Table of ContentsView AllTable of ContentsSymptomsCausesDeath and DyingDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Death and Dying
Diagnosis
Treatment
Cheyne-Stokes respirations may be a sign of a serious lung, brain, or circulatory problem like a pulmonary edema, stroke, or heart failure. It also commonly occurs as a person approaches the end of life.
Diagnosing Cheyne-Stokes respiration can be difficult because it often occurs while you are asleep. The presence of Cheyne-Stokes respirations, particularly in someone who is awake, is generally indicative of a poorprognosis(outcome).
This article explains what Cheyne-Stokes respirations look like, why they happen, and what can be done to diagnose and treat this distressing respiratory symptom.
Ariel Skelley / Getty Images
Cheyne-Stokes Breathing Pattern
During Cheyne-Stokes respirations, the breathing may seem erratic, but it occurs in a relatively consistent, three-part cycle:
Each cycle on average lasts 30 seconds to two minutes. For some people, apnea is replaced with periods of extremely shallow breathing, calledhypopnea.
The irregular breathing episodes most often occur while a person is sleeping (particularly duringREM sleepwhen a person is dreaming). The episodes tend to be worse when a person sleeps on their back.
Cheyne-Stokes respirations can occur while a person is awake and is generally a sign that their health is deteriorating. This irregular breathing pattern is common in the last days and hours of life when a person is dying.
Other Symptoms
Causes of Cheyne-Stokes Breathing
The mechanisms influencing Cheyne-Stokes respirations are not fully understood but are thought to be related to problems with the respiratory, circulatory, and central nervous systems.
Cheyne-Stokes respiration commonly occurs alongsidecentral sleep apnea. This is the type of sleep apnea where the brain temporarily stops sending signals to the muscles controlling respiration.
Associated Conditions
There are many conditions for which Cheyne-Stokes respirations are common:
How Common Is It?Cheyne-Stokes respirations are a relatively uncommon symptom outside of end-of-life situations. With that said, anywhere from 25% to 50% with advanced heart failure will experience Cheyne-Stokes breathing as blood flow from the heart continues to decline.
How Common Is It?
Cheyne-Stokes respirations are a relatively uncommon symptom outside of end-of-life situations. With that said, anywhere from 25% to 50% with advanced heart failure will experience Cheyne-Stokes breathing as blood flow from the heart continues to decline.
Cheyne-Stokes Breathing and Dying
Cheyne-Stokes breathing is commonly seen when people are in thedying process. It can occur in the days or hours before a person dies.
Cheyne-Stokes breathing may be agonizing to watch, but it isnot uncomfortable for the dying person. It is simply the body’s way of compensating for physiological changes as the lungs, heart, kidney, liver, and brain start to fail in succession.
How Long Does It Last Before Death?
When a person is in the process of dying, Cheyne-Stokes respirations generally mean that death will occur within minutes or hours. This is not always the case, however, and the irregular breathing may persist for one or several days.
The same applies to the “death rattle,” which generally suggests death within 24 to 48 hours.
Diagnosing Cheyne-Stokes respirations is relatively straightforward as it involves a characteristic pattern of breathing. With that said, most episodes occur at night and may require a type of sleep study calledpolysomnographyto confirm the diagnosis.
Polysomnography involves an overnight stay in a sleep clinic during which you will be recorded on camera while you sleep. Your heart rate, respiration rate, brain waves, blood oxygen levels, and eye movements will also be monitored.
Cheyne-Stokes breathing in people with heart failure is a poor prognostic sign. It is associated with reducedsurvival times, particularly in those who experience it while sitting or standing.
Treatment of Cheyne-Stokes Breathing
The treatment of Cheyne-Stokes respirations is based on the underlying cause. With certain causes, such as high altitude, medication overdose, and carbon dioxide poisoning, the condition can be resolved. In others, the condition may be ongoing and will need to be managed.
As heart failure is one of the most common causes of Cheyne-Stokes breathing, the treatment may involve heart failure medications like:
People with severe heart failure may also need to undergo procedures and surgeries like:
Other treatment options for Cheyne-Stokes breathing include:
Summary
Cheyne-Stokes respirations most often occur at night and are common in people with advanced heart failure. Other conditions affecting the lungs, brain, or circulatory system can also cause Cheyne-Stokes respiration.
