Cheyn-Stokes Breathing

Just came back from my sleep Dr. pulmonolgist, who is also head of the sleep study center for testing, and recomended that my last sleep study was two years ago, and being I have congestive heart failure, he wants me to have a new sleep study to see if I have Cheyne-Stokes-Breathing which might have been the cause of the congestive heart failure, if that is the case he says my CPAP Auto is not the machine to help the condition, he was saying a Flow-Triggered Adaptive Servo machine would be needed, not a Cpap machine. Any one with input on any of this, please educate me I haven't heard of this before today.
Ed

Hurricane wrote:Just came back from my sleep Dr. pulmonolgist, who is also head of the sleep study center for testing, and recomended that my last sleep study was two years ago, and being I have congestive heart failure, he wants me to have a new sleep study to see if I have Cheyne-Stokes-Breathing which might have been the cause of the congestive heart failure, if that is the case he says my CPAP Auto is not the machine to help the condition, he was saying a Flow-Triggered Adaptive Servo machine would be needed, not a Cpap machine. Any one with input on any of this, please educate me I haven't heard of this before today.
Ed

ASV (adaptive servo-ventilation) machines were designed to treat the Cheyne-Stokes respiration pattern that people with CHF (congestive heart failure) often have. Sounds like your sleep doctor is well "up" on things.

ResMed's VPAP Adapt SV and Respironics BiPAP Auto SV are adaptive servo-ventilation machines.

Thanks Rested Gal, for the machine info, Doctor wanted to check if I had this breathing pattern,so he is setting up an over nite sleep study for me, which will be in the next week or so, I never thought to ask what kind of machine I would need if I had this problem, he only mentioned that my current machine would not be what I needed and he would prescribe a new one that handles that problem. You are ever so helpful for the quick reply, and yes my Doc is up on things he is in charge of the sleep study at a local hospital. I will keep you informed of the results.
Ed

Rested Gal I'm wondering if software is available to read nightly readings on the Resmed vpap Adaptsv, didn't see any listed.

I agree with Rested Gal that your doctor is definitely up on things.

Sleep doctors (and all doctors for that matter) are usually one of two breeds: 1.) those that "know where the money is" and have specialized knowledge by taking up a fellowship program, and 2.) those that have a sincere passion to learn, and keep learning about their field due to their true interest in furthering their expertise. (This is how I found my current sleep doctor - by reading various professional journals to see who was active & publishing articles. Yet I digress...)

The following articles may be of further interest to others that have complex SDB problems, but they both contain info about Cheyene-Stokes breathing. Both articles are by one of the doctors that originally did research with ResMed's prototype SV machines:

http://www.sleepreviewmag.com/issues/ar ... -06_03.asp

http://www.sleepdt.com/adaptive-servo-v ... hen-brown/

Hope this is helpful...

I have Cheyne-Stokes respirations and use a BiPAP AutoSV by Respironics. No congestive heart failure in my case. Just unexplained Cheyne-Stokes. I use Encore software to read my data.

Best wishes,
Tony

Is Cheyne-Stokes checked for/will it show up at a regular sleep study? Or is this something they have to look for deliberately? Thanks.

If you have it, your sleep study will show it. They can tell the difference between your body attempting to breath and being unable to due to obstruction (OSA) and your body making no attempt at all to breath at times (Cheyne-Stokes or "Periodic Breathing").

Tony

tonycog wrote:If you have it, your sleep study will show it. They can tell the difference between your body attempting to breath and being unable to due to obstruction (OSA) and your body making no attempt at all to breath at times (Cheyne-Stokes or "Periodic Breathing").

Tony

Thanks Tony, starting to get a better picture of Cheyne-Stokes, never heard of it till yesterday, realizing it is benificial to have a revaluation sleep study every so often, as to keep up with advances in detections of problems.
Ed

Hurricane wrote:Rested Gal I'm wondering if software is available to read nightly readings on the Resmed vpap Adaptsv, didn't see any listed.

Greetings! Yes, the ResScan software can read the data from the Resmed VPAP AdaptSV units.

Cheyne-Stokes Respiration (CSR) is a type of central apnea. In fact, most of the time the diagnosis of central apnea results from cardiac problems. In essence, CSR and central apneas often result from an undershoot/overshoot cycle in our breathing. For whatever reason (and there are many), we do not properly sence the build up in CO2 in our blood. (Our body senses the CO2 buildup, not the lack of oxygen). When this happens, our drive to breathe decreases. This is the undershoot part of the cycle. When the CO2 buildup is sufficient, our bodies step up the respiration rate and the volume we breathe. In fact, your body tends to "overdo" the breathing. And it blows off too much CO2. This is the overshoot part of the cycle. And of course, since you blew off too much CO2, you have less need to breathe ... repeat ...

