Central Sleep Apnea

What Is Central Sleep Apnea?

Central sleep apnea (CSA) is when you regularly stop breathing while you sleep because your brain doesn’t tell your muscles to take in air. It’s different from obstructive sleep apnea, in which something physically blocks your breathing. But you can have both kinds together, called mixed sleep apnea.

Central sleep apnea usually happens because of a serious illness, especially one that affects your lower brainstem, which controls breathing. In very young babies, central sleep apnea causes pauses in breathing that can last 20 seconds.

Central Sleep Apnea Symptoms

The main symptom of CSA is pauses in breathing. It usually doesn’t cause snoring, the way obstructive sleep apnea does.

Symptoms also include:

• Being very tired during the day
• Waking up often during the night
• Having headaches in the early morning
• Trouble concentrating
• Memory and mood problems
• Not being able to exercise as much as usual

Central Sleep Apnea Causes and Types

There are several types of central sleep apnea, each with a different cause.

• Cheyne-Stokes breathing. This is when your breathing speeds up, slows down, stops, and then starts again. Each of these cycles can last 30 seconds to 2 minutes. Cheyne-Stokes breathing is common in people who’ve had heart failure or a stroke' target='_blank' rel='noopener noreferrer' >stroke. It happens in about half of central sleep apnea cases.
• Narcotic- induced central sleep apnea. Opioid medications like morphine, oxycodone, and codeine can affect your breathing patterns.
• High-altitude periodic breathing. Many people have trouble breathing when they go up to a high elevation, usually 2,500 meters (8,000 feet) or more.
• Treatment-emergent apnea. About 5% to 15% of people who have positive airway pressure treatment for obstructive sleep apnea get CSA.
• Medical condition-induced apnea. Health problems like heart failure, Parkinson’s disease, stroke, and kidney failure can cause CSA.
• Idiopathic (primary) central sleep apnea. This is when there’s no clear cause.

A related condition named congenital central hypoventilation syndrome (CCHS or Ondine’s curse) is linked to a certain gene. It affects about one in 200,000 children around the world.

Central Sleep Apnea Risk Factors

Anyone could have any of the types of sleep apnea. Central sleep apnea is more common among older people, especially those over 65. They may have health conditions or sleep patterns that make them more likely to get CSA.

Men are at higher risk of both central and obstructive sleep apnea.

Conditions that may be linked to central sleep apnea include:

• Congestive heart failure
• Hypothyroid disease
• Kidney failure
• Neurological diseases, such as Parkinson's disease, Alzheimer's disease, and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)
• Damage to the brainstem from swelling (encephalitis), stroke, or injury

Central Sleep Apnea Diagnosis

A family member or bed partner might be the first to notice pauses in your breathing while you sleep.

Your doctor will do a physical exam, ask about your medical history, and recommend a sleep history.

You’ll probably have a sleep study called a polysomnogram. You’ll spend the night in a special lab, where specialists will monitor and record information about your sleep, including:

• Electrical activity in your brain
• Eye movement
• Muscle activity
• Heart rate
• Breathing patterns
• Air flow
• Blood oxygen levels

The technologist will count how many times you stopped breathing while you slept and will grade how severe your apnea is.

Central Sleep Apnea Treatment

Treatment might depend on the cause of your apnea and might involve taking medicine for heart failure or stopping an opioid medication.

Some general sleep apnea treatments can also make you feel better. You could:

• Keep a healthy weight.
• Avoid alcohol and sleeping pills, which make your airway more likely to collapse while you sleep.
• Sleep on your side instead of on your back.
• Use nasal sprays or breathing strips to keep air flowing if you have sinus problems or nasal congestion.
• Get plenty of sleep.

Continuous positive airway pressure (CPAP) can help people with all kinds of sleep apnea, especially CSA caused by heart failure.

A CPAP machine forces a constant stream of air into your nose and mouth through a mask you wear while you sleep. The air pressure is just enough to keep your upper airway tissues from collapsing and blocking your breathing. If you have trouble with CPAP, you might try similar devices called adaptive servo- ventilation (ASV) and bilevel positive airway pressure (BPAP).

A device called the Remede System can help with moderate to severe central sleep apnea. Your doctor implants a small machine under the skin in your upper chest. It helps trigger the nerve that moves your diaphragm when you breathe. It also monitors your respiratory signals while you sleep and helps restore regular breathing patterns.

Medications like acetazolamide (Diamox) and theophylline (Theochron) can stimulate breathing.

Central Sleep Apnea Complications

Any kind of sleep apnea can cause serious health problems, including a higher risk of:

• Stroke
• Obesity
• Diabetes
• heart-disease-heart-attacks' target='_blank' rel='noopener noreferrer' >Heart attack or heart failure
• Uneven heartbeat
• High blood pressure

Sleep apnea may also raise your risk of accidents at work or in the car because of fatigue.

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