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Sleep Care

Cheyne Stokes & Sleep

When the term “sleep apnea” is used, it is often in the context of obstructive sleep apnea (OSA), a condition in which a person has stopped breathing due to a blockage in the upper airway (nose or mouth). While OSA is the most common form of sleep apnea, there is another type that is more prevalent among certain types of individuals. For example, among older patients, the occurrence of central sleep apnea (CSA) tends to be higher. A person with central sleep apnea will stop breathing not only from his upper airway, but also from his chest and abdomen—essentially, he has stopped breathing entirely.

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When CSA is combined with a pattern of breathing that goes from shallow to deep in between the apneic events, this condition is called Cheyne-Stokes breathing. It tends to be most common among elderly patients who are suffering from congestive heart failure: studies have found that 50% of patients with symptomatic congestive heart failure have sleep apnea which is usually Cheyne-Stokes breathing. Cheyne-Stokes and Sleep Patients with Cheyne-Stokes breathing typically will have a higher overall respiratory rate during sleep, although this can be deceptive because their

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breathing rate is elevated between long periods of CSA. The effect of this increased respiratory rate is to place a greater demand on the heart and respiratory system. Because most people with Cheyne-Stokes also have congestive heart failure, the heart is already functioning at a less-than-optimal level and is unable to effectively handle the greater demand. This results in lower oxygen levels and a faster breathing rate, as the body tries to get sufficient oxygen during sleep. Arousals may be a part of this process; these usually occur to a subconscious level that is sufficient to boost oxygen levels for a short period, although the person may not remember these arousals the next day. The cumulative effect of these arousals, however, is to disrupt a person’s normal sleep architecture, which can result in the feelings of daytime fatigue and tiredness that are common to individuals suffering from Cheyne-Stokes. Treatment for Cheyne-Stokes Some treatments for Cheyne-Stokes may actually focus more on congestive heart failure first, if that is present. When treatment for Cheyne-Stokes is focused on the breathing, however, there are several different options that can be considered. Respiratory stimulants, such as carbon dioxide, or the additional of supplemental oxygen during the night can be beneficial in “evening out” the respiratory rate by reducing the number of central apneas and easing the body’s need to hyperventilate in between the long periods of stopped breathing. These treatments are often most effective in a shorter-term capacity, however, and must be carefully supervised and monitored by a physician. Another treatment option is positive airway pressure (PAP) treatment. Instead of a traditional continuous (CPAP) or bi-level (BiPAP) format, the air pressure is often delivered in a variable manner (called auto servo-ventilation, or Auto SV). Instead of the fixed pressures used in CPAP or BiPAP, Auto SV machines use a range of pressures that change dynamically in response to a person’s fluctuating breathing throughout the night. Similar to respiratory stimulants and oxygen, the goal with Auto SV treatment is to normalize a person’s respiratory rate by reducing or eliminating the central apneas occurring during the night.

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