DEAR DR. ROACH: My wife of 52 years is 71 and has developed what I assume is a problem with her breathing when she sleeps. During some periods of sleep, she starts taking a rhythmic set of breaths. There usually are four deep breaths followed by four shallow breaths. Each set of the four breaths decreases in intensity, and the shallow breaths are barely recognizable. She also has developed tics in her arms and legs. She has peripheral neuropathy and takes Lyrica and two different doses of Cymbalta daily. Can you provide any suggestions concerning these maladies and/or recommendations for treatment? — C.G.

ANSWER: I congratulate you on your marriage, but also commend your attention to detail. You seem to be doing an excellent job of describing a type of breathing called Cheyne-Stokes, which can be found in many conditions, including several neurological conditions; heart failure; and in some normal people. However, it is most concerning as a sign of sleep apnea, often in combination with one of these conditions. If I were seeing her, I would strongly consider a sleep study. Since essentially every sleep study I have ever done is positive, I have come to the conclusion that I am not ordering enough sleep studies: I must have had patients with sleep-disordered breathing that I didn’t suspect. If she does have a sleep-disordered breathing diagnosis, treatment may improve her quality of life.