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How to Treat Cheyne Stokes Respiration

Sleep disordered breathing can take many different forms, but one of them stands out: we're talking about Cheyne Stokes respiration. This breathing disorder is characterized by a cyclical pattern of breathing, which alternates between periods of very fast or deep breathing followed by a period of very shallow or slow breathing, often ending in an apnea or total cessation of breath. 

This abnormal breathing pattern can happen at any time, both day and night, but it is the nighttime form that is considered as part of the larger category known as sleep disordered breathing. In addition, Cheyne Stokes breathing that occurs during the night is the form known to lead to other, potentially more serious health problems. 

When an individual is suffering from this abnormal breathing pattern, their breathing rate goes up and down in cycles, with each cycle normally lasting for somewhere between 30 seconds and two minutes. At the beginning of a cycle, the breathing rate and depth will increase dramatically for a period of time. 


This phenomenon of increased breathing, known as a hyperpnea, is then directly followed by a sudden decrescendo in breathing, which may or may not end in a short apnea or total cessation of breathing, usually lasting for somewhere between 10 and 30 seconds.


cheyne stokes respirationThere are actually two distinct types of this abnormal breathing pattern: Cheyne Stokes respiration (CSR) and periodic breathing

The difference between the two is whether or not the breathing cycles end in an apnea. If some of these cycles result in a total stop of breathing functions, then this disorder is recognized as CSR. However, if the person's breathing functions don't totally stop at the end of a cycle, then the person is diagnosed with periodic breathing.

In cases of periodic breathing, the person's breathing rate still becomes abnormally slow or shallow at the end of each cycle. These episodes, known as hypopnea, are still quite dangerous for one's health, but not considered to be nearly as much so as a full apnea.

The reasons behind this increasing-decreasing pattern of breathing are actually quite simple. At the end of a cycle, when the patient experiences either an apnea or hypopnea, the rate of carbon dioxide in their bloodstream rises. 

This phenomenon, known as hypercapnia, then triggers the body to start breathing rapidly (in some cases, hyperventilating). Then as the CO2 levels in the blood reach lower than normal levels due to the hyperventilating, the body responds by slowing down breathing patterns until they reach a decrescendo resulting in either an apnea or hypopnea, and thus starting the entire cycle over again.

Cheyne Stokes and Central Sleep Apnea

When Cheyne Stokes breathing occurs during the night, it is normally thrown into the category of central sleep apnea. This category of sleeping disorders refers to total cessations of breath caused by some other medical condition which interferes with the brain's ability to properly control breathing functions. 

Not all forms of central sleep apnea are a result of Cheyne Stokes, as these apneas are often present without the crescendo-decrescendo pattern of breathing associated with CSR. When a person experiences periodic breathing during sleep, this condition is often considered to be a form of central sleep hypopnea, again caused by some other underlying medical condition.

Both central sleep apnea and hypopnea are considered to be quite serious sleeping disorders, and have been linked to a long list of other potential health problems, the least of which is simple sleep deprivation. In fact, almost all people suffering from either of these two conditions report feelings of extreme fatigue, forgetfulness, trouble concentrating, and many other issues directly related to a lack of sleep.

Causes of Cheyne Stokes Respiration and Periodic Breathing

Generally speaking, both CSR and periodic breathing are usually thought to be a result of some other underlying medical condition

cheyne stokes respirationBoth of these abnormal breathing patterns are most commonly seen in patients who have suffered a stroke, congenital heart failure, brain tumors, or damage to their brain, spinal cord, or brain stem which affects the brain's respiratory centers, located in the medulla oblongata at the bottom of the brain stem. 

In addition, it could also be a result of morphine intake or carbon monoxide poisoning, and is also present in patients with toxic metabolic encephalopathy, a degenerative neurological disorder caused by exposure to certain organic toxins.

However, it seems that these aren't the only possible causes, as both of these conditions can also be a result of sudden, acute exposure to extremely high altitudes, usually over 15,000 feet above sea level. In cases such as this, the majority of people only experience periodic breathing, instead of full blown CSR. These changes in respiratory rates are due to the lower levels of oxygen in the air, which result in cycles of hyperventilation followed by hypoventilation. 

Treating Cheyne Stokes Respiration and Periodic Breathing

More serious forms of CSR and periodic breathing which occur during the day may require the use of a respirator or ventilator to ensure the patient can breathe properly. When these conditions occur during the night, thus leading to central sleep apnea or hypopnea, the most common and by far most effective treatment option is the use of a Bi-PAP machine.

cheyne stokes respirationBi-PAP (bi-level positive airway pressure) is a machine that produces alternating levels of air current, which is basically forced into the patient's lungs while sleeping through the use of a mask. These machines ensure that the person's breathing rate remains the same throughout the night, by forcing air into their lungs even when their brain is not giving the signal to breathe. 

While many people report finding these machines quite uncomfortable to use, the truth is that Bi-PAP is really the only truly effective treatment for central sleep apnea, making its use a necessity for anyone suffering from this disorder.

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