What Is Cheyne Stokes Breathing? The Basics

Cheyne-Stokes breathing is a specific pattern of abnormal breathing where a person’s breath gradually becomes deeper, then shallower, until it stops entirely for a short period before starting the cycle again. This waxing-and-waning pattern typically repeats every 30 seconds to two minutes. It is most commonly seen in people with heart failure, stroke, or brain injuries, and it often occurs during sleep, though it can happen while awake in severe cases.

What Is Cheyne Stokes Breathing?

Cheyne-Stokes breathing is a form of periodic breathing. That means the breathing rhythm is not steady. Instead, it follows a repeating cycle: a gradual increase in breathing depth, a gradual decrease, and then a pause where no breathing occurs at all. This pause is called apnea.

The cycle is not random. It is driven by a delay in how the brain detects carbon dioxide levels in the blood. Normally, the brain monitors carbon dioxide constantly and adjusts breathing to keep it in a narrow range. In Cheyne-Stokes breathing, this feedback loop is slow to respond. The brain overcorrects, causing the breathing to overshoot in both directions — too fast and deep, then too slow and shallow, then a complete stop.

The condition is named after two physicians, John Cheyne and William Stokes, who described it in the 1800s. It is not a disease itself. It is a sign that something else is affecting the body’s breathing control system.

What Causes Cheyne-Stokes Breathing?

The most common cause is congestive heart failure. When the heart pumps less effectively, blood flow to the brain becomes slower and more variable. This slows the delivery of carbon dioxide to the brain’s breathing center, creating a lag in the feedback loop. The brain responds to outdated information, which produces the characteristic overshoot-and-pause pattern.

Stroke and other neurological conditions can also cause it. Damage to the brainstem — the area that controls automatic breathing — disrupts the same feedback system. Traumatic brain injury, brain tumors, and certain degenerative neurological diseases have all been linked to Cheyne-Stokes breathing.

It can also appear in healthy people under specific circumstances. High-altitude exposure can trigger it because lower oxygen levels change how the body regulates breathing. Some healthy older adults show a mild form of it during sleep without any underlying disease. In those cases, it is generally not considered harmful.

How Is Cheyne-Stokes Breathing Different From Sleep Apnea?

Sleep apnea is a broader term that covers several conditions where breathing stops during sleep. Cheyne-Stokes breathing is one specific type of periodic breathing, but it is often grouped under sleep-disordered breathing.

The key difference is the pattern. In obstructive sleep apnea, the airway physically collapses and blocks airflow. The person tries to breathe but cannot. In Cheyne-Stokes breathing, the airway is open. The problem is in the brain’s signaling, not the airway itself.

There is also a difference in who it affects. Obstructive sleep apnea is most common in people who are overweight or have anatomical airway issues. Cheyne-Stokes breathing is most common in people with heart failure or neurological conditions. The two can coexist, but they have different underlying mechanisms and often require different treatment approaches.

What Are the Symptoms of Cheyne-Stokes Breathing?

The most obvious symptom is the breathing pattern itself, which is often noticed by a bed partner. A person may appear to stop breathing for 10 to 30 seconds, then resume with increasingly deep breaths before the cycle repeats. This can happen dozens of times per night.

Many people with Cheyne-Stokes breathing do not realize they have it. They may wake up feeling unrefreshed, experience daytime fatigue, or have morning headaches. Some people wake up gasping or with a sensation of breathlessness, though this is less common than in obstructive sleep apnea.

Because Cheyne-Stokes breathing is frequently associated with heart failure, the symptoms of the underlying condition often dominate. Shortness of breath with exertion, swelling in the legs, and difficulty lying flat are signs of worsening heart failure that should be evaluated by a doctor promptly.

Why Is Cheyne-Stokes Breathing Important in Heart Failure?

Cheyne-Stokes breathing is not just a symptom of heart failure — it is also a marker of how severe the condition is. Studies have consistently found that people with heart failure who also have Cheyne-Stokes breathing tend to have worse outcomes than those without it. This includes higher rates of hospitalization and reduced survival.

