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Cheyne stokes and periodic breathing, what can you tell me?
#11
(12-01-2015, 08:50 AM)StoopidMonkey81 Wrote: So just to reiterate, if I notice a wavy waxing/waning breathing pattern like the one depicted in the graph above, but breathing does NOT stop or result in a CA in between periods, then it's not Cheyne-Stokes? I've seen a few of those on my SH charts myself, and I'm wondering if I can safely ignore them.

Cheyne Stokes is a distinct type of periodic breathing. Brief periods of irregular breathing like the graph above are not CS, nor are they particularly more disruptive than the incomplete hypopnea they represent. It is the labeling in Sleepyhead that is in error.
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#12
I have the same breathing patterns and am investigating it. I also note you are getting the same sort of event clusters that I get.

I will probably have more to say on this later.

Walt
Walter W. Olson, Ph.D., P.E.
Professor Emeritus
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#13
(12-01-2015, 09:04 AM)Sleeprider Wrote:
(12-01-2015, 08:50 AM)StoopidMonkey81 Wrote: So just to reiterate, if I notice a wavy waxing/waning breathing pattern like the one depicted in the graph above, but breathing does NOT stop or result in a CA in between periods, then it's not Cheyne-Stokes? I've seen a few of those on my SH charts myself, and I'm wondering if I can safely ignore them.

Cheyne Stokes is a distinct type of periodic breathing. Brief periods of irregular breathing like the graph above are not CS, nor are they particularly more disruptive than the incomplete hypopnea they represent. It is the labeling in Sleepyhead that is in error.

Sleeprider,

I am interested to know why you don't think the above pattern is not Cheynes Stokes. The waxing waning pattern although not of the length to be scored CSB seems to fit the definition of CSB.

Walt


Walter W. Olson, Ph.D., P.E.
Professor Emeritus
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#14
Walt, Cheyne Stokes Respirations are a regular waxing and waning of respiratory effort, and the classic CSR includes a central apnea in the pattern. It is typically a pattern seen mostly in congestive heart failure patients. There are many posted images online of actual CSR, and this has only some of the characteristics.

The graph posted earlier shows some periodic breathing, and while I'm not qualified to diagnose, I have doubts this is a CSR pattern, and is more likely disrupted sleep. CSR is persistent, and does not go away, and if this was a regular feature of respiration with this individual I would be more inclined to consider it as something to perhaps deal with by speaking to a doctor or changing machines or settings. But this was a one-off event. I have had them (rarely), and I can assure you it is nothing to be concerned about:

[img][Image: j8L37m7l.png][/img]

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#15
I have scored ones at a rate of about 4 per night. I should also say that I have 30+ CA's a night usually preceded by periodic breathing that was not scored. Based on my reading of the Sleepyhead source code, I am lead to believe that it is the PRS1 that is doing the scoring, not Speephead, although I could well be wrong about this as I have yet to understand everything Sleepyhead does and does not do.

One of the reasons I am interested in doing an FFT is that I see the above pattern fairly frequently, EVEN WHEN IT IS NOT SCORED CSB by the PRS1. I do believe it to be CSB and it concerns me especially since it was not not in my sleep study. As a PhD'ed researcher for more than 30 years and have looked at a lot of raw data, I have come to realize that there are very few "acts of God" in data, that almost everything has a cause and meaning. I would really like the raw data from the sleep study to see if there is a delay in SaO2 as this would confirm or reject CHF.

I really question the completeness of my sleep study at this point. There is so much more that I am seeing in the PRS1 data that wasn't noted in the sleep study. There were several obvious errors that even I, as a non-medico could see, in the sleep study. Sleep studies are performed here by a technician and then sent to some doctor in San Francisco to be read and scored so I can not consult with that doctor. My PCP is not an expert in this area. I have some real questions and I need professional answers. I am going to ask my PCP for a cardiac-pulmonary consult as the data seems worrying. That I have COPD and cancer are complications that I don't think have been properly evaluated in this process.

But don't think after reading StoopidMonkey81's post, that I could necessarily dismiss CSB. I think I would need to know more. If it is rare, then probably yes, I would dismiss it. But if it is found in a significant part of the data, then I think it further be evaluated by a qualified physician. My opinion for what it is worth.

Walt
Walter W. Olson, Ph.D., P.E.
Professor Emeritus
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#16
Interesting thread. "waxing waning pattern although not of the length " well there is a requirement for this and if it does not meet the requirement, then it is not CSR. This is kind of the whole point. A miss is a miss.

Now for the graphs and periodic breathing and 30 centrals a night. Personally I chased down the rabbit hole about periodic breathing despite everything my Doctor said, because I was still not sleeping. I was and still am having 70 centrals a night, 30% of the nights.

Well found out I have COPD (mild) and they gave me an inhaler and day one I was sleeping great! and have been ever since.

