Quick Answer: Cheyne-Stokes respiration (CSR) is a pattern of breathing characterised by crescendo-decrescendo cycles -- breaths that gradually increase, then decrease in depth and rate, followed by a brief pause (apnoea). It is most commonly associated with heart failure, stroke, and sometimes high altitude. Unlike obstructive sleep apnoea, the airway is not blocked -- the respiratory drive itself fluctuates due to instability in the brain's breathing control system. Treatment targets the underlying cause.
In This Guide
Reading Time: 6 minutes
Cheyne-Stokes respiration (often searched as "Cheyne-Stoking" or "Cheyne Stokes breathing") is named after John Cheyne, an Irish physician, and William Stokes, an Irish cardiologist, who described the pattern in the early 19th century. It is a specific, clinically recognisable breathing pattern that is always worth investigating when observed in adults, as it typically reflects significant underlying pathology.
What Is Cheyne-Stokes Respiration?
Cheyne-Stokes respiration is a form of periodic breathing in which the rate and depth of breathing alternate between two extremes in a predictable cycle:
- Breaths gradually increase in rate and depth over approximately 15-30 seconds (crescendo phase)
- Breaths gradually decrease in rate and depth over approximately 15-30 seconds (decrescendo phase)
- A brief cessation of breathing (central apnoea) lasting 10-30 seconds
- The cycle repeats
The entire cycle typically lasts 45-90 seconds and repeats continuously. An observer watching someone with CSR sees the breathing wax and wane rhythmically, sometimes with alarming pauses between cycles.
The Neuroscience of Cheyne-Stokes Breathing
Normal breathing is controlled by chemoreceptors that monitor CO2 and O2 levels in the blood and send signals to the brainstem respiratory centres. In Cheyne-Stokes, this feedback loop becomes unstable -- the system overshoots in both directions. After an apnoea, CO2 builds up, triggering hyperventilation (crescendo). Hyperventilation drops CO2 too far, suppressing respiratory drive (decrescendo into apnoea). The cycle then repeats. The instability is caused by either a prolonged circulation time from the lungs to the brainstem chemoreceptors (as in heart failure, where cardiac output is reduced) or by direct brainstem damage from stroke or injury. This is fundamentally different from obstructive sleep apnoea, where the airway physically collapses.
8 min read
Causes of Cheyne-Stokes Breathing
| Cause | Mechanism | Prevalence |
|---|---|---|
| Heart failure (most common) | Reduced cardiac output prolongs circulation time; delayed CO2 feedback creates respiratory instability | 30-50% of patients with systolic heart failure |
| Stroke or brain injury | Damage to brainstem or hemispheric structures disrupts respiratory control centres | Common in bilateral hemispheric strokes |
| High altitude | Low oxygen stimulates hyperventilation; CO2 drops; central apnoea results -- a normal physiological response | Very common above 2,500m; usually resolves with acclimatisation |
| Renal failure | Metabolic acidosis and fluid overload affect respiratory control | Less common than cardiac cause |
| Opioid medications | Opioids suppress respiratory drive and can cause central apnoea patterns | Common with high-dose chronic opioid use |
| Premature infants | Immature brainstem respiratory centres; physiologically normal in premature birth | Normal finding; resolves with maturation |
| End-of-life (terminal) | Multi-organ failure and altered consciousness produce CSR pattern | Common in dying patients; not painful to the patient |
Cheyne-Stokes vs Obstructive Sleep Apnoea
These are two distinct conditions that are sometimes confused because both involve pauses in breathing during sleep:
| Feature | Cheyne-Stokes Respiration | Obstructive Sleep Apnoea |
|---|---|---|
| Airway during apnoea | Open -- no airway obstruction | Collapsed -- physical blockage |
| Cause of apnoea | Loss of respiratory drive from brainstem | Airway collapse from soft tissue |
| Breathing pattern | Waxing and waning (crescendo-decrescendo) | Normal breathing, then abrupt cessation, then gasping return |
| Snoring | Less typical; may snore at crescendo peak | Loud snoring is a hallmark |
| Primary cause | Heart failure, stroke, high altitude | Obesity, jaw anatomy, alcohol, age |
| Standard CPAP treatment | May worsen CSR in some patients; ASV preferred | Highly effective |
Symptoms and Recognition
In a sleeping person, Cheyne-Stokes breathing appears as:
- Rhythmic increase then decrease in breathing effort and audibility
- Periodic complete pauses in breathing (central apnoea)
- Sometimes audible sighing at the end of the apnoea phase as breathing resumes
- The pattern is regular and cyclical, unlike the more variable pattern of obstructive apnoea
Associated symptoms may include disturbed sleep, daytime fatigue, nocturnal awakening with shortness of breath, and worsening of the underlying heart failure symptoms.
Treatment
Treatment of Cheyne-Stokes respiration is primarily directed at the underlying cause:
- Heart failure treatment: Optimising heart failure medications (ACE inhibitors, beta-blockers, diuretics) reduces CSR by improving cardiac output and shortening the circulation time that destabilises the feedback loop
- Adaptive servo-ventilation (ASV): A specialised form of positive airway pressure therapy that continuously adjusts pressure to smooth out breathing fluctuations -- more effective than standard CPAP for CSR associated with heart failure with preserved ejection fraction
- Supplemental oxygen: Can help in some cases by reducing the hypoxia that triggers hyperventilation
- Theophylline or acetazolamide: Sometimes used for high-altitude CSR
- High altitude: Descent resolves altitude-related CSR; acetazolamide prevents it
Important note: Standard CPAP therapy (commonly used for obstructive sleep apnoea) can worsen CSR associated with heart failure in some patients. A proper sleep study with respiratory monitoring is essential for correct diagnosis and treatment choice.
