Make an Appointment
Talk to DoctorOverview
Central sleep apnea occurs when a person’s breathing repeatedly stops and starts during sleep. It happens when the brain fails to send signals to maintain the activity of the muscles responsible for breathing during sleep. Unlike obstructive sleep apnea, where the airway is blocked by relaxed neck muscles, central sleep apnea does not involve such obstructions. It’s worth noting that obstructive sleep apnea is more prevalent compared to central sleep apnea.
Heart failure and stroke are two more disorders that can lead to central sleep apnea. The act of sleeping at a high altitude is another potential factor.
The management of pre-existing diseases, the use of a breathing aid, or the use of supplemental oxygen are all possible treatments for central sleep apnea.
Symptoms
The following are typical signs and symptoms of central sleep apnea:
- Shortness of breath upon sudden awakening.
- Seen occurrences of not breathing while asleep.
- Headaches in the morning.
- Snoring.
- Problem with concentration.
- Mood swings.
- Insomnia, the inability to get asleep and stay asleep.
- Hypersomnia, which is an excessive amount sleeping at daytime.
Snoring can indicate varying degrees of airway obstruction, and in some cases, it may also be a symptom of central sleep apnea. However, when comparing central sleep apnea to obstructive sleep apnea, the former might not always be as prominently associated with snoring.
If you experience any central sleep apnea symptoms, or if your partner does, get medical attention, especially:
- Shortness of breath that causes you to be awakened from sleep.
- Difficulty sleeping.
- Pauses in breathing while you’re sleeping.
- Prolonged daytime sleepiness, which can cause you to nod off while working, watching television, or even driving.
If you frequently experience feelings of exhaustion, sleepy, and irritability, it is essential to discuss these sleep issues with a medical professional. Seeking an appropriate diagnosis is crucial since excessive daytime sleepiness could be attributed to various conditions. Among the potential causes are obstructive sleep apnea, insufficient sleep during the night, or narcolepsy, a condition characterized by unexpected and uncontrollable episodes of sleep. Consulting with your medical team will help identify the underlying cause and enable you to receive the necessary treatment and support.
Causes
When your brain fails to send instructions to your breathing muscles, central sleep apnea develops.
The brainstem connects the spinal cord to the brain. It regulates a variety of processes, including breathing and heart rate. Numerous medical problems that impair the brainstem’s ability to regulate breathing can contribute to central sleep apnea.
There are numerous causes of central sleep apnea, including:
- Heart failure.
- Hypoxia, or low blood oxygen levels, brought on by high altitude.
- Damage to the nervous system, particularly in the brainstem (which controls respiration) or spinal cord regions.
- Using CPAP to treat obstructive sleep apnea in the beginning (this usually goes away with regular CPAP use).
- Disorders of the nervous system like Lou Gehrig’s disease (ALS, also known as amyotrophic lateral sclerosis).
Depending on the type of central sleep apnea you have, several causes apply. Types consist of:
- Cheyne-Stokes breathing. The two conditions most frequently linked to this type of central sleep apnea are congestive heart failure and stroke.
Breathing effort and airflow progressively increase and then decline during Cheyne-Stokes breathing. At the point of the most minimal breathing effort, a complete absence of airflow can take place.
- Drug-induced apnea. The breathing may become erratic or stop altogether for a brief period of time after taking some medications, such as opioids. These medications can be administered orally or by injection. They consist of codeine, oxycodone, and morphine.
- High-altitude periodic breathing. If you’re at an extremely high altitude, a Cheyne-Stokes breathing pattern could appear. At high altitudes, the oxygen content might fluctuate, leading to quick breathing (hyperventilation) and then insufficient air intake.
- Treatment-emergent central sleep apnea. Some patients who are treated with Continuous Positive Airway Pressure (CPAP) for obstructive sleep apnea also develop central sleep apnea. This illness is referred to as “treatment-emergent central sleep apnea”. It combines obstructive and central sleep apneas.
- Medical condition-induced central sleep apnea. Central sleep apnea can be caused by a number of illnesses, such as stroke and end-stage kidney disease. Cheyne-Stokes breathing is not included in this kind of sleep apnea.
- Primary central sleep apnea. The cause of this uncommon type of central sleep apnea is not known. Another term used for this is idiopathic sleep apnea.
Risk factors
The exact cause of this unique type of central sleep apnea remains unknown.
- Gender. In comparison to women, men are more likely to acquire central sleep apnea.
- Age. Older persons, especially those over the age of 60, are more likely to experience central sleep apnea. This might be because those over 60 are more likely to have additional health issues or sleep patterns associated with central sleep apnea.
