Central Sleep Apnea

Central sleep apnea (CSA) is a sleep disorder where your brain temporarily stops sending signals to the muscles that control your breathing during sleep. This causes your breathing to repeatedly stop and start. Unlike obstructive sleep apnea, where an airway blockage causes pauses, CSA is a problem with how your brain communicates with your breathing muscles.

What is Central Sleep Apnea?

Central sleep apnea (CSA) is a sleep disorder where your brain temporarily stops sending signals to the muscles that control your breathing during sleep. This causes your breathing to repeatedly stop and start. Unlike obstructive sleep apnea, where an airway blockage causes pauses, CSA is a problem with how your brain communicates with your breathing muscles.

During normal sleep, your brain sends regular signals to your diaphragm and other breathing muscles. These signals tell your body to inhale and exhale, ensuring a steady flow of oxygen. With central sleep apnea, your brain “forgets” to send these signals for a short time. This means your body makes no effort to breathe, and your breathing pauses. Your airway remains open, but no air moves in or out. These pauses can last for several seconds. Your body then reacts by waking you up briefly, often with a gasp or snort, to restart breathing. This cycle can happen many times throughout the night, severely disrupting your sleep quality and preventing deep, restorative sleep.

Symptoms

The main symptoms of central sleep apnea include observed pauses in breathing during sleep, sudden awakenings with shortness of breath, and excessive daytime sleepiness. You might also experience morning headaches, difficulty concentrating, and changes in mood due to poor sleep quality.

People with central sleep apnea often do not know they have it. A bed partner or family member might notice the pauses in breathing. They may also observe you suddenly waking up gasping for air or feeling short of breath. Because your sleep is constantly interrupted, you may feel very tired during the day. This excessive daytime sleepiness can make it hard to concentrate, affect your memory, and lead to irritability or other mood changes. You might also find yourself falling asleep unintentionally during quiet activities. Other common signs include waking up with a dry mouth or sore throat, and experiencing morning headaches. While snoring can occur, it is usually less prominent and less consistent than in obstructive sleep apnea, as there is no physical airway blockage causing the sound.

Causes & risk factors

Central sleep apnea is often caused by underlying medical conditions that affect the brain's control over breathing, such as heart failure, stroke, or kidney failure. Certain medications, like opioids, can also cause it. Risk factors include being male, older age, and having specific heart or neurological disorders.

The primary cause of central sleep apnea is a problem with how your brain controls your breathing. This can happen due to various medical conditions. For example, severe heart failure can lead to a specific breathing pattern called Cheyne-Stokes breathing, which is a common form of CSA. In this pattern, breathing repeatedly speeds up, then slows down, and then pauses. Other conditions that can cause CSA include stroke, kidney failure, and certain neurological diseases like Parkinson's disease. Injuries to the brainstem, which controls basic life functions, can also disrupt breathing signals. Sometimes, central sleep apnea can develop after treatment for obstructive sleep apnea with continuous positive airway pressure (CPAP), known as complex sleep apnea. Certain medications, especially opioid pain relievers, are known to cause central sleep apnea. High altitude can also trigger CSA in some individuals. Risk factors that increase your chance of developing CSA include being male, being older, and having heart rhythm problems like atrial fibrillation or congestive heart failure.

How it's diagnosed

Diagnosing central sleep apnea typically involves a physical exam and a comprehensive sleep study (polysomnography), usually performed overnight in a sleep lab. This study monitors your brain activity, breathing patterns, heart rate, blood oxygen levels, and other vital signs to identify pauses in breathing and their cause.

If your doctor suspects central sleep apnea, they will first ask about your symptoms and medical history. They may also perform a physical exam to check for underlying conditions. The most definitive test is a sleep study, also called polysomnography. During a sleep study, sensors are placed on your body to record various activities while you sleep. These include your brain waves, eye movements, heart rate, blood pressure, and the oxygen level in your blood. The study also measures airflow through your nose and mouth, and monitors your breathing effort and body position. The results help doctors determine if your breathing pauses are due to a lack of brain signals (central sleep apnea) or a blocked airway (obstructive sleep apnea). Sometimes, a simpler overnight oximetry test, which measures blood oxygen levels, might be used as an initial screening, but a full sleep study is usually needed for a complete and accurate diagnosis.

Treatment options

Treatment for central sleep apnea often focuses on managing the underlying medical condition causing it, such as heart failure or kidney disease. Other options may include adaptive servo-ventilation (ASV), bilevel positive airway pressure (BiPAP), supplemental oxygen, or in some cases, medications.

