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Cheyne Stroke Respiration
#1
Cheyne Stroke Respiration
I've posted before about my CA and they have improved mostly but are still normally half of my events.  My AHI was 30 from sleep study, around 19 when I first started APAP, and now I get results between 2 and 8 pretty regularly.  I have had 2 nights where these CSR events have shown up, and like everyone else who gets them they scare me.   I've been on APAP for close to 3 months now and over all I'd give the experience a D+.  I'm 43, healthy, 5'11'' weight 175 and only take prescription meds for seasonal allergies.  What are your thoughts about these 2 nights I've had events?  I posted  a night between these 2 that is a "normal" night for me.  Although having more CA is pretty common than this particular night's data shows.  Any thoughts or suggestions would be appreciated.  I did take a "sleep aid'" drink last night for the first time that had typrophan and melatonin in it, that I normally do not take.


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#2
RE: Cheyne Stroke Respiration
There is definitely periodic breathing, but the nadir of the oscillation does not have an apnea. Technically, I would not call this CSR, but the variation is on the right magnitude and period. In my non-medical, non-medical opinion this is not CSR, but I'm sure you could find someone to disagree. Your health profile certainly does not point to heart failure, and without that, the respiratory drive mechanism for CSR does not really exist. It's an ugly breathing pattern, but does it awaken you or disturb your sleep in any way? Your AHI is borderline for ASV, and you clearly would not tolerate pressure support or EPR without triggering a bunch of CA events. I have seen other members with similar results move to ASV and clear up both the AHI and the periodic breathing. There is a fairly low probability your doctor would want to fight for ASV therapy and near zero likelihood your insurance will pay, but I seriously doubt you have a disqualifying heart condition, and if results like this are a concern, they would be gone with ASV.
Sleeprider
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#3
RE: Cheyne Stoke Respiration
Sleeprider thank you for your answer.  I'm really new at all of this and am curious what you are seeing in the charts I posted that has you saying I won't tolerate a increase in EPR.  Which based on my experience is true.  I just don't know what you are reading to get this info.  I can't say for sure if these events wake me up or not.  I don't wake up really ever feeling panicy or short of breath or anything.  I do wake up multiple times a night though which is frustrating and why I give the overall experience a D+.  How different is the experience wearing a ASV?  Part of my initial issues with my CPAP was mouth leaks and waking up with my mouth open.  As I have moved to a my APAP and changed the pressures this doesn't occur hardly ever.  I still get some leaks around my pillow from time to time which I think is what wakes me up.  The centrals have been a much bigger concern to me than my doctor.  She just basically disregards them, as they didn't appear on either of my 2 sleep studies.  But if they were totally removed my AHI would be probably under 2 just about every night.
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#4
RE: Cheyne Stroke Respiration
The CSR pattern, or periodic breathing, is a common artifact of new users of CPAP. In some individuals the increased ventilation of CPAP destabilizes the CO2 levels in the blood stream and we see central apnea and periodic breathing. This usually passes in a short time. The use of EPR or pressure support increases that effect. Turn yours on and see if it's true for you. Most new users take to CPAP and EPR pretty easily, but for some others, the ventilation drives down CO2 and as breathing approaches the apneic threshold, we see artifacts like periodic breathing or central apnea. I was just assuming you had already tried EPR and turned it off.
Sleeprider
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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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#5
RE: Cheyne Stroke Respiration
ok.  Yes you are correct.  When I have the EPR at 3 I do ave more CA and just issues in general.  The settings I have set now seem to be the most comfortable for me.  I was just surprised by these 2 CSR events that popped up after using the machine for 3 months.  I'll continue on for now and see if I continue to get them.  If so I talk with doc about the ASV options.  Is it common someone wouldn't have CA on sleep study's, develop emergent ones on CPAP or APAP and then ultimately need ASV to remedy that?
I'm not to concerned with the cost just want to make sure it's necessary and effect for this situation if I pursue it.
Thanks again.  I'll post tonights data from Oscar tomorrow and see a out how many CA I have.
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#6
RE: Cheyne Stroke Respiration
Pretty much what Sleepriders said.
ResMed calls all periodic breathing CSR and you are right it scares people. Other vendors just call it periodic breathing. The pattern, especially in the first example had me checking your EPR for just that very reason. The pattern is one of CO2 controlling your breathing near the apneic threshold.

To repeat SR this is periodic breathing, and IMHO not CSR.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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