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Why this periodic breathing?
#1
Why this periodic breathing?
Hi all,

I am on CPAP for about 9 months now. Since the last few weeks I experience some nights with periodic breathing (once or twice a week, mainly in the early morning). I've shedded a few pounds but nothing spectacular. There are no other reasons I can think of. I lowered my pressure from 8,8-4,0 to 8,6-4,0 and last night to 8,4-4,0 but it keeps happening.

What does this have to say? The machine is reporting CA but how reliable is that? I mean, could it be chin tucking (OA) as well? Should I be worried for congestive heart failure? 

I've had this waxing and waning amplitudes before but never to this degree and with CA in between. Normally my AHI is between 0.5 and 1.0, mainly CA.

Thanks a lot for your thoughts.

   

   

   
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#2
RE: Why this periodic breathing?
Happens to me too, some times, and always while leaks are present. As the leakage vanishes, so does the periodic breating. Can you notice some slight periodic breathing around 2:40?

As long as this happens all night, I won't worry.

Mike
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#3
RE: Why this periodic breathing?
At 2.40 I do see some irregularities indeed. Apparently as a result of leakage.
   

However, my question regards the 04.51- 05.12 interval.
   
   
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#4
RE: Why this periodic breathing?
And my answer referred to it: as the (mask-) leakage is gone the periodic breathing is gone as well. It seems that the leakage washes out too much air, hence CO2 decreases, hence the start of the periodic breathing cycle. You'll notice that in the first screenshot some periodicity starts at the time the leaks occur and immediately come back to normal at 2:44 when the leakage is gone.

From here I don't consider this periodic breathing to be Cheyne-Stokes but a leakage-induced periodic breathing. IMHO there's nothing to worry about. The same thing happens occasionally to me. Usually, my AHI is under 1, but in some nights leakage triggers periodic breathing. (Those screenshots could have been mine.)

Maybe this a P30i-related problem: i'm using the same mask.

Mike
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#5
RE: Why this periodic breathing?
I got your point with respect to the interference of leakage.
However, in the 04:51-05:12 interval the leakage is practically negligible and I do experience a repetitive serie of CA.
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#6
RE: Why this periodic breathing?
Please substitute the pressure graph for the tidal volume graph.  Seeing the pressure changes could be of help in answering your "why" question.

Meanwhile, I want to reassure you in case you are concerned about Cheyne-Stokes respiration.  One characteristic of CSR is a "sinusoid" curve at the top of the flow rate, and that pattern is absent from the zoomed-in view you posted.
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#7
RE: Why this periodic breathing?
Hi Dormeo,

Thank you for responding. I was assuming that perfectly rounded curve tops are a sign that the CAs a real (as messy tops will rather point to OA or Hypopneas/ FL). Is that correct? And is that what you mean by sinusoid curve tops?
To be honest I thought my zoom-in picture shows rather perfect rounded curve tops. 
   

Please correct me if I'm wrong. Just trying to learn here. And figuring out what is actually happening.

Could it be that the CAs are real and it's a sign that my PS is a bit to high? And if so, does it make sense it only happens once or twice a week and only in the early morning?

I had my pressure settings at EPAP4.0 IPAP8.4 (fixed) so the Pressure graph is showing straight lines. In the mean time I lowered my pressure to 4.4-8.4 (PS went from 4.4 to 4.0) and I haven't experienced any periodic breathing episodes since then.
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#8
RE: Why this periodic breathing?
The "sinusoid" refers to the overall pattern in the flow rate during CSR, rather than to individual breaths.  See the attached image for an example.

For an individual breath, a smooth curve for inhalation shows the absence of flow limitations on that breath. 

A "real" CA is one that occurs while you're asleep.  We can't tell for sure when someone's awake or asleep from their flow rate, but there's one clue that points to a wake-up, and that's irregular breathing.  So if you see irregular breathing before a CA (or a series of CAs), you're probably not entirely asleep during the CA (or CAs).  See attached image for an example.

Hope this helps!


Attached Files Thumbnail(s)
   

.docx   CSR pattern.docx (Size: 163.35 KB / Downloads: 8)
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#9
RE: Why this periodic breathing?
This appears to be a flurry of sleep transition central apnea later in morning. Some people seem to get these, not sure why.

The pressure range is unlikely to be the issue. If anything the low pressures may not be fully treating your apnea at those times. The more likely culprit is 4.4 PS, you don't have obviously bad flow limitations so can try reducing that and see if it helps.
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#10
RE: Why this periodic breathing?
Concerning the time 04:51-05:12: Your view ist too narrow. Wink Have a look from 4:40 on: leaks occur and periodic breathing starts. And it takes some time to normalise. But there was few chances as from 5:00 new leakage occurred.

I'm not claiming that periodic breathing will happen only in presence of leaks, but leaks may trigger periodic breathing -- as shown in your screenshots.

Mike
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