Central Sleep Apnea

Last updated: May 20, 2019

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

Central Sleep Apnea is a disorder wherein breathing repeatedly stops and starts during sleep. This type of sleep apnea is less common compared to Obstructive Sleep Apnea. Central sleep apnea is a result of the brain’s inability to send proper signals to the muscles that control breathing. This breathing-related sleep disorder may occur as a result of another medical condition. Heart failure and stroke are the usual causes of this type of sleep apnea.

What are the signs and symptoms of Central Sleep Apnea?

Some of the common signs and symptoms of this disorder include:

  • Stoppage of breathing during sleep
  • Abnormal breathing patterns during sleep
  • Frequent and abrupt arousals during sleep
  • Shortness of breath
  • Insomnia
  • Nocturnal chest pains
  • Lack of concentration
  • Morning headaches
  • Mood changes
  • Snoring

Although snoring is often a result of an obstructed airway, snoring can also occur when a person has Central Sleep Apnea. However, snoring due to central sleep apnea is not as pronounced as snoring caused by obstructive sleep apnea.

What causes Central Sleep Apnea?

Central sleep apnea happens when the brain fails to send signals to the muscles responsible for controlling breathing. This failure can be a result of a variety of conditions affecting the brain stem. The brainstem is the part of the brain that links the brain to the spinal cord. This is also the part of the brain that controls other functions such as heart rate and breathing. The cause of this disorder varies depending on the type of central sleep apnea.

The types of central sleep apnea include:

  • Cheyne-Stokes breathing. This is a type of central sleep apnea commonly associated with those who have congestive heart failure or stroke. Cheyne-Stokes is an abnormal pattern of breathing. It is characterized by progressively deeper, sometimes faster, breathing. This is usually followed by a gradual decrease in breathing. The pattern repeats itself. Each cycle usually takes about 30 seconds to 2 minutes.
  • Drug-induced apnea. Drugs that cause central nervous system (CNS) depression, respiratory muscle dysfunction, or myopathy can increase the risk of drug-induced apnea. The elderly and the chronically debilitated are more prone to this type of central sleep apnea. Medications that can increase the frequency and duration of apnea include long-acting benzodiazepines and narcotics.
  • High-altitude periodic breathing. Periodic breathing is frequent at high altitude. This frequency increases as the altitude increases. When a person experiences high-altitude periodic breathing, he alternates between periods of deep breathing and shallow breathing. There is usually a pattern of three to five deep breaths followed by a couple of very shallow breaths. Sometimes the deep breaths are followed by a complete pause in breathing. It is this pause in breathing that causes central sleep apnea. The pause in breathing usually lasts around five to 15 seconds. During this episode, the oxygen levels drop and the heart rate slows.
  • Complex Sleep Apnea. Complex Sleep Apnea is also called treatment-emergent central sleep apnea. This type of central sleep apnea appears to those who previously had obstructive sleep apnea. The appearance of complex sleep apnea is due to the use of continuous positive airway pressure (CPAP) as a treatment. Complex sleep apnea is relatively common during the initial phase of treatment period using CPAP or even bilevel therapy.
  • Medical condition-induced central sleep apnea. This type of central sleep apnea is a result of medical conditions such as heart and kidney problems.
  • Idiopathic (Primary) central sleep apnea. This is a condition characterized by periodic episodes of apnea or hypopnea. It is often a result of the decrease in neural input to the respiratory neurons. This condition is often characterized by complaints of snoring, witnessed apneas, insomnia, restless sleep, or excessive daytime sleepiness.

Central sleep apnea is more prevalent among older adults. Adults older than 65 years of age have a higher risk of contracting central sleep apnea. Men are also more at risk for both obstructive sleep apnea and central sleep apnea.

There are also medical conditions associated with central sleep apnea. These include:

  • Congestive heart failure
  • Kidney failure
  • Hypothyroid disease
  • Amyotrophic lateral sclerosis or ALS (also known as Lou Gehrig’s disease)
  • Parkinson’s disease
  • Alzheimer’s disease
  • Damage to the brainstem as a result of injuries, stroke, or encephalitis

How is central sleep apnea diagnosed?

Central sleep apnea is diagnosed through a physical examination of the patient. A doctor will also study the patient’s medical history and sleep history. It is also possible for a doctor to recommend an overnight sleep study or a polysomnogram. This is a test performed in a sleep laboratory and conducted under the direct supervision of a trained technologist.

During a polysomnogram body functions that can contribute to central sleep apnea get monitored. These include:

  • Eye movements
  • Heart rate
  • Muscle activity
  • Breathing patterns
  • Electrical activity of the brain
  • Blood oxygen levels
  • Airflow

How is central sleep apnea treated?

If the case of central sleep apnea is a direct result of another medical condition, that condition is the one treated. For example, if the central sleep apnea is a result of kidney failure the treatment will focus on trying to treat kidney failure.

Some of the treatment for obstructive sleep apnea can also benefit people who suffer from central sleep apnea. These treatments that don’t require medications include:

  • Weight loss and the maintenance of a healthy weight
  • Avoidance of alcoholic beverages and sleeping pills
  • Change in sleeping position if the apneic events occur while sleeping on the back
  • Use of nasal sprays or nasal strips in the presence of sinus problems or nasal congestion.

CPAP

Another possible treatment is the use of continuous positive airway pressure (CPAP). This is also the preferred initial treatment for those who suffer from obstructive sleep apnea. This is an effective treatment especially for those who have central sleep apnea associated with heart failure.

During a CPAP therapy, the patient wears a mask over his nose or mouth. The mask may be worn over both the nose and mouth as determined by the sleep specialist. An air blower or ventilator then forces pressurized air through the nose and/or mouth. The sleep specialist adjusts the air pressure to make sure that it is just enough to prevent the upper airway tissues from collapsing during sleep. CPAP helps prevent the closure of the airway while the patient sleeps. However, apnea episodes return once CPAP is stopped. There are also patients who are unable to tolerate CPAP. Adaptive servo-ventilation (ASV) and Bilevel Positive Airway Pressure (BPAP) are other devices that can deliver pressurized air. These are alternatives available for patients who cannot tolerate CPAP.

The Food and Drug Administration has recently approved the use of an implantable device called the Remede System. This is only for those who have moderate to severe central sleep apnea. The Remedy System is a small machine surgically placed under the skin in the upper chest. Once it is surgically implanted, it can help stimulate the nerves that move the diaphragm during breathing. This machine monitors the respiratory signals while a patient sleeps. It then helps restore the patient’s breathing patterns to normal.

Under some circumstances, medications might be prescribed to treat central sleep apnea. Some of the medications that can help improve central sleep apnea include theophylline, acetazolamide, and sedative-hypnotic agents.

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

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