The most important step in treating central sleep apnea is to address any underlying health problems. For example, if heart failure is causing your CSA, treating the heart failure can often improve your breathing during sleep. If opioid medications are the cause, your doctor may adjust your dosage or switch to a different pain reliever. Several devices can help regulate breathing during sleep. Adaptive servo-ventilation (ASV) is a device that learns your normal breathing pattern and provides pressure support to prevent pauses. However, ASV is generally not recommended for people with symptomatic chronic heart failure and a reduced ejection fraction. Bilevel positive airway pressure (BiPAP) machines deliver more pressure when you inhale and less when you exhale, which can help stabilize breathing. Supplemental oxygen can be used to increase the amount of oxygen in your blood if your levels drop too low during sleep. In some specific cases, medications like acetazolamide or theophylline might be prescribed to stimulate breathing. A newer treatment, phrenic nerve stimulation, involves a device that sends electrical impulses to the diaphragm to encourage breathing.

Recovery & outlook

The recovery and outlook for central sleep apnea largely depend on its underlying cause and how well that condition is managed. Many people experience significant improvement in their symptoms with effective treatment, leading to better sleep quality and reduced daytime fatigue.

If central sleep apnea is caused by a treatable condition, such as heart failure or opioid use, addressing that condition often leads to a good prognosis. For example, successful treatment of heart failure can reduce or eliminate CSA symptoms, improving both sleep and overall health. For those with ongoing CSA, consistent use of prescribed therapies like ASV or BiPAP can greatly improve sleep quality and reduce the risks associated with untreated sleep apnea. These treatments help stabilize breathing patterns and ensure adequate oxygen levels throughout the night. While central sleep apnea can be a chronic condition, it is often manageable. Regular follow-up appointments with your healthcare team and adherence to treatment recommendations are key to improving your overall health and quality of life. Your doctor will monitor your progress and adjust your treatment as needed.

When to see a doctor

You should see a doctor if you experience persistent symptoms like loud snoring, observed pauses in breathing during sleep, or excessive daytime sleepiness that affects your daily life. Seek immediate medical attention if you suddenly wake up gasping for air, feel severe shortness of breath, or experience chest pain along with breathing difficulties.

It is important to talk to your doctor if you or your bed partner notice any signs of central sleep apnea. These include frequent pauses in your breathing while you sleep, or if you often wake up feeling short of breath. Persistent daytime tiredness, morning headaches, or difficulty concentrating should also prompt a visit to your doctor. Early diagnosis and treatment can help prevent potential complications and improve your quality of life. Your doctor can evaluate your symptoms, discuss your medical history, and determine if a sleep study is needed to accurately diagnose your condition. Seek immediate medical care if you experience severe or sudden symptoms. This includes waking up suddenly with extreme shortness of breath, feeling chest pain, or having a very fast or irregular heartbeat along with breathing problems. These could be signs of a more serious underlying medical condition that requires urgent attention.

Frequently asked questions

Is central sleep apnea as common as obstructive sleep apnea?

No, central sleep apnea (CSA) is much less common than obstructive sleep apnea (OSA). OSA is caused by a physical blockage in the airway, while CSA is due to a problem with the brain's signals to breathing muscles. CSA accounts for a smaller percentage of all sleep apnea cases.

Can central sleep apnea be cured?

Whether central sleep apnea can be cured depends on its cause. If it's due to a treatable underlying condition, such as heart failure or opioid use, addressing that condition can often resolve the CSA. In other cases, it may require ongoing management rather than a complete cure.

What is the difference between CPAP and BiPAP for central sleep apnea?

CPAP (continuous positive airway pressure) delivers a constant air pressure. BiPAP (bilevel positive airway pressure) delivers two different pressures: a higher one when you inhale and a lower one when you exhale. BiPAP is often more effective for central sleep apnea because it can better support the brain's irregular breathing signals, making breathing more comfortable and effective.

Can losing weight help central sleep apnea?

Losing weight is primarily helpful for obstructive sleep apnea, where excess weight can narrow the airway. While maintaining a healthy weight is good for overall health, weight loss typically does not directly treat central sleep apnea, which is a brain signal issue. Treatment focuses on the underlying cause or specialized breathing devices.

Are there any natural remedies for central sleep apnea?

There are no proven natural remedies that effectively treat central sleep apnea. Treatment usually involves addressing underlying medical conditions or using specialized breathing devices. Always discuss any alternative therapies with your doctor to ensure they are safe and appropriate and do not interfere with prescribed treatments.

Can central sleep apnea lead to serious health problems?

Yes, untreated central sleep apnea can lead to serious health problems. These include worsening of underlying heart conditions, high blood pressure, increased risk of stroke, and impaired quality of life due to chronic fatigue, difficulty concentrating, and mood changes. Early diagnosis and treatment are important to mitigate these risks.

Sources

• MedlinePlus — Central Sleep Apnea
• Mayo Clinic — Central Sleep Apnea
• Cochrane Library — Central Sleep Apnea