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Cheyne-Stokes...Imminent Rigor Mortis? - Printable Version

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Cheyne-Stokes...Imminent Rigor Mortis? - HalfAsleep - 11-12-2017

SleepyHead has been tagging Cheyne-Stokes episodes on my charts. Apart from the fact that the syndrome—alas—conjures up the visage of Dick Cheney, I'm quite concerned that Cheyne-Stokes is considered to be the breathing pattern of the half-dead. (This would be a significant deterioration for HalfAsleep).

Until now, I didn't think I was at death's door, but evidently Cheyne-Stokes is a significant precursor to fatality. Since I don't seem to be there yet (perhaps I'm in denial?), does anyone know anything about this breathing pattern that might be generally enlightening, as well as less foreboding?

Is this all a hoax perpetrated by for-profit sleep centers and estate attorneys?

Are we quite certain that I must hurry up and organize my Last Will and Testament?

Can anyone reflect on how SleepyHead evaluates periodic breathing?

Is Cheyne-Stokes a noteworthy problem?

If it doesn't persist for a considerable length of time, is it really Cheyne-Stokes?

RE: Cheyne-Stokes...Imminent Rigor Mortis? - DeepBreathing - 11-12-2017

It would help to see the #SleepyHead output, zoomed in on the period of CS breathing. SleepyHead reports all periodic breathing as Cheyne-Stokes, when it may only be "ordinary" periodic breathing. True CSR is characterised by a period of waning airflow followed by a period of no flow (effectively a central apnea) followed by generally increasing flow. This repeats over and over.

CSR can be an indication of congestive heart failure or other serious conditions, so if you're seeing a lot of it then certainly get it checked out by your doctor. On the other hand, it may be indicative of nothing in particular.

There is a good fairly technical discussion in our wiki: http://www.apneaboard.com/wiki/index.php?title=Cheyne-Stokes_respiration

RE: Cheyne-Stokes...Imminent Rigor Mortis? - HalfAsleep - 11-13-2017

[Image: xD94gGPm.png]
I  should have got my thumbnails linking now. Please let me know if I haven't.

[Image: aQnXeN5m.png]

RE: Cheyne-Stokes...Imminent Rigor Mortis? - srlevine1 - 11-13-2017

There are other causes of Cheyne-Stokes breathing other than dying and heart failure. They include carbon monoxide poisoning, increased arterial pC02, Hyponatremia (a low sodium level in the blood), sleeping at high altitudes, stroke, traumatic brain injury, as well as some medications like sedatives and opioids.

I have often questioned the algorithm used to detect and report Cheyne-Stokes breathing (periodic shallow breathing or under-breathing that alternates with deep over-breathing) because I find falsely flagged events.

Some suggest that lower pressures and the use of maximum EPR ease breathing to the point of encouraging the type of shallow breathing, followed by rescue breaths, that looks like Cheyne-Stokes breathing.

I welcome anyone with an authoritative explanation on how to weed out false reports of Cheyne Stokes breathing -- especially using a ResMed AirSense AutoSet.

RE: Cheyne-Stokes...Imminent Rigor Mortis? - HalfAsleep - 11-13-2017

Oh-jeez None of those potential conditions sound very comfortable.

Like you, I'm wanting to know how the algorithm works and how to evaluate it for veracity.

RE: Cheyne-Stokes...Imminent Rigor Mortis? - ajack - 11-13-2017

sorry mate, ya gonna live, they are obstructive and not CS, someone (me) may have mentioned you need more pressure.

RE: Cheyne-Stokes...Imminent Rigor Mortis? - HalfAsleep - 11-13-2017

Cheyne-Stokes is an obstructive mode, AFAIK. 

The higher my pressure goes the more events I have....

RE: Cheyne-Stokes...Imminent Rigor Mortis? - ajack - 11-13-2017

you might want to google that.
If your CA are blown out of the park with higher pressure. Go back to the doctor and see of it's bad enough and not too early to consider another type of machine. You obviously don't mean it increases your OA and H.

RE: Cheyne-Stokes...Imminent Rigor Mortis? - DeepBreathing - 11-13-2017

HalfAsleep Wrote:Cheyne-Stokes is an obstructive mode, AFAIK.

No - CSA is not an obstructive phenomenon. It is (as mentioned above) associated with heart failure and a whole lot of other medical conditions and possibly drug effects. What I see in your charts looks like a series of obstructive apneas and hypopneas. I don't think it's real CSR. However I'm not a medico and if you're concerned you should seek qualified medical advice and not rely on the internet.

RE: Cheyne-Stokes...Imminent Rigor Mortis? - Hojo - 11-13-2017

I have the same issues, lots of CSR with no real reason; I'm in perfect health, haven't seen any reduction in CSR over time (apparently it takes time for the body to get accustom to the extra washout of carbon dioxide from CPAP), pressure doesn't seem to make any difference (we've looked at high vs low pressure), and EPR changes hasn't changed my CSR.

I've changed sleep docs (actually transferred to a better one by the original doc I was seeing) and he isn't convinced that it is true CSR since I don't have it all the time and I have no predisposing history (no head injury, no stroke, no hear failure).  The new doc did give me a BIPAP titration (with ST) study recently and I felt I had the best night sleep ever but I'm still waiting on the results.