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[Diagnosis] Cheyne Stokes Respiration
#1
Cheyne Stokes Respiration
Hello all, on another thread I opened on Jan. 11th "Sleep health tips needed" I discussed starting Trazadone 50mg to address waking up too much at night. The drug is going well, waking up far less. I'll update more on that thread shortly. The purpose of this post is to get comments on bad sleep I had on the 4th night of taking the drug (6 days ago). Note I don't think the bad sleep on Jan. 11th was caused by the drug, since I did find some other nights in the last couple months with CSR, noted below.

The bad sleep is characterized by (a) I felt bad the next day, like sleeping with someone playing a loud noise in the room all night, my head couldn't focus during the daytime (b) I had a much higher AHI that night (4.0) relative to other nights (around 1 - 2) and ( c ) A Cheyne Stokes Respiration (CSR) for 15 minutes. Here are the stats:

   

Below is attached a screenshot of the charts. I see that:
1. There was some mask leakage in the last 30 minutes more than normally
2. Just prior to the mask leakage, there is a cluster of CA (clear airway) events
3. Just earlier to that at around 4:45am was a 15 minute span of CSR

Note:
- I only woke once that night. No eating, due to the effect of the Trazadone.
- Before sleep I did eat a vegetable protein weight loss shake my wife had bought, chock full of Vitamin B's and Chromium, something called Garcinia cambogia and various other vitamins, minerals. Spooked that it caused the bad sleep I stopped eating it. I did have a small amount of the shake only one night prior with no effect. No other changes in food, liquid or environment.
- I have taken Trazadone for 6 nights since then and every other AHI averages about 1.3 (between 0.7 and 1.5) and my sleep is good.
- I just reviewed two months prior in OSCAR and there is some CSR on Dec. 25th that lasted about 5 minutes (AHI 2.7). And on Nov. 11th for 20 minutes (AHI 4.8), Nov. 15th for 15 minutes (AHI 5.5), Nov. 16th for 42 minutes (AHI 7.6). All the other days back to Nov. 1st had zero CSR. 
- I didn't see any leakage on those CSR days but they have much higher AHI.
- During CSR, OSCAR indicates a lot of CA events.
- I have noticed in the past that if I have a longer nights sleep, more than my usual 7.5, I will get the bulk of my apnea events in the last hour or two.
- For each of the days listed above, the CSR occurs about 30 - 60 minutes before I wake. Each is in a long segment, like 3 - 4 hours where I haven't woken.
- My mask pressure on those days peaks at about 12 cmH2O.

What causes the CSR and CA events, are they causing my really bad head that day, and what can be done, are they a big concern?

I've been told in the past that unless you have heart or other serious issues (I have none) to ignore occasional CSR, but in writing all this up it seems clear that the CA events during and or the CSR pattern is causing me feeling really bad the next day, at least on Jan. 15th, and probably the Nov. nights with the higher AHI's, but it depends also on the duration of the CSR and if I had enough total hours, etc.

I can upload more data if needed. Here's one screenshot from OSCAR, hope it's readable and sorry if it was the wrong or too much data:

   

Thanks!
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#2
RE: Cheyne Stokes Respiration
Best practice is to include the left panel statistics on OSCAR with the right side chart. Give the group a zoomed in 10 and 3 minute of the daily details section right at the CSR area.

As for this being CSR, unless you have a known heart condition like congestive heart failure, the CSR area will be a mislabeled event. ResMed flags periodic breathing as CSR. Again in most cases it's not real CSR.
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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#3
RE: Cheyne Stokes Respiration
If you think Trazadone is helping you sleep through the night, but your CPAP statistics and sense of well-being are telling you otherwise, then maybe you should listen to how your feel. Trazadone has been connected to poor sleep and CPAP outcomes on this forum many times. Try this search on your search-engine of choice:
"Trazadone site:Apneaboard.com"
Results are mixed, but it definitely has both positive and negative effects on sleep. If you want to sleep better, I would suggest less aggressive sleep aids are available than a prescription antidepressive drug with the known side-effects of Trazadone. To me this is a last resort after optimizing CPAP, trying non prescription sleep aids like Melatonin, and using sleep hygiene therapy. It sure would not be my first stop.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#4
RE: Cheyne Stokes Respiration
To SarcasticDave:
Here's a zoomed screenshot over the approx. 15 min. period of flagged "CSR":
   
