Central sleep apnea is a condition that causes short pauses in a person’s breathing as they sleep. This occurs because the brain temporarily stops signaling the respiratory muscles to breathe.
These pauses in breathing can occur multiple times throughout the night, which can affect sleep quality and put a person at a risk of other health issues.
Central sleep apnea is not the same as obstructive sleep apnea, which is more common. The latter relates to obstructive respiratory issues and is often linked to obesity, whereas central sleep apnea is a neurological condition.
Keep reading to learn more about the symptoms, causes, and treatments associated with central sleep apnea.
Sleep apnea is a relatively common condition, and although most people are familiar with obstructive sleep apnea, central sleep apnea is lesser known. It gives rise to similar symptoms, though the causes are very different.
A thorough diagnosis is important in each case to begin treatment for the underlying cause, which could reduce the risk of long-term issues.
In general terms, sleep apnea causes a person to experience pauses in their breathing pattern while asleep. These pauses range in length and severity. All forms of sleep apnea cause this. The sections below discuss some different types of sleep apnea in more detail.
Obstructive sleep apnea
Obstructive sleep apnea is the most common form of sleep apnea, affecting around 9–38% of the adult population.
In obstructive sleep apnea, pauses in breathing occur due to a physical blockage in the upper airway. This could be due to extra tissue (from having overweight or obesity) or weaker tissue (due to older age) in the area.
Some other factors may cause physical blockages in the airways, such as inflamed tonsils and abnormal growths in the area.
Learn more about obstructive sleep apnea here.
Central sleep apnea
People with central sleep apnea do not have a physical blockage present in the upper airways. Instead, the pauses in sleep occur because the brain is not sending the correct signals to the respiratory muscles.
The result is a change in breathing patterns or a complete pause in breathing, called apnea.
Mixed sleep apnea
Some people may also have mixed sleep apnea. This is a combination of obstructive and central sleep apnea, wherein both physical and neurological factors lead to symptoms.
The main symptoms of central sleep apnea are pauses in a person’s breathing as they sleep. Although some people may not notice this symptom, they may notice others, including:
- waking up multiple times during the night
- not feeling rested from sleep
- waking up gasping for breath
- shortness of breath
- chest pain at night
- excessive daytime sleepiness
- headaches upon waking
- changes in mood
- memory loss
The person may also snore, though this is more commonly a symptom of obstructive sleep apnea than central sleep apnea.
Anyone experiencing concerning symptoms can see a healthcare provider for a full diagnosis.
Diagnosing central sleep apnea usually begins with a physical examination. The doctor will ask the person what symptoms they are experiencing and how often they occur.
They will also ask questions about the person’s medical history, including any medications they are currently taking and any conditions they may have.
If a doctor suspects that a person has central sleep apnea, they will order a few tests to confirm this diagnosis.
Tests that may help diagnose central sleep apnea or eliminate other issues include:
- a sleep study, or polysomnography
- an electrocardiogram, to observe the heart
- lung function testing, to rule out other conditions
- an MRI of the spine and brain, to check for structural issues
It is important to receive treatment for central sleep apnea in order to reduce the risk of other conditions. The primary goal of treatment will be to treat the underlying cause of the sleep apnea.
For instance, if a person has had a major cardiac event — such as heart failure — that causes their central sleep apnea, a doctor will work to treat the heart failure itself.
That said, during treatment for the underlying cause, a doctor may also recommend one or more treatments to help control the symptoms of the sleep apnea. Examples of these include:
Continuous positive airway pressure machines
In many cases of sleep apnea, doctors will suggest using a continuous positive airway pressure (CPAP) machine as a first line of treatment.
CPAP machines move air through a mask and into the person’s airways. This can help reduce the likelihood of sleep apnea, as the force of the air helps keep the airways open and air moving through them.
That said, CPAP machines may not be effective in people with central sleep apnea. A study in the Journal of the American College of Cardiology notes that CPAP is only effective in about 50% of people with central sleep apnea.
If CPAP does not improve symptoms, it is important to seek an alternative treatment option.
Adaptive servo ventilation
Adaptive servo ventilation (ASV) is a less invasive way to deliver air to the body.
ASV continuously monitors the person’s breathing to help identify and deliver the ideal air pressure to relieve symptoms. This makes the therapy highly adaptive and allows for more comfort when using the machine.
Oxygen supplementation involves adding extra oxygen to the lungs during sleep.
This is generally achieved by pumping oxygen through the nose and into the airways at night. This can help ensure that the body has enough oxygen, thereby reducing the risk of sleep apnea events.
Sometimes, a doctor may also recommend specific medications to help the body control its breathing patterns.
In other cases, adjusting existing medications may help treat sleep apnea. For instance, people who take narcotics or opioids for pain relief may need to lower their dosage to control the symptoms of sleep apnea.
Phrenic nerve stimulation
The phrenic nerve controls the diaphragm and the process of breathing itself. By stimulating this major nerve during sleep, the therapy can control many central sleep apnea symptoms.
The direct cause of central sleep apnea is a failure in the brain during sleep to send the signals needed for breathing to occur correctly.
The underlying cause of this failure may vary depending on the type of central sleep apnea a person has. Some different types include:
Cheyne–Stokes breathing is a pattern of deep and rapid breathing followed by a series of short, shallow breaths leading to apnea.
High-altitude apnea is a form of the Cheyne–Stokes breathing pattern that occurs when a person is at a very high altitude. It occurs because differing oxygen levels can also trigger changes in breathing.
A number of drugs may interfere with the nervous system or nerves in some way, potentially leading to central sleep apnea.
Drugs such as opioid pain medications may cause changes in breathing. Specifically, they may cause the breathing to become irregular or shallow, or to stop completely for a short period.
Apnea from other medical conditions
Central sleep apnea may also arise from other conditions, such as late stage kidney disease, severe obesity, or stroke.
Treatment-emergent sleep apnea
Some people who use CPAP machines for obstructive sleep apnea may develop central sleep apnea. If this occurs, a person may require continuous treatment or a change in treatment.
Idiopathic central sleep apnea
Idiopathic central sleep apnea occurs without an underlying cause. This type is also known as primary central sleep apnea.
In any case, the outlook may depend on a number of factors, including how well the person adheres to their treatment plan and how effectively doctors can treat any underlying conditions.
Treatment devices such as CPAP and oxygen machines may take some getting used to, but they can improve a person’s symptoms with time.
Treatment is especially important with sleep apnea, as the condition can lead to a number of long-term health issues without treatment.
Sleep apnea can significantly disrupt a person’s sleep. Sleep should be restful, and a time when activity in the brain and body decrease, allowing them to recharge. However, sleep apnea events increase activity in the brain and stress levels in the body.
Because of this, sleep apnea is a risk factor for a number of other issues, such as:
- oxidative stress
- vascular dysfunction
- issues with metabolism
- changes in the nervous system
Without treatment, these issues can increase the risk of other conditions, including:
Finding and treating the underlying cause of sleep apnea is crucial in preventing these serious complications. The overall outlook will depend on treating the underlying cause and avoiding these complications.
When a doctor can find and correctly treat the underlying cause, a person’s symptoms of sleep apnea are likely to greatly improve or stop altogether.
Sleep apnea occurs when a person stops breathing periodically throughout the night. In central sleep apnea, this occurs due to faulty signals in the brain not telling the respiratory muscles to breathe correctly.
There are several potential causes, and properly diagnosing the cause is the key to finding the correct form of treatment.
Getting prompt and early treatment for central sleep apnea may help reduce the risk of long-term complications.
Properly treating the underlying cause of central sleep apnea can stop or greatly reduce the apnea itself in many cases.