Central Sleep Apnea

What is central sleep apnea?

Central sleep apnea (CSA) is a form of sleep apnea, which causes you to experience pauses between breaths as you sleep. Typically, central sleep apnea is a complication of other medical issues or medication/drug use. For example, people with heart disease may develop CSA. Healthcare providers focus on treating the underlying condition.

Types of central sleep apnea

There are a few types of central sleep apnea:

• Primary CSA. Central sleep apnea that has no apparent cause.
• CSA with Cheyne-Stokes Breathing (CSB). If you have CSB, your breathing goes through cycles. You take frequent breaths followed by pauses in breathing. Each cycle lasts 40 to 90 seconds.
• CSA due to underlying medical conditions like heart disease or neurological conditions.
• Treatment-emergent CSA. Sometimes, people who have obstructive sleep apnea develop central sleep apnea after using a continuous positive air pressure (CPAP) machine.
• CSA due to periodic high-altitude breathing.
• CSA from taking prescription pain medication that contains opioids or opioid use disorder.

What are central sleep apnea symptoms?

You experience most central sleep apnea symptoms when you’re awake. The following are a few symptoms associated with central sleep apnea:

• Daytime sleepiness.
• Severe morning headaches.
• Dry mouth.
• Feeling irritable.
• Trouble concentrating.

If you have CSA, you may wake up abruptly during the night for no obvious reason. If you live with other people, they may notice that you’re restless and move around a lot when you sleep.

What causes central sleep apnea?

It happens when something affects your brainstem, the part of your brain that regulates breathing. Your brainstem sends breathing signals to muscles in your respiratory system.

In central sleep apnea, your brainstem doesn’t react as it should to the changes in the amount of carbon dioxide in your blood. Carbon dioxide (CO2) is a waste your body gets rid of when you exhale. When you have high carbon dioxide levels, your brainstem notifies your respiratory muscles to pull in and push out air more often and more deeply, so you take deep breaths.

When your carbon dioxide levels drop, your brainstem orders those muscles to pull in and push out less air less often. You breathe more slowly than usual, take fewer deep breaths or stop breathing for a few seconds altogether.

What are risk factors for central sleep apnea?

You may have increased risk if you:

• Are age 60 or older. As you get older, your brain changes how it controls breathing during sleep.
• Are a man or assigned male at birth (AMAB).
• Have a heart condition like congestive heart failure or atrial fibrillation.
• Have a neurological condition like stroke, amyotrophic lateral sclerosis (ALS) or myasthenia gravis (MG).
• Take opioid pain medications or have opioid use disorder.
• Have certain inherited disorders like Rett syndrome, Prader-Willi syndrome or congenital central hypoventilation syndrome.
• Have treatment-emergent sleep apnea or hypoxemia.

What are the complications of central sleep apnea?

Central sleep apnea may do more than interrupt restful sleep. Your body goes through a lot when it must restart your breathing. Central sleep apnea means your body stops and starts breathing more often than usual. All that extra activity may damage your organs and blood vessels. Central sleep apnea may increase your risk of developing:

• Arrhythmia.
• Disrupted sleep.
• Fatigue.
• Insomnia.

How is central sleep apnea diagnosed?

Healthcare providers will ask about your symptoms and your medical history, including medical conditions that may cause central sleep apnea.

Your provider will recommend that you participate in a sleep study to check if you have central sleep apnea or obstructive sleep apnea. In a sleep study, you spend the night in a sleep laboratory so your care team can monitor and analyze different body system activities. For example, they’ll monitor and analyze your brain waves, your heartbeat and your breathing patterns.

How is central sleep apnea treated?

Healthcare providers treat central sleep apnea with positive air pressure (PAP) systems that prevent sleep apnea symptoms. PAP systems include:

• Continuous positive air pressure (CPAP) machines.
• Bilevel positive air pressure (BiPAP) machines.
• Adaptive servo-ventilation (ASV) machines.

Your provider will explain which system is right for your situation.

Can you live a long life with central sleep apnea?

Central sleep apnea doesn’t affect how long you’ll live.

How do I take care of myself?

Central sleep apnea often is a complication of other conditions, and you should continue or seek treatment for those conditions.

If you have central sleep apnea, be sure to schedule regular check-ups with your provider. They’ll make sure your treatment is working and check for any complications. Your provider may recommend you have follow-up sleep studies.

What questions should I ask my healthcare provider?

You may want to ask the following questions:

• How do you know I have central sleep apnea?
• Which treatments do you recommend?
• How long will I need treatment?
• Will treatment cure central sleep apnea?