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Cheyne-Stokes and periodic breathing
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RedCoPete Offline

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Posts: 28
Joined: May 2016

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage Activa LT
Humidifier: ResMed S9
CPAP Pressure: 6-20 (usually below 8)
CPAP Software: SleepyHead

Other Comments: CPAP since 1999. Type II diabetic, AFIB. Yeah, I'm a wreck.

Sex: Male
Location: Oregon, USA

Post: #11
RE: Cheyne-Stokes and periodic breathing
No signs of a CSR channel in the Sleepyhead report for my machine (ResMed S9 Autoset). The event flags include Clear Airways, Hyponeas, OSAs, and Undetermined. The CAs look like Cheyne-Stokes as far as I can tell.

Last night was decidedly mediocre, with no big change from my no-ESR average. I had to get up to pee the two nights I've used 2 cm ESR, and both times it took a bit longer than usual to fall back asleep. I'll give things a week, and see what to do. I might try dropping the ESR to 1; I'm used to exhaling against full pressure, and I think it will take some time to get used to it. I do like starting at 6 cm-H2O. (I said 5 in a previous post--that was a typo.)

For what it's worth, I've never seen Sleepyhead (or might be ResMed) flag an event as CA with a pause below 10 seconds. The shorter minima seem to get flagged as Hypos. There's a discussion of CSR and PB in the "Beginner's guide to Sleepyhead". A lot depends on the machine's programming.
06-23-2016 09:34 AM
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tmoody Offline

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Posts: 175
Joined: Mar 2016

Machine: PR System 1 BPAP AutoSV
Mask Type: Nasal pillows
Mask Make & Model: Swift FX nose pillows
Humidifier: PR System 1 attached
CPAP Pressure: 8-25
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Philadelphia

Post: #12
RE: Cheyne-Stokes and periodic breathing
When I was switched from straight CPAP to DreamStation APAP last November, and started monitoring sleep data for the first time, my AHI tended to be between 10 and 15, but I had massive amounts of PB--often 20-25%. I had no idea what this meant, and it freaked me out when I started reading about CHF. When I finally got to see the sleep doc, he was concerned about the AHI and centrals, but didn't seem too bothered about the PB. He suggested a cardiology exam anyway, since I hadn't been to a cardiologist in 20 years or so.

The cardiologist understood the immediate reason for the visit, and did EKG and echocardiogram. No Holter. He saw no evidence of Afib or CHF. I also had another sleep study, since I hadn't had one in nine years. Complex apnea was confirmed, but no heart rhythm abnormalities. ASV was prescribed, and a titration study was done. I've now been on ASV for three months. My average AHI for the past month is 2.8. I don't know my average PB, but it's 2% or less, often 0. Once in a while I'll see a 4.

What I don't know, and will never know, is whether my PB was as high on straight CPAP as it was on APAP. I don't know if the APAP algorithm could have produced or exacerbated PB, especially after nine years of constant pressure.

Incidentally, I have the impression that SleepyHead doesn't count any event at all--CA, OA, hypo, or PB--unless it's over 10 seconds. That's probably more a PRS1 thing than a SH thing.
06-23-2016 02:23 PM
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rkl122 Offline

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Posts: 75
Joined: Apr 2016

Machine: Philips Respironics System One 560P (Auto, Aflex, 60 Series)
Mask Type: Nasal pillows
Mask Make & Model: PR Dreamware Frame Med, Pillow MW
Humidifier: Remstar System One - Hose Unheated
CPAP Pressure: low 8.5, high 12.5, expting
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: NJ

Post: #13
RE: Cheyne-Stokes and periodic breathing
(06-23-2016 02:23 PM)tmoody Wrote:  ..............................
The cardiologist understood the immediate reason for the visit, and did EKG and echocardiogram. No Holter. He saw no evidence of Afib or CHF.
.......
Quote: My average AHI for the past month is 2.8. I don't know my average PB, but it's 2% or less, often 0. Once in a while I'll see a 4.

Good going! And good to know the PB is not necessarily diagnostic for bad stuff, and that it can diminish over time.............

