Biots Breathing pattern

Discussion in 'Sleep Apnea & CPAP Users Forum' started by CelL4, Apr 1, 2018.

  1. CelL4

    CelL4 New Member

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    After few weeks of dithering, I finally undertook my titration study one month ago, and the follow-up appointment. I was recommended a BiPap, but all apneas were central and were told I did not tolerate ASV. Intrigued, I discussed and asked questions about this with my doctor. I knew I hadn’t slept well due to a head-splitting migraine; I might have slept for maybe 4-5 hours and was worried about my worst central apneic episodes not showing up in the study. I was noted to have a sleep efficiency of around 69%, (I thought it might be less).

    Anyways looking at my detailed report, I was assured that my worst central apneic episodes showed up almost immediately. I was informed that I have something known as Biot's breathing. Having no idea of what it meant, I was just looking at report wanting to see why I was tested on Bi-PAP mode. It turns out the tech tested me on ASV (Adaptive Servo Ventilation) for only 45 minutes as he felt it was disturbing my sleep and shifted back to Bi-PAP mode, instead of trying other settings.

    I told my doctor that I knew BiPAP would not help in resolving central apnea and I am in no mood to undergo the test again. Even he was wondering why was Bi-PAP setting used and checked with his other colleague and came back saying ASV would do fine and in case I am not comfortable, he would run it closer to the Bi-PAP setting.

    Cutting a long story short, my central question is what is Biot's breathing and whether ASV would be suitable for the same. Moreover, I do not have the copy of the detailed report yet since they said they would give me the report after including the new recommendations. Also, do I need ASV (certainly an afterthought) or can I handle my Biot's on Bi-PAP?

    Another doubt that I have is regarding nasal pillows. I was told nasal pillow would be a problem with ASV. I am unable to use FFM since I have severe pain using that and I was switched from FFM to nasal pillow mask.

    Eagerly waiting for recommendations.
     
  2. hendrix

    hendrix New Member

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    While I have very little knowledge about Biot's, but I can assure you that you can use a nasal pillow with ASV. Though some may have problems with it, it is more individualized reasons. Many people are using it, including me (I use S9 VPAP Adapt), and have had no issues at all with it.
     
  3. CelL4

    CelL4 New Member

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    Thanks, @hendrix. That certainly takes off a big burden off my mind. Was dreading whether I would have to return to FFM.
     
  4. Pluslykell

    Pluslykell New Member

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    Pardon me, but can somebody tell me what does Biot’s Breathing and ASV mean…never heard of it….
     
  5. Neil

    Neil New Member

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    As per Wikipedia:
    I am also attaching a comparison graph for Biot’s and Cheyne–Stokes respiration.

    Normal Breathing
    upload_2017-11-3_11-3-49.png
    Biot's Breathing
    upload_2017-11-3_11-4-56.png
    Cheyne-Stokes Respiration
    upload_2017-11-3_11-5-47.png


    From the graph, it looks like there is a period of normal breathing interspersed between two episodes of hyperpnoea. I might be wrong, but I think using ASV would result in stabilizing the pattern.

    BTW, I initially started on Mirage Swift II nasal pillows from ResMed with my ASV machine for nearly one year, but later switched to FFM as my longstanding ear problem flared up due to the nasal pillow issues.

     
  6. Cristina

    Cristina New Member

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    ASV stands for Adaptive Servo Ventilation, a non-invasive ventilatory treatment developed for treating adults who have OSA and central and complex sleep apnea. I have a video link for Biot’s breathing.
    Hope it is useful for you:

     
  7. CelL4

    CelL4 New Member

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    Well, thanks @Neil and @Cristina for the graphs and link. The comparison graph looks very neat; however, my flow chart seems very erratic with central apneas, hypo and hyperventilating episodes having a field day. Never knew the difference between Biot’s and Cheyne's Stokes is unpredictable nature of the flowchart. Opened my eyes. Also thanks for assurance on the nasal pillow.
     
  8. cubbaluege

    cubbaluege New Member

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    I have come across an article which says that patients having symptomatic heart failure with the left ventricular ejection fraction of less than 45 should be careful about using ASV machines for the treatment of central and obstructive sleep apnea. This is worrying for me since I have the heart failure and my LVEF is 41. Not sure whom to turn around to for this. I read the article on the following link -- https://aasm.org/special-safety-not...tral-sleep-apnea-patients-with-heart-failure/
     
  9. evie

    evie New Member

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    Dear @cubbaluege, I think you should check with your cardiologist first about this and as per his suggestion follow up with your sleep MD. There are many patients who have heart failure and are using ASV without any issues.
     
  10. Kingston

    Kingston New Member

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    Hi @CelL4, is there any particular reason for you having Biot’s breathing…or shall I say do you use opioids or had any traumatic or stroke-related brain injury which has resulted in this? I have not heard about Bi-PAP being used for Biot’s, and I think you should look for a second opinion as well as find out any particular reason why ASV was switched over, as “not having a comfortable sleep” seems too reasonable to be the real reason.
     
  11. CelL4

    CelL4 New Member

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    Thanks for the advice @Kingston. I had met with a car accident around 10 years ago and had an injury to my brain and have been using painkillers after undergoing surgery for the brain injury. Even my thinking was along the same lines as far as the second opinion was concerned as my sleep specialist has not much experience in treating Biot’s. He agreed for ASV since I pushed very hard for it..so I think I would go for a second opinion and see what the diagnosis is.


    Anyways would keep all posted about the same.
     

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