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[Diagnosis] Cheyne Stokes Respiration
#11
RE: Cheyne Stokes Respiration
As Dave and SR have stated this is periodic breathing and not CSR.
It is IMHO CO2 induced and based on your reportedly late night occurrence it could be sleep state or dream state stress related. I'm other words, you breath deeply (stress related?) Which flushes CO2 from your system to near your apneic threshold resulting in much shallower breathing do to the reduction in CO2, which results in a feedback loop as you increase CO2 during the shallow breathing gradually breath deeper repeating the cycle. Occasionally you go below your apneic threshold resulting in a central apnea.
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#12
RE: Cheyne Stokes Respiration
Thank you very much Gideon. Sorry I fell back to typing CSR when I had been trying to type "CSR"-pattern or cluster of CAs... And now I see it is in fact "Periodic breathing", and from 7 years ago I remember all that about the feedback cycle. Great, thanks.

I was told by my first sleep doctor when I investigated CAs that I wasn't supposed to worry about CAs. She insisted that my AHI < 5 meant that I my sleep was just just being interrupted by "alpha-wave intrusion" (per the sleep & brainwave study) and I need Ambien or Doxepin or similar drug (at smaller doses, not the anti-depressant dose). I tried as she said and I hated the drugs, didn't want to be on them, joined a gym lost weight and felt much better. So I moved to a new doctor about 5 years ago, who didn't pursue drugs with me.

The new doc said I needed to reduce my cpap pressure, that the CAs can be pressure induced. Here's an excerpt from Mayo Clinic:

    "Some people with obstructive sleep apnea develop central sleep apnea while using [CPAP treatment]. This condition is known as treatment-emergent central sleep apnea and is a combination of obstructive and central sleep apneas."

That excerpt uses the term "central" but in fact all we know, without a sleep / brainwave study, is OSCAR reports "clear airways" - is my understanding. And that sometimes we turn during the night and there's just a spurious CA event recorded -
http://www.apneaboard.com/forums/Thread-...rway-Event

I did reduce my pressure from 11 to 10 and then tried to go to 9 but at 9 I didn't feel I got enough flow, and felt bad the next day. I tried to go to 9 or 9.2 two or three times. I had to settle on 10. But I could try again I suppose to go lower.

(That doctor left the practice and the new replacement doctor I'm with now asked if I wanted to try Trazodone, reasons stated in my just-prior post)

Anyway, back to my Periodic Breathing (the subject of this post). I've noticed a couple months ago quite remarkably, and this has never happened before, that I could take a nap (my sleep got a little worse since COVID / gaining weight or for whatever reason like stress) - without my CPAP - and after the nap I felt fine. Previously I'd wake up feeling horrible.

So last night I woke up once at 3am and didn't put the mask back on. I feel like I slept the rest of the night well, but it's just one time, getting consistency on trying things is a herculean task. But the idea is that maybe I don't need the CPAP. Maybe I'm actually not that ok - like how I feel later today - so take this with a grain of salt.

Since my OSCAR charts / stats show few obstructive apneas, and few hypopneas, maybe I don't need CPAP? But then I am in fact using CPAP which is providing the continual positive airflow to reduce them to begin with. So maybe I just have to try it and find out.

Is my CPAP treatment helping in reducing the occurrences of Periodic Breathing (PB) by providing a steady airflow? Or could the CPAP actually be inducing the PB? But if it's stress correlated as it appears (I'll start up again my rigorous sleep spreadsheet), that's another story I won't pursue here, but as SR said, sleep hygiene and CBT type treatments for anxiety once further along could help all this.

I did have a new overnight sleep study a few years ago, a "split study" and found that without CPAP I had an AHI of like 17, obstructive apneas, not good. I don't recall how they measured that, but the result was I needed CPAP. I need to take all this up with the new sleep doctor.

Thanks
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#13
RE: Cheyne Stokes Respiration
In all likelihood, you still need CPAP, sorry. It is possible another form of treatment could work for you, surgery, appliance, inspire but the gold standard is still CPAP.
Any long-term issues should include Sleep Hygiene and or CBT. Issues other than apnea may, only may, need meds to help them.
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#14
RE: Cheyne Stokes Respiration
Just to clarify, if one has treatment emergent Central Apnea, expected timing for them to diminish is 3 months.

The treatment emergent Central Apnea are not a mix of Central and Obstructive Apnea, but are Central Apnea brought on by higher CO2 flushing out due to the PAP increasing breath efficiency. A new PAP user can have both Obstructive and Central events. In other words, just having both Obstructive and Central events isn't counted as or called treatment emergent CA. There needs to be an increased CA rate from what was recorded on the diagnostic sleep study to help identify treatment emergent CA while using a CPAP.

If any CA are disturbing sleep, they need to be addressed not ignored.

CA flagged in OSCAR is called clear airway because the the PAP has no way to test if it is a Central. But the PAP uses air oscillating to determine if the airway is clear or obstructed. But in most cases a clear airway on the chart is a Central Apnea.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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