Quote:Incidentally, I have the impression that SleepyHead doesn't count any event at all--CA, OA, hypo, or PB--unless it's over 10 seconds. That's probably more a PRS1 thing than a SH thing.
That's what I thought too, but I am noticing OA's at 6,7,8,9 seconds durations. A few CA's below 10 also. I also tried toggling on UF1 and UF2, leaving the default criteria. Yikes, a whole slew of previously hidden events down to 8 seconds' duration. I toggled 'em off again.

Under the Events tab of the SH Preferences menu, JediMark has indicated a bunch of PRS1 events for which, I've read, he has no definition. So yeah, apparently a lot of algorithms ticking away in these machines.

-Ron

We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
06-23-2016 05:36 PM
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Sleeprider Offline
Wiki Editor
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Posts: 3,840
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #14
RE: Cheyne-Stokes and periodic breathing
(06-22-2016 04:26 PM)rkl122 Wrote:  Too late to edit previous note, but by "PR" I meant "PB" (except when referring to the machine.) Sorry for confusion.

Older versions of Sleepyhead labeled all periodic breathing events as CSR. The label could be changed in preferences, and still can. To be more clear, periodic breathing may be Cheyne-Stokes, but not all PB is.

It was changed because it was obvious that most CSR flags were actually just plain old breathing fluctuations or sleep-wake-junk. CSR is in fact a pretty alarming condition mostly associated with congestive heart failure. So the author of the software changed the label to the more accurate PB, and the few people with CSR will probably know who they are, or will soon know. CSR is not transient, it occurs throughout the sleep session at frequencies over 60%. I for one, agree the change was appropriate, and hopefully will cut down on the number of posts on the forums asking about their CSR.

Sleepyhead itself does not generate any event flags. It reports the ones contained in the machine data.

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(This post was last modified: 06-23-2016 06:09 PM by Sleeprider.)
06-23-2016 06:08 PM
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rkl122 Offline

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Posts: 75
Joined: Apr 2016

Machine: Philips Respironics System One 560P (Auto, Aflex, 60 Series)
Mask Type: Nasal pillows
Mask Make & Model: PR Dreamware Frame Med, Pillow MW
Humidifier: Remstar System One - Hose Unheated
CPAP Pressure: low 8.5, high 12.5, expting
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: NJ

Post: #15
RE: Cheyne-Stokes and periodic breathing
Thank you for the clarification Sleeprider. Very helpful.

-Ron

We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
06-23-2016 09:56 PM
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RedCoPete Offline

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Posts: 28
Joined: May 2016

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage Activa LT
Humidifier: ResMed S9
CPAP Pressure: 6-20 (usually below 8)
CPAP Software: SleepyHead

Other Comments: CPAP since 1999. Type II diabetic, AFIB. Yeah, I'm a wreck.

Sex: Male
Location: Oregon, USA

Post: #16
RE: Cheyne-Stokes and periodic breathing
Third night running, and AHI over 10. I think I'll give it a week, unless it gets worse. Starting at 6 is more comfortable, but with the ESR at 2, I'm simply more used to breathing out against pressure.
06-24-2016 10:19 AM
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RedCoPete Offline

Preferred Members

Posts: 28
Joined: May 2016

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage Activa LT
Humidifier: ResMed S9
CPAP Pressure: 6-20 (usually below 8)
CPAP Software: SleepyHead

Other Comments: CPAP since 1999. Type II diabetic, AFIB. Yeah, I'm a wreck.

Sex: Male
Location: Oregon, USA

Post: #17
RE: Cheyne-Stokes and periodic breathing
OK, I think I know enough for now. Without ESR, my AHI over 32 days was 6.56 (std deviation of 4. Good days 2 or better, bad days up to 15). 5 days with ESR of 2 cm-H2O, and I got an average of 6.78, with a std deviation of 3.4. I had two "good" days, running 3.08 and 3.4, and a couple over 10.

I don't feel comfortable with the ESR, and it doesn't look like it's helping the centrals and hypopneas. I'm going to keep the starting pressure of 6.
06-26-2016 09:32 AM
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