Cheyne-Stokes respiration, or periodic respiration, involves an atypical pattern of breathing. It consists of cycles of deep breathing followed by shallow breathing. Cheyne-Stokes breathing can be a sign of lung or circulatory problems.

On average, each cycle lasts between 30 seconds and 2 minutes. It occurs when a person is asleep and awake, but healthcare professionals believe it to be more common during sleep.

Read more to learn about what causes Cheyne-Stokes respiration, its symptoms, how to treat it, and more.

A woman taking a deep breath.Share on Pinterest
Tatiana Maksimova/Getty Images

Researchers do not fully understand the physiological processes that lead to the development of Cheyne-Stokes respiration. However, they think it links to:

  • Unstable feedback in the respiratory control system: Varying levels of oxygen and carbon dioxide in the blood cause the cycles of apnea and hyperventilation.
  • Delayed circulation: Circulation time increases in people with congestive heart failure and Cheyne-Stokes respiration. Doctors do not consider this a significant contributor to the cause of the condition, but it has direct links to the length of these atypical breathing cycles.
  • Reduced blood gas buffering capacity: Another potential cause of Cheyne-Stokes respiration. The bicarbonate buffer system helps maintain the pH of the body by expelling carbon dioxide through exhalation. As those with Cheyne-Stokes respiration hyperventilate, their total carbon dioxide stores are likely to reduce. This interferes with the carbon dioxide buffering capacity of the body.

People with Cheyne-Stokes respiration usually experience:

  • Orthopnea: This refers to shortness of breath when lying down.
  • Paroxysmal nocturnal dyspnea: This refers to severe shortness of breath and coughing fits. It usually occurs at night and disrupts sleep.
  • Excessive daytime sleepiness and fatigue: This occurs due to periods of interrupted sleep.

Cheyne-Stokes respiration can occur in people with neurological conditions or congestive heart failure. Some research estimates that 50% of all people with moderate to severe congestive heart failure also have significant Cheyne-Stokes respiration.

Doctors recognize it as a component of sleep apnea, a common condition where a person temporarily stops breathing during sleep.

Doctors can mistake other atypical breathing patterns for Cheyne-Stokes respiration. They include:

Kussmaul breathing

Deep, rapid breathing characterizes Kussmaul breathing. However, this condition does not feature the shallow breaths, apnea, or alternations in breathing patterns of Cheyne-Stokes respiration — it remains deep and rapid throughout.

Kussmaul respiration can be observable in people with diabetic ketoacidosis or kidney failure. It is a compensatory measure to try and regain a balance between acid and alkaline in the body.

Cluster breathing

Also known as Biot’s respirations, cluster breathing involves groups of rapid, shallow breathing, after which periods of apnea then follow.

Unlike Cheyne-Stokes respiration, it does not involve cycles of deep breathing or gradual changes in breathing patterns.


This involves over-breathing. A person’s breathing becomes deep and rapid, causing low levels of carbon dioxide and high levels of oxygen in the blood.

People who are feeling anxious or stressed or experiencing a panic attack may hyperventilate. Symptoms include dizziness, weakness, fainting, and confusion.


Breathing that is too slow or too shallow is called hypoventilation. It causes high levels of carbon dioxide and low levels of oxygen in the blood.

It may occur due to lung problems, such as emphysema or cystic fibrosis. Symptoms include daytime sleepiness, headaches, and fainting.

Obstructive sleep apnea

People with obstructive sleep apnea experience brief periods when their breathing stops. These periods result from upper airway collapse and may occur several times each hour.

Obstructive sleep apnea has links to obesity. Symptoms include headaches upon waking, difficulty concentrating, and daytime sleepiness.

Diagnosing Cheyne-Stokes respiration can be difficult because it usually occurs during sleep.

Those experiencing the symptoms of Cheyne-Stokes or other atypical breathing patterns should contact a doctor. They can evaluate a person’s symptoms and perform a physical examination.

If the condition occurs at night, a doctor may recommend polysomnography, a type of sleep study. It records heart rate, breathing rate, brain waves, blood oxygen levels, eye movements, and other movements during sleep.

Management of Cheyne-Stokes respiration focuses on treating the underlying cause of the condition.

Heart failure treatment

If congestive heart failure is causing Cheyne-Stokes respiration, doctors will aim to treat it with the following approaches:

  • medications
  • cardiac valve surgery
  • heart transplant
  • pacemakers and other devices

Supplemental oxygen

Short-term oxygen treatment during sleep can reduce Cheyne-Stokes respiration. Night oxygen therapy could also improve a person’s symptoms, quality of life, and heart function.

Continuous positive airway pressure (CPAP)

CPAP is the leading treatment for sleep apnea. This therapy uses mild air pressure to keep a person’s airway open. A person wears a mask that connects to a CPAP machine via a tube to supply a positive flow of air.

Benefits include better sleep quality, reduced snoring, and less daytime sleepiness. Long-term benefits include blood pressure control, reduced risk of stroke, and improved memory.

Although some older research indicates that CPAP does not increase survival rates in people with heart failure, other research says that CPAP treatment is helpful to individuals with Cheyne-Stokes respiration.

According to the National Sleep Foundation, most insurance companies cover CPAP treatment.

Preventing Cheyne-Stokes respiration involves stopping the medical conditions associated with it, including heart failure and stroke. People with these health issues should ensure they follow their treatment plan to help manage their symptoms.

Additionally, avoiding exposure to heavy metals and other toxins, which can cause toxic encephalopathy, may also help prevent the condition.

Cheyne-Stokes respiration is an atypical pattern of breathing involving deep breathing followed by shallow breathing. It is a serious condition that usually occurs due to an underlying health condition, such as congestive heart failure.

Treatment typically involves managing the underlying condition. Doctors may also recommend CPAP and supplemental oxygen.