ooo-weee!  I just googled something RAM mentioned I think we are on to something!!!  HYPERNEA:  deep breathing

Biot's Breathing:
alternating depths of breathing and periods of hyperpnea (deep breathing)

Cheyne-Stokes Breathing:
periods of hyperpnea alternating with periods of apnea

Kussmaul Breathing:
hyperpnea (deep breathing) with abnormal large volumes, followed by hypopnea (shallow breathing), followed by apnea


These are all so similar though!  How is a differential diagnosis made?

it seems, according to the above definitions, that  Biot's is Cheyne-Stokes without the apnea...but what's the difference between Cheyne-Stokes and Kussmaul?


I am excited because this change in depth of breathing is what happens with my son....I didn't know there were different disorders with this as a characteristic......does that mean apnea normally does NOT include changes in the depth of breathing??  If so, then this would differentiate what my son is doing from regular apnea...

anybody with info?  experience?

thanks!

I've been searching the net for info....

Although the description of Kussmaul breathing sounds very similar to my son's breathing, it seems that it only occurs with diabetes, severe hypoglycemia, starvation, or carbohydrate metabolism disorders.  I don't believe any of those apply to my son.

 re: Cheyne-Stokes  http://www.sleepdisordersguide.com/cheyne-stokes-respiration.html
"Patterns of cheyne-stokes respiration:
Cheyne-stokes respiration has alternate periods of no breathing changing smoothly into periods of hyper breathing, which smoothly change back into no breathing. This type of breathing is abnormal and can occur during sleep or wakefulness. If it occurs in wakefulness, it is a sign of more advanced disease.

If a person who is sleeping has cheyne-stokes respiration, the apnea durations are ten seconds or larger, and if there are more than five such apneas per hour of sleep, then the person has central sleep apnea. "


ok.....round & round we go....back to central apnea!

Kussmaul respirations, or hyperpnea, are deep, rapid respirations and indicate the body is trying blow off the excess carbon dioxide in the system or after strenuous exercise. They have an increased rate, very large tidal volume (deep breath) and no expiratory pause. In other words there is no stopping between inhaling and exhaling.

Cheyne-Stokes respirations are a cyclic type of breathing in response to hypercapnia (carbon-dioxide buildup) in the system. The cycle starts with a smooth increase, or crescendo effect, in the rate and depth of respirations followed by a gradual smooth decrease, or decrescendo effect, in the rate and depth of respirations ending in a short period of apnea that can last from 15 to 60 seconds. Then the cycle repeats itself. Cheyne Stokes respirations result from any condition that slows the blood flow to the brain stem because it slows impulses sending information to the respiratory center of the brain stem. An injury or compromise of the brain above the brain stem will also contribute to the development of Cheyne-Stokes respirations.

Biots’ Breathing is irregular respirations with irregular periods of apnea. There is no cyclic nature to them as in Cheyne-Stokes breathing. Breaths are generally of equal depth (also distingishing them from Cheyne-Stokes). Think of them as Cheyne-Stokes cycle gone chaotic.

Found this on the web and found it be very a pretty good description.

Cheynes-Stokes:  increase in the rate & depth of breathing....
this does not happen with my son....the rate never increases above normal----it gradually decreases in rate while it increases in depth and in length of apnea, then the will eventully increase  to more normal when the apnea subsides---but that doesn't sound like " gradual cresendo" to me, does it to you?  maybe that is what they mean??


This is what I have observed w/my son:

deep inhalations lasting 2-4 sec then exhalation lasting 3-5 sec followed by apnea episode (varies between 13-34 sec as cycle continues) for 35 minutes.  There were 5 brief, shallow breaths (not back-to-back though) toward the last 5-10 of this 35 min. period.

then for 10 min his inhalations were neither deep, nor shallow and the pauses between them were 1-6 secs.  with 2 arousals.

then back to deep inhalations followed by apnea episodes of 14-55 sec...woke, snorted, sat up, lay down, yawns,

then begins to hold his breath for 17-47 sec before exhaling audibly followed by only 3-5 sec pause between breathing very shallow.


Do you (anybody) see any of the patterns definined as Biot, Cheynes, or Kussmaul?

embryopathy wrote:

Cheynes-Stokes:  increase in the rate & depth of breathing....
this does not happen with my son....the rate never increases above normal----it gradually decreases in rate while it increases in depth and in length of apnea, then the will eventully increase  to more normal when the apnea subsides---but that doesn't sound like " gradual cresendo" to me, does it to you?  maybe that is what they mean??


