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Cheyne-Stokes and periodic breathing
#1
I've been using my ResMed S9 APAP since May 20th. The good news is my OSA issues are pretty well gone, but on some days I'll get a huge amount of CAs and hypopnea events. Last night I had an overall AHI of 15.8, most of which were short (15 second) centrals, all related to Cheyne-Stokes respiration and periodic breathing.

Looking at the waveforms, I'll go into periodic breathing/Cheyne-Stokes around 2-3AM, and it will last 15 minutes to an hour. (Not every day, but at least once or twice a week.) I'll get some hypopneas, and central apneas lasting 15 seconds to not more than 24 seconds. I never seem to awaken from these, and eventually the breathing evens out.

My reading on this says that atrial fibrillation is associated with Cheyne-Stokes, and the AFIB has been a bit more intense in pollen season. Anybody else in this situation? I wake fairly well rested (barring the bad back and arthritis), but Sleepyhead thinks I'm a wreck.
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#2
I've read about a correlation between Afib and CSR.
I'm curious... Are you continuously in Afib; or is it episodic?
I assume you have a cardiologist who's doing their best to control Afib; and possibly you are on a blood thinner to prevent clots...

Now, my attempt at humor -- perhaps Sleepyhead read your profile -- that's why it thinks you're a wreck?
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
The AFib is episodic, usually presenting under some form of stress. It showed up in spades for my second cataract procedure (two weeks after the first), after the Pac Power transformer died at bedtime. Proved that I really can't sleep without CPAP, and that I needed better backup power.

Main treatment now is warfarin to keep clots from killing me. (As my doctor's nurse delicately puts it: "Rat Poison to keep you alive".) If the AFib gets worse, I'd go for the catheter nerve-ablation procedure, but it's good enough now. Medicare starts next year, and cost would be better. So long as I'm sleeping all right, I'll not worry too much.
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#4
Hi RedCoPete,

There seems to be a correlation between CSR and various heart related issues. Atrial Fib and Congestive Heart Failure are both associated with Cheyne-Stokes Respiration and Periodic Breathing. One study: Sleep Apnea Syndrome in Patients with Atrial Fibrillation —2 Cases Whose Atrial Fibrillation Was Controlled by Treatment for Sleep Apnea Syndrome— http://www.sciencedirect.com/science/art...7607800275
is interesting because it suggests that controlling Sleep Apnea helps reduce A-fib. In your case you have already been on CPAP. You may now need an ASV machine to reduce the effects of the CSR and Periodic Breathing.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#5
I've been on cpap over a year, and it tells me I have Cheyne Stokes respiration and Periodic Breathing sometimes 4% of the time. Usually one or two groupings a night....2-2:30am.....sometimes after I first fall asleep - My AHI goes from 3 - 17 and everywhere in Between! but varies wildly with no rhyme or reason, mostly it hovers around 8-9. I have a good mixture between obstructives, centrals, hypopneas. I sometimes have sporadic episodes of stopping breathing at the moment I'm falling asleep. This can occur 50-100 times a night for hours, which they attribute to centrals. Maybe maybe not. Happens a few days in a row maybe every month or two....those nights I might get 2 hrs sleep if I'm lucky.

I can't figure it out. I've worn a holter monitor for a month and no a fib. I've had people (and doctors) tell me that Cpaps can give false readings of Cheyne stokes.....

My doctors don't seem concerned, they only care that I am compliant for insurance purposes.

Since my numbers very WILDLY for no reason (same sleeping position, etc) I could have one sleep study with crazy numbers, and another sleep study with great numbers......

I'm disgusted and have given up trying to figure this out. I feel like crap most days and will be changing insurance in a year, going to a very high deductible, so I will have to probably stop cpap anyway.

Hope you have better luck figuring out your Cheyne Stokes / Periodic breathing.
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#6
How do you identify Cheyne-Stokes using the SH data from an S9? CS doesn't show up in any of my graphs
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#7
How do you identify Cheyne-Stokes using the SH data from an S9

Mine are identified as CA events (no-flow 14 to 23 seconds, with a gradual increase, followed by tapering off, repeating once a minute) by Sleepyhead, and reading about Cheyne-Stokes, the pattern looks right. If the minimum is really short, it'll flag as a hypopnea, with about 2/3's of the events CAs and the rest HAs.

I'm trying two things on the S9 tonight.

1) The minimum has been at 4 cm-H2O, but SH shows that 6 is a better minimum. I'd like to not have that 5-15 minutes of struggling when I start up.
2) I'm trying EPR. Set it up to "patient" and for tonight, it'll be at 2. Various forum messages have indicated it could help. We'll see what happens.

On bad nights, I'll have an AHI in the double digits, mostly from CAs with a few HAs for flavor. My very best night was 0.71, and I'm averaging about 6. I'd like to do better, but don't really want to bend the budget for an ASV. The joys of self insurance.
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#8
Not bad for a first night. Setting the minimum at 5 meant immediate comfort, and the AHI was 3.4, far better than the mid 6s. (2/3s of the days are worse than this value.) I'll keep the setting and carry on.
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#9
(06-21-2016, 09:23 PM)RedCoPete Wrote: How do you identify Cheyne-Stokes using the SH data from an S9

Mine are identified as CA events (no-flow 14 to 23 seconds, with a gradual increase, followed by tapering off, repeating once a minute) by Sleepyhead, and reading about Cheyne-Stokes, the pattern looks right. ....................
So you are interpreting data from other channels, but not the Cheyne-Stokes (CSR) channel?

My (PR) machine doesn't yield a CSR channel in SH either, but it does give the PB channel, and I'm getting events there 3-12% of most nights. I don't have CHF as far as I know, but I do have sinus bradycardia, so this is of particular concern to me.

I see various threads where people seem to assume Cheyne-Stokes and Periodic Breathing are equivalent. But I'm confused, because SleepyHead explicitly supplies a separate channel - therefore presumably a different algorithm - for each.

So questions for the experts: Is CSR the same thing as PR or not? If so, why does SH have separate channels for each? If not, is the difference one of degree or qualitative? What concerns are raised by the presence of PR events?

Thanks for any insight,

-Ron

PS to OP: Hope I'm not hijacking your thread. I'm assuming my questions will interest you too.
We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
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#10
Too late to edit previous note, but by "PR" I meant "PB" (except when referring to the machine.) Sorry for confusion.
We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
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