- Heart problems. People with heart issues are more likely to develop central sleep apnea. Atrial fibrillation, an erratic heartbeat, can raise the danger. Congestive heart failure, or inadequate blood pumping from the heart muscles, can further increase the risk.
- Brain conditions. Having stroke, brain tumor or a structural problem with the brainstem may impair a person’s capacity to control their breathing.
- High altitude. Your chance of developing sleep apnea may rise if you spend the night at an altitude higher than you are used to. After returning to a lower altitude for a few weeks, high-altitude sleep apnea resolves.
- Opioid use. The risk of central sleep apnea may rise as a result of opioid medications.
- CPAP. While using continuous positive airway pressure (CPAP), a small percentage of persons with obstructive sleep apnea develop central sleep apnea. The term “treatment-emergent central sleep apnea” refers to this condition. It combines central and obstructive sleep apneas.
With continued usage of their CPAP machine, some persons with complicated sleep apnea experience improvement. Positive airway pressure therapy of a different kind might be used to treat other patients.
Diagnosis
Based on your symptoms, a doctor may evaluate your condition, or you might be referred to a sleep specialist at a sleep problem center. If necessary, you can discuss the need for further testing with the sleep expert. This may involve undergoing a sleep study, specifically a polysomnography, where various devices are attached to monitor your breathing patterns, blood oxygen levels, heart, lung, and brain activity while you sleep. Depending on the situation, you may undergo either a split-night or full-night sleep study.
In a split-night sleep study, the first half of your sleep are monitored. If central sleep apnea is detected, the staff may wake you up to initiate therapy for the second half of the night. Treatment options could include the use of positive airway pressure or supplemental oxygen to alleviate the condition.
Polysomnography is a valuable tool for diagnosing central sleep apnea, and it also helps in ruling out other sleep disorders like narcolepsy, sleep-related movement disorders, and obstructive sleep apnea. Proper diagnosis is essential because even though these conditions can all lead to excessive daytime sleepiness, they require different treatment approaches.
In evaluating your condition, it might be necessary to involve doctors specialized in heart illnesses, known as cardiologists, and experts in neurological disorders, known as neurologists. They may conduct further tests, including imaging of your heart or head, to identify any underlying issues that could be contributing to your sleep problems.
Treatment
The following are possible therapies for central sleep apnea:
- Decreasing opioid medicines. Your medical team may gradually lower the dose of your opioid medications if they are the root cause of your central sleep apnea.
- Addressing associated medical problems. Other illnesses may contribute to central sleep apnea. Your central sleep apnea might improve if those symptoms are treated. For instance, treatment for heart failure may make central sleep apnea better.
- Medicines. People with central sleep apnea have been treated with medications like acetazolamide to encourage breathing. If you are unable to tolerate positive airway pressure, these medications may be recommended to assist you breathe while you sleep.
- Supplemental oxygen. If you suffer central sleep apnea, you might benefit from using supplemental oxygen while you sleep. You can get oxygen into your lungs using a variety of devices.
- Continuous positive airway pressure (CPAP). This technique involves putting on a mask over the nose or a mask over the nose and mouth while you sleep. It is also used to treat obstructive sleep apnea.
The mask is connected to a tiny pump that continuously delivers compressed air to keep the upper airway open. The airway closure that can cause central sleep apnea may be avoided using CPAP.
It’s crucial that you use the CPAP machine solely as instructed if you have central sleep apnea, just like if you have obstructive sleep apnea. Speak with your medical staff if the pressure on your mask is too intense or if it is uncomfortable. There are various sorts of masks. Additionally, the air pressure can be changed.
- Adaptive Servo-ventilation (ASV). You might be prescribed ASV if CPAP is ineffective in treating your disease. ASV also provides pressured air, just like CPAP.
ASV, as opposed to CPAP, changes the pressure on each breath that is taken. This results in a smoother breathing pattern. Additionally, if a specific amount of time passes without you taking a breath, the gadget may give a breath for you automatically.
For those with symptomatic heart failure, ASV is not advised.
- Bilevel positive airway pressure (BPAP). Similar to ASV, BPAP applies a predetermined amount of pressure when you inhale and a different amount when you exhale. In contrast to ASV, the amount of pressure you inhale is fixed rather than changeable. Additionally, BPAP can be programmed to deliver a breath if you haven’t taken a breath for a predetermined period of time.
Surgery or other procedures
Transvenous phrenic nerve stimulation is a relatively novel treatment for central sleep apnea. The U.S. Food and Drug Administration has given the Remede System device approval. It sends an electrical pulse to the nerve that regulates the diaphragm while you sleep. You take a breath as a result of this. The system consists of an implanted, battery-operated pulse generator in the upper chest.
This technique generates a consistent breathing pattern and is used for moderate to severe central sleep apnea. More research is required.
