25% Periodic Breathing

[dankoziolek]

I was diagnosed with obstructive sleep apnea 3 months ago and have been on BiPap since with minimal reductions in my level of fatigue. Over this time period my machine has recorded some nights with as much as 60% periodic breathing, 1 night where it was 0, with an average of just over 25% since I started. When I first saw this data I posted a question on this forum asking if I should be worried and was advised to ask my sleep doctor. My sleep doctor told me not to pay any attention to the periodic breathing numbers on my machine because it isn't accurate accurate enough to really tell and I am not diagnosed with it. Yet, my wife tells me that my breathing during sleep is peaks and valleys with gaps in breathing that is better with the machine, but often still present. Then a month ago I was hospitalized with irregular heartbeat and atrial fibrillation. The cardiologist at the hospital believes I have likely been in A-Fib for a long time and may be for the rest of my life. My sleep doctor agreed today to do a titration study if it will make me feel better and to prescribe a different machine if he gets convinced I do have periodic breathing. I would love to hear from anyone else whose machine is reporting significant levels of periodic breathing. I would just like some way of figuring out if I really am overreacting to the data from my machine as my sleep doctor is suggesting. Thanks.

[SleepyBobR]

A-fib would have been caught by the sleep study if you were in it at the time. You may be paroxysmal (a-fib stops and starts on its own). As for your doctor, I'd suggest finding another one who isn't afraid of looking at reports from your machine's data. Makes me laugh how averse most of them are to actually digging in and understanding how our machines really work; instead they pretend the reports don't mean anything to avoid revealing that they haven't a clue how to read them. Periodic breathing is a possibility with any heart condition but I certainly wouldn't jump to conclusions. You need a doctor to look at the data and run further tests if required, not one that blows you off.

[icipher]

Wow. I would definitely recommend getting another titration study to take a look at your periodic breathing. I don't know if periodic breathing and Afib are tied together, but you PB numbers warrant another look at a sleep study...

[Sir NoddinOff]

When I was using my PR S1 auto, I'd feel terrible in the morning if I had 5% PB, (classic Cheyne-Stokes Syndrome, in my case). My diaphragm would feel like someone was using it for a trampoline all night long. I was nowhere near 25%, but I can't imagine how you feel in the morning. I'd certainly get that checked out.

It's not just the percentage of PB that matters, it's also the length of the breathless pause in between periodic cycles, plus the subsequent amplitude of the waxing/waning waveforms that have to be taken into consideration. It's not easy stuff to simply diagnose with Sleepyhead or whatever. A sleep doctor with a neurology doctorate would be the first source I would personally seek help from.

[Sludge]

I would love to hear from anyone else whose machine is reporting significant levels of periodic breathing. I would just like some way of figuring out if I really am overreacting to the data from my machine as my sleep doctor is suggesting.

If you were to upload your data file to a 3rd party server (Dropbox, Google Docs, etc.) perhaps a qualified individual might look at breath-by-breath to see if it is, in fact, periodic breathing or overzealous machine scoring.

[JohnBFisher]

If I had such high periodic breathing numbers, I would probably go see a cardiologist to have my heart checked. If everything is fine there, I would probably find another sleep doctor with whom you can discuss the situation.

While the machines are not all that accurate there is a big difference between 5% and 25%. Especially if that number is very consistent. Such a large number is statistically significant. Remember that some doctors don't really understand statistics. But with something like this you want to have it properly checked.

Hope that helps.

[carojae]

I find this post interesting. I too wonder about my breathing pattern.
I lay in bed and listen to my wife's breathing. In out in out in out - she is pretty consistent.
Me? Even awake I am erratic; no matter how much I try I can't keep a constant rhythm and it bugs me and I wonder why I am that way.
Here is what I think of. I know I have a hernia, does this affect my breathing pattern? If not, what does tell me when to breathe? Is it my sub conscience out of wack?
I wish I knew these answers.
Sometimes I can't keep focused and wonder if its a by product of my poor breathing. Would I be a smarter man if I could get my breathing right?

Jim

[Sludge]

I would love to hear from anyone else whose machine is reporting significant levels of periodic breathing. I would just like some way of figuring out if I really am overreacting to the data from my machine as my sleep doctor is suggesting.

If you were to upload your data file to a 3rd party server (Dropbox, Google Docs, etc.) perhaps a qualified individual might look at breath-by-breath to see if it is, in fact, periodic breathing or overzealous machine scoring.

And pull it right off the card instead of exporting from SH.

2 months ago you posted

I have a Phillips System One 760P REmstar BIPAP Auto with Bi-Flex. Mode APAP 9-13cmH2O, with humidifier, and a Mirage Quattro mask.

Are you, in fact, in APAP Mode?

