Central Sleep Apnea – Symptoms, Diagnosis, and Treatment Options 

What Is Central Sleep Apnea?

Sleep apnea is when a person’s breathing repeatedly starts and stops while they are asleep. Central sleep apnea¹ is caused by the brain not sending signals to the muscles that regulate breathing. This form of sleep apnea can result from various health and situational circumstances, and we will cover these in detail further below.

Central Sleep Apnea vs. Obstructive Sleep Apnea

The difference between obstructive and central sleep apnea is what causes periodic gaps in breathing during sleep. In contrast to central sleep apnea, obstructive apnea² results from a blockage in the upper airway. More specifically, the muscles at the back of the throat relax to the point that they significantly narrow the airway, impacting the individual’s breathing.

The American Academy of Sleep Medicine³ (AASM) reports that sleep apnea numbers are rising, affecting as many as 25 million American adults.

Get More Info: Complete Guide to Sleep Apnea

What Are the Symptoms of Central Sleep Apnea?

If you notice any of the following symptoms, you may have central sleep apnea and should schedule a visit with your doctor¹.

• Not breathing or abnormal breathing patterns while asleep
• Waking up abruptly with shortness of breath
• Difficulty staying asleep (insomnia)
• Excessive daytime sleepiness (hypersomnia)
• Trouble concentrating
• Mood changes
• Morning headaches
• Snoring
• Cardiovascular problems

What Causes Central Sleep Apnea?

According to experts, less than ten percent^[4] of patients referred to sleep laboratories have central sleep apnea. Though the numbers are significantly lower than obstructive, central sleep apnea can be just as dangerous to individuals’ health.

Most experts encourage central sleep apnea treatment to avoid additional health complications down the road. According to the Cleveland Clinic^[5], an untreated case of sleep apnea could lead to hypertension, stroke, arrhythmias, cardiomyopathy, heart failure, diabetes, obesity, and heart attacks.

Regarding central sleep apnea treatment, it is vital to try and understand the underlying cause.

According to the Mayo Clinic, the following conditions can lead to central sleep apnea:

Cheyne-Stokes

Cheyne-Stokes is typically associated with congestive heart failure or stroke. With this condition, a person’s airflow power gradually increases and decreases. When the breath is at its weakest point, this is when central sleep apnea occurs.¹

Drugs

Certain medications such as opioids can also lead to improper breathing. Opioids are often prescribed to help alleviate pain. If you take opioids or another medication and notice sleep apnea symptoms, you should speak with your doctor.¹

High-Altitude

A slow rise and decline in breathing effort can also occur from exposure to extremely high altitudes. Experts say the change in oxygen is what causes these breathing discrepancies.¹

Treatment-Emergent

In some cases, a person with obstructive sleep apnea could inadvertently develop central apnea using a CPAP machine, a popular treatment device for apneas. When this occurs, it is referred to as treatment-emergent CSA. When a patient exhibits both obstructive and central apnea, this is known as complex sleep apnea.

Medical Condition

Certain medical conditions may also lead to central sleep apnea. The conditions that could generate this apnea include end-stage kidney disease and stroke.¹ When a person reaches end-stage kidney disease⁶, they typically need to begin dialysis or receive a kidney transplant.

Idiopathic

Lastly, idiopathic central sleep apnea is arguably the most difficult to treat because its cause is unknown. Idiopathic is a general term for a disease or condition in which doctors cannot determine its origin.¹

Central Sleep Apnea Risk Factors

Certain factors can put some at a greater risk of developing central sleep apnea, as reported by the Mayo Clinic.¹

• Sex – Men are more likely than women to have central sleep apnea.
• Age – Adults over the age of 60 are at an increased risk. Experts say this is likely because of additional sleep or medical issues that could induce apnea.
• Heart disorders – Those who have atrial fibrillation or congestive heart failure also have a higher risk of this sleep disorder. Atrial fibrillation is when someone has an irregular heartbeat, while congestive heart failure is when the heart does not pump enough blood.
• Brain conditions – Brain issues such as a stroke, tumor, or structural brainstem lesion could impair breathing.
• Sleeping at a high altitude – If you are not used to resting at higher altitudes, that could induce central sleep apnea.
• Opioid use – We also mentioned earlier that people who take opioid medications could develop sleep apnea.

CPAP use – Those using continuous positive airway pressure to treat obstructive sleep apnea are at increased risk of contracting central sleep apnea.

Diagnosing Central Sleep Apnea

To get a formal central sleep apnea diagnosis, you will need to first consult your doctor, who will likely do an initial evaluation. Following this, your physician may refer you to a sleep specialist for further testing.

When you visit a specialist, they will perform a polysomnography test to help determine what is causing your sleep troubles. During this process, you are hooked to machines that monitor your heart, lungs, brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you are asleep.

Read More: How and Why is Sleep Apnea Misdiagnosed?

How to Treat Central Sleep Apnea

By addressing the root cause of your CSA, a healthcare professional can help you find the best central sleep apnea treatment plan. The following remedies can aid with central sleep apnea.¹

Address Related Medical Problems

Certain health complications can cause a person to develop central sleep apnea. Therefore, treating the underlying medical condition could help your apnea.

Reduction of Opioid Medication

In the event opioids are causing your sleep disorder, you may need to discontinue use. However, for those who rely on this medication to treat pain, your doctor may be able to find an alternative solution.

Continuous Positive Airway Pressure (CPAP)

CPAP treatment involves wearing a mask while you sleep. The CPAP mask covers the nose and mouth and is hooked up to a pump that provides pressurized air to help keep the airway open. CPAP machines are a well-known treatment method, but they may be difficult to get accustomed to for some.

Check Out Our Guide: Top Rated CPAP machines

Adaptive Servo-Ventilation (ASV)

Like a CPAP, adaptive servo-ventilation also provides pressurized air to the sleeper. However, ASV adjusts the air pressure on each breath for a more consistent pattern and can provide an extra breath if the device notices a gap. Individuals with symptomatic heart failure should avoid ASV.¹

Bilevel Positive Airway Pressure (BPAP)

BPAP is an additional method of pressurized air treatment for those with sleep apnea. This system is similar to ASV in that it delivers a particular amount of air pressure when you inhale and a different amount when you exhale. However, the amount of pressure with BPAP is fixed in contrast to the varied levels with ASV.¹

Those with heart failure should speak with their doctor if they are considering BPAP because this method could worsen their central sleep apnea.¹

Supplemental Oxygen

Supplemental oxygen, also known as oxygen therapy⁷, could also alleviate symptoms of central sleep apnea, and you can choose from different devices to use in the comfort of your home.¹ If you are new to oxygen therapy, your physician can help select the best device for you.

The air is usually provided through nasal prongs or a face mask. In addition to being a sleep apnea treatment, supplemental oxygen could help with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pneumonia, asthma, and cystic fibrosis.¹

Certain Medications

Researchers have found that the medication acetazolamide may help stimulate breathing in individuals with central sleep apnea.¹ Acetazolamide⁸ is listed as a “diuretic and carbonic anhydrase inhibitor” used to treat glaucoma, idiopathic intracranial hypertension, heart failure, altitude sickness, periodic paralysis, and epilepsy.

Surgery

Surgery may also be an option for folks with central sleep apnea. Transvenous phrenic nerve stimulation is a newer FDA-approved procedure for moderate to severe central sleep apnea.¹A pulse generator is placed beneath the skin on the upper chest. The generator is battery-powered and sends an electrical pulse to the nerve that regulates the diaphragm during sleep. The pulse should then cause the patient to take a breath.¹