Thanks, understood I do recall the CSR being mislabeled by the software sometimes, but then why am I getting this pattern in my sleep, causing so much AHI (CA events) and such a poor sleep quality characterized by feeling like I got terrible sleep the next day. Why is it happening at the end of sleep, and only occasionally like a couple times a month? The one on Jan. 11th definitely corresponds to a terribly stressful day, and similarly on Dec. 25th.
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#5
RE: Cheyne Stokes Respiration
To Sleeprider, definitely not saying that my CPAP stats are telling me otherwise. As my post stated, my AHI is excellent on Trazodore, my well-being is excellent EXCEPT for Jan. 11th and other than a bit wooshy during the day (so yeah don't want to continue it forever unless it improves - as it's supposed to). Since there were occasional  "CSR" (CA events) patterns in Dec. and Nov. I don't see how Trazodone has anything to do with it. You're preaching to the choir on sleep hygiene. I've been battling this for 7 years. What helps is a lot of exercise and losing weight and reducing stress. I haven't touched ANY drugs until my new sleep doctor, also a pulmonologist at a major hospital in a large city, recommended Trazodore. The result I am seeing definitely proves that "calming my mind down" (aka sedation) has dramatic results: Reduced apneas and awakenings, and a feeling of finally being rested, energetic, happy. For someone with anxiety it makes sense. Is it a perfect drug, will I want to keep taking it? Definitely NOT. But am I forced to? Yes, unfortunately, I have to. Yep, "last resort", you got it! CPAP with AHI < 5 didn't cure me. Seems likely a lot of folks may be lost in the weeds, like me (see below).

I recommend looking at my other thread titled "Sleep health tips needed" with all the details on this topic (other than my observation of CSR which is the purpose of this thread).

The elephant in the room on that thread is stress. Cortisol. If I hike a few miles, with uphill, I will sleep through the night. Thoroughly refreshed.

I've been lost in the weeds for years with apnea's. What that means is, all the work I did to address treating my apneas with mask and machine, pressure and settings never addressed the elephant. Is the CSR pattern from stress?

Thanks!
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#6
RE: Cheyne Stokes Respiration
Something to note that it seems like you've dealt with is consistently inconsistent Central Apnea since you've been on Apnea Board. Maybe it might be time to consider testing and treating them to see if this resolves your Apnea and unrest issues. The CA levels may not be high, but they're in the charts frequently enough to be an issue.
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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#7
RE: Cheyne Stokes Respiration
I don't know why this is a separate thread, yet you expect that might be aware of your other thread. I can merge them if you want. Your CSR is real and if that is present before and after Trazidone, then fine. If not, then get off this drug.

If you expect people to consider what you have said in another thread, then don't start a new one.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#8
RE: Cheyne Stokes Respiration
Thanks SarcasticDave. I will ask my doctor about the CSR-flagged patterns comprised of CAs. It was helpful to get focus specifically on my occasional stress-correlated CAs in this dedicated thread. If others have insights on the interesting late sleep onset of all the CAs and/or stress related correlation to CSR patterns of CAs, or high Cortisol, please share.
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#9
RE: Cheyne Stokes Respiration
Trazodone takes about 2 weeks for full effects to kick in. If the effects are unacceptable or ineffective, work with your doctor to taper off as stopping it instantly can cause serious problems.
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#10
RE: Cheyne Stokes Respiration
Thank you LindanHotAir. The effects so far are good as described, and so far only stress and the odd near-end-of sleep onset of CSR seem interesting commonalities to my clustered CAs on those nights. I understand about duration and tapering, thanks much. The goal here in using the (small dosage for anxiety and sleep) Trazodone is to reset the learned periodic daytime-like wake ups during sleep, to be longer, night-like, as described by the Doctor, so minimum of 3 weeks he said. Then taper, is my understanding, still hoping ;-). Haven't got that far, it's Day 10 now.
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