Periodic breathing describes an irregular breathing pattern characterized by cycles of deeper breaths that gradually become shallower, sometimes leading to brief pauses in breathing. This pattern involves fluctuations in breathing depth and rate rather than a steady rhythm. It can occur in various contexts and does not inherently signify a medical problem.
Identifying Periodic Breathing
Observing periodic breathing involves noticing a distinct pattern in the depth and rate of breaths. An individual’s breathing will wax and wane, gradually increasing in depth and speed, then progressively slowing and becoming shallower. This slowing often culminates in a short pause where breathing temporarily ceases. After this pause, the breathing cycle restarts, beginning again with shallow breaths that deepen over time. These cycles can repeat consistently, often lasting between 30 seconds and two minutes per full cycle.
Such patterns can be subtle or more pronounced, and they may occur during wakefulness or sleep. The pauses are central apneas, meaning they occur without effort from the respiratory muscles. Recognizing these cyclical changes helps distinguish periodic breathing from consistent, regular respiration.
Periodic Breathing in Healthy Individuals
Periodic breathing is not always a sign of an underlying health issue and can occur in healthy individuals under specific circumstances. Infants, especially premature ones, commonly exhibit this breathing pattern as a normal part of their development. This pattern typically resolves by six months of age. These pauses usually last between five and ten seconds, followed by a series of rapid, shallow breaths before returning to a steady rhythm. This common occurrence is generally considered harmless and requires no intervention if the infant restarts breathing on their own without other concerning symptoms.
Another scenario where periodic breathing is frequently observed in healthy individuals is at high altitudes. When ascending to altitudes above 2,500 meters (approximately 8,200 feet), lower oxygen availability can trigger this pattern during sleep. This is a physiological adjustment as the body attempts to acclimate to reduced oxygen, and it often disappears as individuals become acclimatized. Periodic breathing can also occur during sleep in some healthy adults, where the body’s respiratory control system may experience minor instability, particularly during non-REM sleep.
Medical Conditions Associated with Periodic Breathing
While sometimes benign, periodic breathing can also be a symptom of various medical conditions, particularly a specific form known as Cheyne-Stokes respiration (CSR). This pattern is characterized by breaths that gradually increase in depth and rate, then decrease, followed by a period of apnea. It reflects an instability in the respiratory control system, often due to delayed feedback between the lungs and the brain’s respiratory centers.
Heart failure is a prominent condition associated with Cheyne-Stokes respiration, affecting 30% to 50% of individuals with moderate to severe heart failure. In heart failure, the heart’s reduced pumping efficiency leads to slower blood circulation, which delays the transport of oxygen and carbon dioxide signals to the brain’s respiratory control center. This delayed feedback causes the body to overcompensate, leading to periods of hyperventilation that excessively lower carbon dioxide levels, followed by pauses in breathing until carbon dioxide builds up again. The recurrent hypoxia and sympathetic surges associated with Cheyne-Stokes respiration can further stress the failing heart.
Stroke is another condition where Cheyne-Stokes respiration is frequently observed, occurring in up to half of individuals following a stroke. Similar to heart failure, the underlying mechanism involves unstable central respiratory control, often related to altered carbon dioxide sensitivity. While delayed circulation can contribute, other factors, such as damage to brain regions controlling respiration, may also play a role. Kidney failure can also be associated with Cheyne-Stokes respiration. The condition can also manifest in certain neurological disorders, traumatic brain injuries, and in severely ill patients nearing the end of life.
When to Seek Medical Advice
If periodic breathing is observed, especially in an adult, certain indicators suggest that medical attention may be warranted. While often harmless in infants, parents should seek medical care if a baby’s pauses in breathing last longer than 10 seconds, occur more frequently than usual, or if the infant’s skin changes color (e.g., bluish around the lips) or they become unresponsive. These symptoms differentiate periodic breathing from more concerning conditions like apnea.
For adults, periodic breathing that occurs regularly or is accompanied by other symptoms should prompt a medical evaluation. Symptoms such as excessive daytime sleepiness, chronic fatigue, loud snoring, morning headaches, or a sudden feeling of breathlessness or gasping during sleep are concerning signs. Difficulty concentrating, mood swings, or chest pain at night can also signal an underlying issue. A healthcare provider may recommend a sleep study to accurately diagnose the breathing pattern and identify any associated conditions like central sleep apnea. Addressing the root cause, such as treating heart failure or other medical conditions, can often alleviate periodic breathing.