Long term this is very damaging to your heart, and your entire cardiovascular system.

Here is some background reading for you. The following page is a set of links that Rested Gal gathered for us. This is her Links to Central Apnea:

viewtopic.php?p=22702

In particular, you might want to read:

Central Sleep Apnea: Implications for Congestive Heart Failure
http://chestjournal.chestpubs.org/conte ... l.pdf+html

A Randomised Controlled Trial of Adaptive Ventilation for Cheyne-Stokes Breathing in Heart Failure
http://ajrccm.atsjournals.org/cgi/repri ... 2-1476OCv1

Adaptive Servo-Ventilation in Patients With Idiopathic Cheyne-Stokes Breathing
http://www.aasmnet.org/JCSM/Articles/020212.pdf

And please feel free to ask more questions.

John, thanks for to input, I was first diagnost in 2004 with congestive heart failure, at that time I had cardio version done, lasted about one year then I was back in AFIB, when I had the cardio version done, thats when my cardioligist sent me for a sleep study, and that began my CPAP treatment, I feel well, no big problems still play golf once a week, and stay active, I am also on supplemental oxygen at sleep time, so I guess this new sleep study is to see if I need flow-triggered adaptive ventilation.
Thanks again, Ed

Greetings! It's great you are able to remain active. If you've developed a significant amount of Cheyne-Stokes Respiration (the waxing and waning of breathing during sleep), then catching it early will help keep you active and healthy.

The great news is that ASV machines have been out for several years and more and more sleep centers are getting used to them. Even better news for you is that (as you've seen) we have several members with ASV machines. Thus you won't be on your own trying to figure out how to make it work.

A little bit about the ASV experience. The ASV unit breaks that undershoot/overshoot cycle by carefully monitoring your breathing. If it sees you are going to undershoot, then it intervenes by increasing pressure. Essentially it becomes (for a short time) a ventilator to help you continue to breathe. It essentially maintains about 90% of your respiration in that mode. By doing this, it bumps up the oxygen, decreases the CO2 buildup and breaks the undershoot/overshoot cycle.

How effective is ASV therapy? Very. The following study provides the most remarkable comparison of the various methods to treat Central Apneas and/or Cheyne-Stokes Repiration (CSR). It is well worth a read.

Efficacy of Adaptive Servoventilation in Treatment of Complex and Central Sleep Apnea Syndromes
http://chestjournal.chestpubs.org/conte ... l.pdf+html

Within that article is perhaps the most persuasive graphic that I've seen.



It compares ASV to other therapies for different types of issues. And from their test it is very clear that ASV mades a SIGNIFICANT difference. The improved sleep helps improve the quality of life for those patients. In the case of someone with congestive heart failure, it will help them forstall continued problems by decreasing the strain on their heart.

By the way, others have dismissed ASV compared to CPAP plus oxygen. This study actually compares ASV to CPAP+O2. Though CPAP+O2 is quite effective, it is not as effective as ASV.

Though I do not have CSR, I do have severe central apnea. I can tell you from my own experience that when I use CPAP and/or BiPAP, it does not touch my central apnea. However, with an ASV unit, I generally have NO apneas throughout the night. That's not to say that ASV is not needed. Rather it DOES intervene to help sustain my breathing. And I feel MUCH better when I sleep with an ASV unit.

Of course, you might not need this therapy. We can hope that is the case for you. However, if you have developed CSR, it's great to know that it can be adddressed through a very effective therapy.

Best wishes and keep us posted.

A little bit about the ASV experience. The ASV unit breaks that undershoot/overshoot cycle by carefully monitoring your breathing. If it sees you are going to undershoot, then it intervenes by increasing pressure. Essentially it becomes (for a short time) a ventilator to help you continue to breathe. It essentially maintains about 90% of your respiration in that mode. By doing this, it bumps up the oxygen, decreases the CO2 buildup and breaks the undershoot/overshoot cycle.

How effective is ASV therapy? Very. The following study provides the most remarkable comparison of the various methods to treat Central Apneas and/or Cheyne-Stokes Respiration (CSR). It is well worth a read.

Wow John, thanks for the explanation of ASV therapy, I read your description, and will try and digest alot of the article you pointed out, I like the explanations of the abbriveations of the different cause of apnea.
Ed