Cheyne-Stokes respirations are also a part of the dying process and typically indicate death within minutes, hours, or days.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Wang Y, Cao J, Feng J, Chen B.Cheyne-Stokes respiration during sleep: mechanisms and potential interventions.Br J Hospital Med. 2015;76(7):390-6. doi:10.12968/hmed.2015.76.7.390Sands SA, Bradley A, Edward KK, et al.Control theory prediction of resolved Cheyne−Stokes respiration in heart failure.Eur Respir J. 2016;48:1351-9. doi:10.1183/13993003.00615-2016Saito K, Takamatsu Y.Cheyne-Stokes breathing as a predictive indicator of heart failure in patients with obstructive sleep apnea; a retrospective case control study using continuous positive airway pressure remote monitoring data.Front Cardiovasc Med.2022;9:790331. doi:10.3389/fcvm.2022.790331Hui D, Dos Santos R, Chisholm G, et al..Bedside clinical signs associated with impending death in patients with advanced cancer: preliminary findings of a prospective, longitudinal cohort study.Cancer.2015;121(6):960–7. doi:10.1002/cncr.29048American Academy of Sleep Medicine.Sleep study.Somers VK, Karim S.Upright Cheyne-Stokes respiration in heart failure: look but don’t touch.J Am Coll Cardiol.2020;75(23):2947-9. doi:10.1016/j.jacc.2020.04.033
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Wang Y, Cao J, Feng J, Chen B.Cheyne-Stokes respiration during sleep: mechanisms and potential interventions.Br J Hospital Med. 2015;76(7):390-6. doi:10.12968/hmed.2015.76.7.390Sands SA, Bradley A, Edward KK, et al.Control theory prediction of resolved Cheyne−Stokes respiration in heart failure.Eur Respir J. 2016;48:1351-9. doi:10.1183/13993003.00615-2016Saito K, Takamatsu Y.Cheyne-Stokes breathing as a predictive indicator of heart failure in patients with obstructive sleep apnea; a retrospective case control study using continuous positive airway pressure remote monitoring data.Front Cardiovasc Med.2022;9:790331. doi:10.3389/fcvm.2022.790331Hui D, Dos Santos R, Chisholm G, et al..Bedside clinical signs associated with impending death in patients with advanced cancer: preliminary findings of a prospective, longitudinal cohort study.Cancer.2015;121(6):960–7. doi:10.1002/cncr.29048American Academy of Sleep Medicine.Sleep study.Somers VK, Karim S.Upright Cheyne-Stokes respiration in heart failure: look but don’t touch.J Am Coll Cardiol.2020;75(23):2947-9. doi:10.1016/j.jacc.2020.04.033
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Wang Y, Cao J, Feng J, Chen B.Cheyne-Stokes respiration during sleep: mechanisms and potential interventions.Br J Hospital Med. 2015;76(7):390-6. doi:10.12968/hmed.2015.76.7.390Sands SA, Bradley A, Edward KK, et al.Control theory prediction of resolved Cheyne−Stokes respiration in heart failure.Eur Respir J. 2016;48:1351-9. doi:10.1183/13993003.00615-2016Saito K, Takamatsu Y.Cheyne-Stokes breathing as a predictive indicator of heart failure in patients with obstructive sleep apnea; a retrospective case control study using continuous positive airway pressure remote monitoring data.Front Cardiovasc Med.2022;9:790331. doi:10.3389/fcvm.2022.790331Hui D, Dos Santos R, Chisholm G, et al..Bedside clinical signs associated with impending death in patients with advanced cancer: preliminary findings of a prospective, longitudinal cohort study.Cancer.2015;121(6):960–7. doi:10.1002/cncr.29048American Academy of Sleep Medicine.Sleep study.Somers VK, Karim S.Upright Cheyne-Stokes respiration in heart failure: look but don’t touch.J Am Coll Cardiol.2020;75(23):2947-9. doi:10.1016/j.jacc.2020.04.033
Wang Y, Cao J, Feng J, Chen B.Cheyne-Stokes respiration during sleep: mechanisms and potential interventions.Br J Hospital Med. 2015;76(7):390-6. doi:10.12968/hmed.2015.76.7.390
Sands SA, Bradley A, Edward KK, et al.Control theory prediction of resolved Cheyne−Stokes respiration in heart failure.Eur Respir J. 2016;48:1351-9. doi:10.1183/13993003.00615-2016
Saito K, Takamatsu Y.Cheyne-Stokes breathing as a predictive indicator of heart failure in patients with obstructive sleep apnea; a retrospective case control study using continuous positive airway pressure remote monitoring data.Front Cardiovasc Med.2022;9:790331. doi:10.3389/fcvm.2022.790331
Hui D, Dos Santos R, Chisholm G, et al..Bedside clinical signs associated with impending death in patients with advanced cancer: preliminary findings of a prospective, longitudinal cohort study.Cancer.2015;121(6):960–7. doi:10.1002/cncr.29048
American Academy of Sleep Medicine.Sleep study.
Somers VK, Karim S.Upright Cheyne-Stokes respiration in heart failure: look but don’t touch.J Am Coll Cardiol.2020;75(23):2947-9. doi:10.1016/j.jacc.2020.04.033
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