[dankoziolek]

Thanks for all of the responses. I see the cardiologist I met at the hospital on Monday and one of the top researchers in the heart condition I have now been diagnosed with in early February. I do believe that I was likely not in A-fib when I had my physical in September and my sleep study in October. Yet, even on medication, I don't believe I have come out of A-fib since I was in the hospital. My cardiologist is willing to try a cardioversion just as soon as I am stabilized on a blood thinner.

My machine is set to a fixed pressure of 13 on inhale and 9 on exhale. I did ask my sleep doctor about more fully utilizing the capacity of the machine to see if it would reduce periodic breathing, and that is when I got the first lecture about the machine not really knowing what is going on and how it would mess up the results I am getting. And clearly my machine is making a big difference just as it is set. My AHI during my sleep study was 35.5. With consistent use and when I can manage consistent bedtimes and avoiding leaks, my AHI on the machine is generally <2 and my periodic breathing falls to the 15% range. My sleep doctor's solution was for me to spend 15% more time asleep. I tried that and found that spending more time in bed doesn't equate to more time asleep and in the end I don't believe going to bed an hour earlier reduced my fatigue at all. Yesterday my sleep doctor told me that most of his patients would be delighted to be getting the results I am getting. Yet I keep thinking that my machine also reports periods of normal breathing so that something must be different when it is reporting periodic breathing and I am struggling to believe that the results I am getting are good enough.

The graph below is from last Friday night. It is one of the higher AHI numbers I have had on my machine and the most significant example of periodic breathing I have seen. While my breathing periods are consistently 60 seconds in length, the period without a breath is often less than 10 seconds.

[Sludge]

While my breathing periods are consistently 60 seconds in length, the period without a breath is often less than 10 seconds.

Long cycle central apnea:

The cycle time of this pattern of unstable ventilation (typically 60 to 90 s) is much longer than other forms of CSA, due to prolonged circulation time in patients with CHF.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287191/

However, the preferred approach is fix the cause (normalize circulation time).

[Sludge]

BTW, when you see the guy, don't tell him you have "periodic breathing". Tell him you are "Cheyne-Stoking".

[JohnBFisher]

... My AHI during my sleep study was 35.5. With consistent use and when I can manage consistent bedtimes and avoiding leaks, my AHI on the machine is generally <2 and my periodic breathing falls to the 15% range. My sleep doctor's solution was for me to spend 15% more time asleep. I tried that and found that spending more time in bed doesn't equate to more time asleep and in the end I don't believe going to bed an hour earlier reduced my fatigue at all. Yesterday my sleep doctor told me that most of his patients would be delighted to be getting the results I am getting. Yet I keep thinking that my machine also reports periods of normal breathing so that something must be different when it is reporting periodic breathing and I am struggling to believe that the results I am getting are good enough. ...

Let me be frank. I would take one of two approaches. If you don't like your current sleep doctor then look for another sleep doctor. However, if you like him overall, review and print the following article. Take it with you during the next appointment and see if he would consider

http://www.medscape.com/viewarticle/736829

Since you have an underlying heart issue, 15% is NOT a "normal" thing. If you were otherwise healthy (no heart issues) then 15% would be acceptable, if not normal. But you do have heart issues. You don't want them to progress. ASV (Adaptive Servo Ventilation) therapy is the recommended approach to reduce the stress that c-s respiration can place on the cardiovascular system.

That's just my two cents.

[Sludge]

Yet I keep thinking that my machine also reports periods of normal breathing so that something must be different when it is reporting periodic breathing...

I would say you're either sleeping laterally or in REM (REM don't like CSA).

[JohnBFisher]

Yet I keep thinking that my machine also reports periods of normal breathing so that something must be different when it is reporting periodic breathing...

I would say you're either sleeping laterally or in REM (REM don't like CSA).

+1 ... It's pretty normal for Central Sleep Apnea and periodic breathing to disappear when you are in REM sleep. Why? The primary theory that I've seen is that during REM sleep there is more neural activity. Thus, the normal autonomic nervous system functions - such as breathing - are strengthened during REM sleep unlike deep sleep.

[Sir NoddinOff]

I would go along with what Sludge and John just stated, at least for the majority of PB/CS sufferers. It should also be noted that going into REM and exiting REM often causes spikes of disordered sleep; hopefully only briefly and not accompanied by arousal.

People often misunderstand where REM appears in relation to the other sleep stages. Below is an up-to-date graphic that clearly demonstrates current thinking about REM sleep. I hope it helps people get a grip on the ideas expressed earlier in this thread... especially John's comment on neural issues with REM.


It's interesting to note that REM is a virtual mentally alert state (tho in the form of dreams) combined with a nearly complete state of muscle paralysis (excluding the autonomic nervous system, like heart and lung function)... quite a big paradox to get one's head around, not helped by the many years of confusion while the medical establishment took time to sort it all out .