All this really means is periodic breathing may not be that big of a deal. Doctor said that unless I was having 30-40 centrals an hour that it was not a big deal, for me he was right. As for CSR, I would suggest that you be very happy that you do not have CSR and get on with discovering the culprit that is keeping you from sleeping well. Is your COPD well treated? COPD and Sleep Apnea evidently interact with each other a lot.

IF you have a good sleep Doctor and they keep saying no, sometimes it's because the answer is no. This also does not mean that there is not a problem.
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#17
(01-09-2016, 09:48 PM)PoolQ Wrote: Now for the graphs and periodic breathing and 30 centrals a night. Personally I chased down the rabbit hole about periodic breathing despite everything my Doctor said, because I was still not sleeping. I was and still am having 70 centrals a night, 30% of the nights.

Well found out I have COPD (mild) and they gave me an inhaler and day one I was sleeping great! and have been ever since.

All this really means is periodic breathing may not be that big of a deal. Doctor said that unless I was having 30-40 centrals an hour that it was not a big deal, for me he was right. As for CSR, I would suggest that you be very happy that you do not have CSR and get on with discovering the culprit that is keeping you from sleeping well. Is your COPD well treated? COPD and Sleep Apnea evidently interact with each other a lot.

IF you have a good sleep Doctor and they keep saying no, sometimes it's because the answer is no. This also does not mean that there is not a problem.

Very interesting! My COPD is not being treated. What inhaler do you have?

Walt
Walter W. Olson, Ph.D., P.E.
Professor Emeritus
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#18
Tudorzo Pressair http://www.tudorzahcp.com/
twice a day. Another that my insurance would not cover is Spiriva
Perhaps you feel like apneas are starting just after you lay down, before you are asleep? Chest gets heavy and breathing is like inhaling through a straw that is just a little too small?
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#19
(01-09-2016, 09:48 PM)PoolQ Wrote: Interesting thread. "waxing waning pattern although not of the length " well there is a requirement for this and if it does not meet the requirement, then it is not CSR. This is kind of the whole point. A miss is a miss.

You are quite right: there is an AASM criteria for scoring CSB.

HOWEVER, a scoring criteria for CSB does not mean that periodic breathing not fitting the scoring priority is not CSB ... it just means that in a PSG, it would not be scored that way. Yet if periodic breathing that waxes and wanes exists but doesn't meet the AASM criteria for CSB, that it should be ignored. This is not natural breathing and has a cause.

Whether or not you wish to call it CSB is matter of semanitics, not medicine in my opinion. I am interested in health, not semantics here, so I am less interested in the formal definition and more so in whatever effects this has or is the result of. I am not yet willing to ignore it.

I know that CSB has been observed as the result of high elevation in formal sleep studies and in research into the subject. I know that it is coincident with congestive heart failure. But its cause and effects is still not well enough defined in my understanding. Perhaps the more we know, the more we don't know about it ... there are many of these conundrums in research and in medicine. I guess I haven't chased it deep enough down the hole yet to quit on it. As you can see, I don't give up easily.

"Curiosity kiiled the cat and satisfaction brought it back!"

Walt

Walter W. Olson, Ph.D., P.E.
Professor Emeritus
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#20
(01-09-2016, 10:10 PM)PoolQ Wrote: Tudorzo Pressair http://www.tudorzahcp.com/
twice a day. Another that my insurance would not cover is Spiriva
Perhaps you feel like apneas are starting just after you lay down, before you are asleep? Chest gets heavy and breathing is like inhaling through a straw that is just a little too small?

Thank you for the quick come back. I will mention these to my PCP.

As I mentioned eariier, I usually have four event clusters a night, each of which seems to have some periodic breathing (I call it CSB) associated with it. The first cluster is about ten minutes after I get to sleep. The scored CSB's are typically in my last two hours of sleep.

I don't feel the heavy chest or breathing through a straw feeling.

My pattern of falling to sleep is characterized by a decreasing flow from about 90 ml/sec to 30 ml/sec and corresponding tidal volumes until I settle into more or less regular breathing. Then for no apparent reason, I start periodic breathing with about 7 breaths between minimum points nodes with the flow in fully developed periods from near 0 ml/sec to roughly 40 ml/sec. This will be followed by scored RERA's, then scored hypopneas and then scored CA's where after expiration, there is a cessation of breathing for a period of time. In between the major CA events there may be more periodic breathing. These clusters last about 45 minutes when they occur. If I weren't on my IPAD, I would post the Sleepyhead flow graph. I may do that at a later date.

The COPD that I have was diagnosed through chext X-rays as result of my cancer (I doubt the cancer is an issue here as it is uveal melanoma that has been treated with radiation.)

Walt
Walter W. Olson, Ph.D., P.E.
Professor Emeritus
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