This is what I have observed w/my son:

deep inhalations lasting 2-4 sec then exhalation lasting 3-5 sec followed by apnea episode (varies between 13-34 sec as cycle continues) for 35 minutes.  There were 5 brief, shallow breaths (not back-to-back though) toward the last 5-10 of this 35 min. period.

then for 10 min his inhalations were neither deep, nor shallow and the pauses between them were 1-6 secs.  with 2 arousals.

then back to deep inhalations followed by apnea episodes of 14-55 sec...woke, snorted, sat up, lay down, yawns,

then begins to hold his breath for 17-47 sec before exhaling audibly followed by only 3-5 sec pause between breathing very shallow.


Do you (anybody) see any of the patterns definined as Biot, Cheynes, or Kussmaul?

Did you watch his eyes during this time period. Was he in REM sleep?

that's an interesting question.....no I don't watch his eyes....am pretty focused on his rib cage .

what would it tell you if he was in REM?

[quote="RAM_Sleep"]

embryopathy wrote:

Cheynes-Stokes:  increase in the rate & depth of breathing....
this does not happen with my son....the rate never increases above normal----it gradually decreases in rate while it increases in depth and in length of apnea, then the will eventully increase  to more normal when the apnea subsides---but that doesn't sound like " gradual cresendo" to me, does it to you?  maybe that is what they mean??

I guess it could be this if I look at it another way....I have usually considered his apnea to gradually increase (in length) and then it gradually decreases in length until back to normal.....I guess this might be the same thing as repirations increasing & decreasing?
....see that's why I always get confused....I usually think of increased rate of respiration as tachypnea/pantying/hyperventilating and he does not do this.  It is his rate of NOT breathing that increases and decreases.....does that rule out Cheynes-Stokes?

RAM_Sleep wrote:

Kussmaul respirations, or hyperpnea, are deep, rapid respirations and indicate the body is trying blow off the excess carbon dioxide in the system or after strenuous exercise.

Kussmaul is actually driven by a low pH (increased acidosis).  pCO2 is simply carried along for the ride, and becomes moderately to severely to very severely reduced.

RAM_Sleep wrote:

Cheyne-Stokes respirations are a cyclic type of breathing in response to hypercapnia (carbon-dioxide buildup) in the system.

In CSR, mean pCO2 is again sub-normal and overall is a disturbance of hypocapnia, and not hypercapnia.

Indeed, if one were to raise pCO2 in these patients, they would actually improve:

Treating CSR With Inspired CO2

RAM_Sleep wrote:

Biots’ Breathing is irregular respirations with irregular periods of apnea. There is no cyclic nature to them as in Cheyne-Stokes breathing.

Biot's can demonstrate periodicity.  Given the grave prognosis associated with Biot's, however, I wouldn't be looking for them on a sleep apnea board.

Ed

Morbius wrote:

RAM_Sleep wrote:

Kussmaul respirations, or hyperpnea, are deep, rapid respirations and indicate the body is trying blow off the excess carbon dioxide in the system or after strenuous exercise.

Kussmaul is actually driven by a low pH (increased acidosis).  pCO2 is simply carried along for the ride, and becomes moderately to severely to very severely reduced.

RAM_Sleep wrote:

Cheyne-Stokes respirations are a cyclic type of breathing in response to hypercapnia (carbon-dioxide buildup) in the system.

In CSR, mean pCO2 is again sub-normal and overall is a disturbance of hypocapnia, and not hypercapnia.

Indeed, if one were to raise pCO2 in these patients, they would actually improve:

Treating CSR With Inspired CO2

RAM_Sleep wrote:

Biots’ Breathing is irregular respirations with irregular periods of apnea. There is no cyclic nature to them as in Cheyne-Stokes breathing.

Biot's can demonstrate periodicity.  Given the grave prognosis associated with Biot's, however, I wouldn't be looking for them on a sleep apnea board.

Ed

No sense in trying to prove me wrong. I copied from another site (a nursing site).

1) i simply pasted a description. im not suggesting that anyone in particular has any of these conditions.

I was taught that Cheynes-Stokes is associated with brain damage and usually is the type of breathing just prior to death.  Is this incorrect?


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BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

it is often assoc. w/congestive heart failure and can be seen in people who are dying...but it is not always assoc with either.