How It Affects Sleep Quality
Cheyne-Stokes breathing significantly disrupts sleep. The repeated central apnoeas cause arousals and prevent deep sleep. People with heart failure and CSR have very fragmented sleep with little slow-wave sleep, worsening the cardiac and cognitive effects of already-compromised heart function. The sleep disruption contributes to the excessive daytime sleepiness, cognitive impairment, and poor quality of life characteristic of symptomatic heart failure.
When Customers Mention Breathing Problems During Sleep
At Mattress Miracle, customers sometimes mention that a partner's breathing is irregular during sleep -- occasional pauses, crescendo-decrescendo patterns, or alarming stops and starts. If the breathing pattern sounds rhythmic and cyclical (not just occasional loud snoring with gasping), particularly in an older adult with known heart disease, CSR is a possibility worth reporting to a doctor. A sleep study can distinguish between obstructive and central apnoea and guide treatment appropriately.
Shop: View All Our Mattresses
Find Your Perfect Mattress at Mattress Miracle
We are a family-owned mattress store in Brantford, helping our community sleep better since 1997. Come try mattresses in person and get honest, no-pressure advice.
441 1/2 West Street, Brantford, Ontario
Call 519-770-0001Frequently Asked Questions
What is Cheyne-Stokes breathing?
Cheyne-Stokes respiration (CSR) is a pattern of periodic breathing in which breaths gradually increase then decrease in depth and rate, followed by a brief pause (central apnoea) before the cycle repeats. It is caused by instability in the brain's breathing control system -- not by airway obstruction. It is most commonly associated with heart failure, stroke, and high altitude.
Is Cheyne-Stokes breathing dangerous?
Cheyne-Stokes breathing at sea level in adults is almost always a sign of significant underlying disease (usually heart failure or stroke) and should be medically evaluated. It disrupts sleep significantly and is associated with worsened cardiovascular outcomes. High-altitude CSR is physiologically normal and resolves with acclimatisation or descent.
What is the difference between Cheyne-Stokes breathing and sleep apnoea?
Cheyne-Stokes is a central apnoea pattern -- the airway is open but the respiratory drive temporarily stops, caused by feedback loop instability in the brainstem. Obstructive sleep apnoea involves a physically collapsed airway. The breathing patterns look different: CSR has a gradual waxing and waning quality, while OSA has abrupt cessation followed by gasping. Treatment also differs -- standard CPAP for OSA may worsen CSR.
How is Cheyne-Stokes breathing treated?
Treatment focuses on the underlying cause. For heart failure, optimising cardiac medications reduces CSR. Adaptive servo-ventilation (ASV) is more effective than standard CPAP for heart failure-related CSR. Supplemental oxygen helps in some cases. High-altitude CSR resolves with descent or can be prevented with acetazolamide.
Sources
- Javaheri, S., & Dempsey, J.A. (2013). Central sleep apnea. Comprehensive Physiology, 3(1), 141-163. doi.org/10.1002/cphy.c110057
- Oldenburg, O., et al. (2012). Prevalence and risk factors of sleep-disordered breathing in patients with stable chronic heart failure. Circulation Journal, 76(1), 64-70.
- Naughton, M.T., & Lorenzi-Filho, G. (2009). Sleep in heart failure. Progress in Cardiovascular Diseases, 51(4), 339-349. doi.org/10.1016/j.pcad.2008.06.001
- Ponikowski, P., et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 37(27), 2129-2200. doi.org/10.1093/eurheartj/ehw128
- American Academy of Sleep Medicine. (2014). International Classification of Sleep Disorders, 3rd edition. AASM.
Visit Our Brantford Showroom
Mattress Miracle
441 1/2 West Street, Brantford
Phone: (519) 770-0001
Hours: Mon-Wed 10-6, Thu-Fri 10-7, Sat 10-5, Sun 12-4
If a partner's breathing is a concern, we are not medical professionals -- but we are good listeners. If you are also looking for a mattress with better motion isolation so that breathing irregularities disturb your sleep less, come in for a conversation. We have been helping Brantford families sleep better since 1997.
Visit Our Brantford Showroom
We are located at 441 1/2 West Street in downtown Brantford. Free parking available. Our team does not work on commission, so you get honest advice based on your needs.
Mattress Miracle -- 441 1/2 West Street, Brantford, ON -- (519) 770-0001
Hours: Monday-Wednesday 10am-6pm, Thursday-Friday 10am-7pm, Saturday 10am-5pm, Sunday 12pm-4pm.
Come in and let our team help you find the right mattress for your needs. No pressure, no commission.
Shop This Topic at Mattress Miracle
Popular picks at Mattress Miracle:
- Restonic ComfortCare Dalton & Albany pocket-coil mattress
- Whitney two-sided bamboo mattress
- Somnia 3.0 support pillow
Or view all our mattresses in our Brantford showroom.
Related Reading
- Waking Up Gasping for Air: Causes and When to Seek Help
- Waking Up Every Hour: 8 Causes and How to Sleep Through the Night
- Shaking While Sleeping: Causes, Types, and When to See a Doctor
- Why Do I Keep Waking Up at 5am? Causes and How to Sleep Later
- Waking Up Gasping for Air: Causes, When It's Serious, and What to Do
- Waking Up and Shaking: Causes, Red Flags, and Sleep Fixes