: ↑

Fri Apr 20, 2018 8:27 pm

My first thought would be that going on the Effexor, especially if you did not taper over a long time as most of the antidepressants need to be, could have caused the blip. Second is that the 90% gauge is about your result (10.5) being at or below 90%, not AT that level for the time, so don't imagine it was there all the time by any means. I can't talk about periodic breathing as others are more famiiiar with it, but I'd wait another week or so til the Effexor's really gone down in your system before jumping to any conclusions. BTW if you've gained even a very little weight recently that can make a surprising difference sometimes.

Hi Julie, thanks for your advice. I was on 75mg of the Effexor for several months then spoke with my doctor about tapering off. She put me on 37.5mg for two weeks. This was started two weeks ago yesterday. Monday the 9th of April greeted me with HORRIFIC withdrawal symptoms so I gave the tapering down one more day for a total of 5 days of the tapering down. Symptoms did not improve so I just said to heck with it and stopped it altogether after 5 days. So I did 5 of the prescribed 14 days. Had some issues this past week with dizziness, nausea, and mood swings (all related to the withdrawal/tapering) but they are pretty much resolved as of yesterday.

I'm just concerned about the periodic breathing incident and didn't even think to connect it in any way to the Effexor.

Your doctor should be sanctioned by some board or other... she did NOT taper you properly and did not apparently follow-up. I hope you're ok, but do take more time now before making any decisions. Come back to this thread with news.

Without seeing the flow rate graph to look at what the machine flagged as PB it's had to say much but not all PB is CSR.

Here's what I call plain PB and PB is really just a waxing and waning of the flow rate that lasts at least 2 minutes...CSR which sounds the scariest is just one of many forms of PB and this plain PB is NOT remotely looking like CSR.



And here is an example of PB that looks more like CSR (Cheyne Stokes Respiration) that scares people because it can sometimes point to heart issues.



Your AHI is still low and it's doubtful that you had many events during the flagged PB time but without using available software there is no way to know for sure.

All that said...I have no idea if this is related to Effexor or not...I doubt it though.
It is possible that the PB is nothing more than some sleep/wake/junk breathing...you were awake or partially awake and the machine just flagged some awake breathing irregularities.
3% of the night in PB even if it was for sure CSR isn't usually enough to alarm a doctor.
For sure wouldn't alarm a doctor if it was plain PB.

Unless you start seeing a lot more of it and more consistently I wouldn't worry so much about it since you have an upcoming doctor appointment where you can have a chat with him about it.

You do need to use the available software to see the flow rate though.
On the machine just a year or so..unless you have an old model machine you should be able to use manufacture software and probably SleepyHead.
https://sleep.tnet.com/equipment
SleepyHead plays nice with most ASVs that use a SD card. If there is no SD card in the machine...you can't see the flow rate because flow rate by either ResMed or Respironics machines isn't save in the machine's memory. It goes directly to the SD card.

Since it is calling it PB and not CSR I assume a Respironics machine...what is the model number?

The above plain PB example...that's mine. I used to see it flagged every now and then and it's no big deal and I never worried.
The above example that looks like CSR...that's not mine ...that is someone who had a significant problem but you can plainly see that he had large prolonged periods of PB with a truckload of events mixed in...he had a problem and ended up needing a different machine and the machine he needed...the ASV like you are using.

So you need to figure out first if it is plain PB or CSR looking PB and for that you need to use software.
And unless you start seeing a lot more of it every night...3 % doesn't usually raise much of an alarm when random and rare.

You guys are wonderful when it comes to explaining things! After that one night of 3% PB, I had no other episodes. Had one last night and it was just 1%. Can having a nasty cold throw a weird PB stat? I am on the decline of an upper respiratory infection with a ton of post-nasal drip, cough, alternating stuff/runny nose, and did I mention cough? Cough is largely non-productive but the PN drip is most certainly there.

Of note, I did switch to a smaller headgear and this last night was just my third night on it. Didn't change cushions, just headgear.

AHI was .5 last night and I feel fine this morning so this PB thing has me a little confused.

My most recent doctor visit didn't yield any concern. She wasn't excited at all about the PB and saw the results of my most recent echo and was pretty satisfied with that.

If your doctor isn't worried then neither would I.
And yes, having a nasty cold can sure seem to trigger the breathing form that ends up getting a PB flag.
Anything that seems to disturb sleep can seem to do it. I used to see the PB more when I didn't sleep well due to back pain. I am thinking it just flagged some irregular awake breathing when I was tossing and turning and trying to get comfortable.