Respiratory disorders – Cheyne Stokes breathing

Breathing comes naturally, it seems. Yet every inhalation and exhalation is the result of a complex physiological and chemical process. The respiratory center in the brain and the acidity (pH) of the blood play a major role. Healthy people breathe almost without noticing. However, disorders can occur that make breathing less easy. Many diseases can also be recognized by a typical form of breathing. Cheyne Stokes breathing is a symptom that certain processes are going wrong in the brain. One of the characteristic features is apnea (breathing arrest). The dying process (sickness) is almost always accompanied by Cheyne Stokes breathing.


  • Breathing ‘naturally’
  • The course of Cheyne Stokes breathing
  • Apnea
  • Respiratory rate
  • The role of carbon dioxide
  • CO² level in the blood and Cheyne Stokes respiration
  • Causes of Cheyne Stokes Breathing
  • Sleeping pills and painkillers

Breathing ‘naturally’

Breathing can be influenced to a certain extent . An example of this is holding the breath and the fact that its frequency can be determined yourself, although problems quickly arise. The feeling of breathing automatically is in itself a beneficial body experience, which indicates that breathing at that moment is adapted to the needs of the body processes, or metabolism.

Respiratory center
When holding the breath, the urge to breathe occurs after a longer or shorter period of time , whereby the oxygen level in the blood has fallen and the carbon dioxide level has risen. As soon as the carbon dioxide content has exceeded a certain limit value, the respiratory center stimulates the respiratory muscles via certain nerves and inhalation follows. The cells in the cerebral respiratory center respond to chemicals, such as carbon dioxide, and are called chemoreceptors .

Cheyne Stokes breathing / Source: Cheyne Stokes / Ivanov / Archibald Tuttle, Wikimedia Commons (CC BY-SA-3.0)

The course of Cheyne Stokes breathing

In short, Cheyne Stokes breathing is an alternation of deep and shallow breaths. The disorder is named after the British physician and surgeon John Cheyne (1777-1836) and the Irish physician William Stokes (1804-1878), of the University of Dublin. Both have conducted research into this breathing type. The characteristic breathing pattern is easy to recognize.


Typically, breathing becomes deeper and deeper, often followed by an even deeper sigh, after which the tidal volume slowly decreases again and eventually becomes very superficial. Then a respiratory arrest (apnea) occurs, during which breathing is virtually unnoticeable. The patient then breathes shallowly again, but deeper after each breath.

Respiratory rate

The frequency is sometimes regular and slow, sometimes irregular and fast. The same applies to the evenness of the breaths and exhalations. However, the general characteristic breathing pattern always shines through. The apnea can sometimes last up to a minute.

The role of carbon dioxide

Not the lack of oxygen, but the increase in carbon dioxide in the blood is the most important breathing stimulus. The chemoreceptors in the respiratory center are sensitive to carbon dioxide and other acids and their increase in the vascular system. Due to the underlying cause of Cheyne Stokes breathing, the respiratory center does not respond sufficiently.

CO² level in the blood and Cheyne Stokes respiration

The cause of this breathing disorder is always located in the respiratory center, in the medulla oblongata, which is located in the brain stem. This usually concerns conditions in which blood circulation in the brain stem is no longer adequate and this part of the brain responds poorly to normal stimuli. The respiratory center is then less sensitive to the carbon dioxide tension in the blood. When the carbon dioxide level in the arterial vascular system slowly rises within the normal range, breathing becomes less deep and the frequency decreases.

Blood gas values
By breathing quickly and deeply, the body tries to normalize the blood gas values after the CO² level has subsequently exceeded a certain blood value. This type of breathing is usually observable in patients with, for example, a cerebral hemorrhage, but it can also be the result of an overdose of sleeping pills , opiates or alcohol. In any case, this disorder invariably involves the respiratory center (respiratory center).

Source: FotoshopTofs, Pixabay

Causes of Cheyne Stokes Breathing

There are many factors that negatively impact the respiratory center and induce Cheyne Stokes breathing. A small selection from this:

  • Arteriosclerosis (hardening of the arteries) in the brain, usually in the elderly.
  • Stroke.
  • Brain thrombosis.
  • Brain tumor.
  • Heart failure.
  • During the dying process (sickbed).
  • Certain medications, such as sleeping pills and opiates.
  • Alcohol.
  • Sometimes this type of breathing is observed in the onset of altitude sickness.

Sleeping pills and painkillers

In clinical situations it is important that the caregiver/nurse notices breathing disorders, such as Cheyne Stokes breathing. After all, this disorder is an indication of the progression of a condition or its development. With this breathing type, a consideration must also be made regarding the administration of sleeping pills and opiates (painkillers), because they hinder the functioning of the respiratory center (even more).

read more

  • Respiratory disorders – deviations from normal breathing
  • Respiratory disorders – Kussmaul breathing
  • Shortness of breath on slight exertion (dyspnea d’effort)
  • Physical characteristics of dying (dying process)
  • Count and observe breaths