The relationship works in both directions. Heart failure causes Cheyne-Stokes breathing, and Cheyne-Stokes breathing can make heart failure worse. The repeated drops in blood oxygen levels during apnea periods add stress to an already weakened heart. The frequent awakenings and poor sleep quality also increase the body’s stress hormone levels, which can further strain the cardiovascular system.

For this reason, doctors often screen for Cheyne-Stokes breathing in patients with heart failure. Identifying it can help guide treatment decisions and provide important information about prognosis.

How Is Cheyne-Stokes Breathing Diagnosed?

A formal diagnosis usually requires a sleep study, called polysomnography. During this test, you spend a night in a sleep lab while monitors track your breathing, oxygen levels, heart rate, and brain activity. The test can identify the specific pattern of Cheyne-Stokes breathing and distinguish it from other types of sleep-disordered breathing.

The diagnosis is based on a specific pattern. The typical cycle involves at least three consecutive breaths that gradually increase and then decrease in depth, followed by a pause. In clinical practice, the diagnosis is made when this pattern is seen repeatedly during sleep.

If you have heart failure or a neurological condition and a bed partner reports that you stop breathing during sleep, a sleep study may be recommended. Some newer home sleep testing devices can also detect periodic breathing patterns, though in-lab testing remains the gold standard for a full evaluation.

What Are the Treatment Options?

Treatment starts with managing the underlying condition. For people with heart failure, optimizing heart failure medications is the first priority. Medications that improve heart function, such as ACE inhibitors, beta-blockers, and diuretics, can reduce the severity of Cheyne-Stokes breathing by improving blood flow and reducing fluid overload.

For some people, treating the heart failure is enough to resolve the breathing abnormality. For others, the breathing pattern persists despite optimal medical therapy. In those cases, additional treatments may be considered.

Positive airway pressure therapy is the most commonly used approach. Continuous positive airway pressure, or CPAP, delivers a steady stream of air through a mask to keep the airway open. While it is the standard treatment for obstructive sleep apnea, it is also used in some people with Cheyne-Stokes breathing.

A specialized form of this therapy, called adaptive servo-ventilation or ASV, was developed specifically for Cheyne-Stokes breathing. ASV monitors your breathing continuously and adjusts the pressure to stabilize the pattern. It does not just keep the airway open — it actively smooths out the waxing and waning.

There is an important caution here. A major clinical trial published in 2015 found that ASV increased mortality in heart failure patients with reduced ejection fraction who also had Cheyne-Stokes breathing. For this reason, ASV is no longer routinely recommended for this specific group. It may still be used in other situations, but the decision requires careful evaluation by a specialist.

Oxygen therapy is another option. Supplemental oxygen can reduce the severity of Cheyne-Stokes breathing in some patients by stabilizing the oxygen levels that contribute to the abnormal breathing drive. However, it does not work for everyone, and it is not considered a first-line treatment.

Can Cheyne-Stokes Breathing Be Prevented?

There is no specific way to prevent Cheyne-Stokes breathing itself. The best preventive approach is to manage the conditions that cause it. For people with heart failure, this means taking medications as prescribed, following a low-sodium diet, monitoring weight daily, and staying physically active within the limits recommended by a doctor.

For people with neurological conditions, preventing further damage to the brain is the focus. This includes controlling blood pressure, managing diabetes, and avoiding behaviors that increase stroke risk.

In otherwise healthy people who develop mild Cheyne-Stokes breathing at high altitude, the condition typically resolves on its own once they return to lower elevation. No treatment is usually needed.

When Should You See a Doctor?

You should seek medical evaluation if a bed partner observes that you stop breathing during sleep, especially if you have heart failure, a history of stroke, or another neurological condition. Daytime sleepiness, morning headaches, or waking up gasping are also reasons to talk to a doctor.

Cheyne-Stokes breathing in the setting of known heart failure is particularly important to report. It may indicate that your heart failure is not optimally controlled, and medication adjustments may be needed. Do not ignore it or assume it will resolve on its own.

If you have no underlying health conditions and notice an unusual breathing pattern, discuss it with your doctor. While it may be a benign finding, it can also be an early sign of an undiagnosed problem that deserves investigation.