Central Sleep Apnea (CSA)
Central Sleep Apnea is a disorder in which your breathing repeatedly stops and starts during sleep. Central sleep apnea occurs because your brain doesn’t send proper signals to the muscles that control your breathing. This condition is different from obstructive sleep apnea, in which you can’t breathe normally because of upper airway obstruction. Central sleep apnea is less common than obstructive sleep apnea. Central sleep apnea can result from other conditions, such as heart failure and stroke. Another possible cause is sleeping at a high altitude.
Treatments for central sleep apnea might involve treating existing conditions, using a device to assist breathing or using supplemental oxygen.
Symptoms
Common signs and symptoms of central sleep apnea include:
- Observed episodes of not breathing or abnormal breathing patterns during sleep
- Abrupt awakenings accompanied by shortness of breath
- Difficulty staying asleep (insomnia)
- Excessive daytime sleepiness (hypersomnia)
- Difficulty concentrating
- Mood changes
- Morning headaches
- Snoring
Although snoring indicates some degree of airflow obstruction, snoring can also be heard in the presence of central sleep apnea. However, snoring may not be as prominent with central sleep apnea as it is with obstructive sleep apnea.
Causes
The cause varies with the type of central sleep apnea you have. Types include:
- Cheyne-Stokes breathing:This type of central sleep apnea is most commonly associated with congestive heart failure or stroke. Cheyne-Stokes breathing is characterized by a gradual increase and then decrease in breathing effort and airflow. During the weakest breathing effort, a total lack of airflow (central sleep apnea) can occur.
- Drug-induced apnea:Taking certain medications such as opioids — including morphine (MS Contin, Kadian, others), oxycodone (Roxicodone, Oxycontin, others) or codeine — can cause your breathing to become irregular, to increase and decrease in a regular pattern, or to temporarily stop completely.
- High-altitude periodic breathing:A Cheyne-Stokes breathing pattern can occur if you’re at a very high altitude. The change in oxygen at this altitude is the reason for the alternating rapid breathing (hyperventilation) and underbreathing.
- Treatment-emergent central sleep apnea:Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP) for their sleep apnea treatment. This condition is known as treatment-emergent central sleep apnea and is a combination of obstructive and central sleep apneas.
- Medical condition-induced central sleep apnea:Several medical conditions, including end-stage kidney disease and stroke, may give rise to central sleep apnea of the non-Cheyne-Stokes variety.
- Idiopathic (primary) central sleep apnea:The cause of this uncommon type of central sleep apnea is unknown.
When to see doctor
Consult a medical professional if you have — or if your partner notices — any signs or symptoms of central sleep apnea, particularly the following:
- Shortness of breath that awakens you from sleep
- Pauses in your breathing during sleep
- Difficulty staying asleep
- Excessive daytime drowsiness, which may cause you to fall asleep while you’re working, watching television or even driving
Ask your doctor about any sleep problem that leaves you chronically fatigued, sleepy and irritable. Excessive daytime drowsiness can be due to other disorders, such as not allowing yourself time to get enough sleep at night (chronic sleep deprivation), sudden attacks of sleep (narcolepsy) or obstructive sleep apnea.
Risk Factor
- Sex:Males are more likely to develop central sleep apnea than are females.
- Age:Central sleep apnea is more common among older adults, especially those older than age 60. This could be because people older than 60 are likely to have other medical conditions or sleep patterns that are linked to central sleep apnea.
- Heart disorders:People with irregular heartbeats (atrial fibrillation) or whose heart muscles don’t pump enough blood for the body’s needs (congestive heart failure) are at greater risk of central sleep apnea.
- Stroke, brain tumor or a structural brainstem lesion:These brain conditions can impair the brain’s ability to regulate breathing.
- High altitude:Sleeping at an altitude higher than you’re accustomed to may increase your risk of sleep apnea. High-altitude sleep apnea resolves a few weeks after returning to a lower altitude.
- Opioid use:Opioid medications may increase the risk of central sleep apnea.
- CPAP:Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP). This condition is known as treatment-emergent central sleep apnea. It is a combination of obstructive and central sleep apneas.
For some people, complex sleep apnea goes away with continued use of a CPAP device. Other people may be treated with a different kind of positive airway pressure therapy.
Treatment
- Addressing associated medical problems:Possible causes of central sleep apnea include other disorders and treating those conditions might help your central sleep apnea. For example, therapy for heart failure might improve central sleep apnea.
- Reduction of opioid medications:If opioid medications are causing your central sleep apnea, your doctor might gradually reduce your dose of those medications.
- Continuous positive airway pressure (CPAP):This method, also used to treat obstructive sleep apnea, involves wearing a mask over your nose or your nose and mouth while asleep. The mask is attached to a small pump that supplies a continuous amount of pressurized air to hold open your upper airway. CPAP may prevent the airway closure that can trigger central sleep apnea. As with obstructive sleep apnea, it’s important that you use the device only as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your doctor. Several types of masks are available. Doctors can also adjust the air pressure.
- Adaptive servo-ventilation (ASV):If CPAP doesn’t effectively treat your condition, you might be given ASV. Like CPAP, ASV also delivers pressurized air. Unlike CPAP, ASV adjusts the amount of pressure breath-by-breath during inhalation to smooth out your breathing pattern. The device might also automatically deliver a breath if you haven’t taken a breath within a certain number of seconds. ASV isn’t recommended for people with symptomatic heart failure.
- Bilevel positive airway pressure (BPAP):Like ASV, BPAP delivers pressure when you breathe in and a different amount of pressure when you breathe out. Unlike ASV, the amount of pressure during inspiration is fixed rather than variable. BPAP can also be set to deliver a breath if you haven’t taken a breath within a certain number of seconds. BPAP could worsen central sleep apnea in people with heart failure. Talk to your doctor about the potential risks of BPAP if you have heart failure.
- Supplemental oxygen:Using supplemental oxygen while you sleep might help if you have central sleep apnea. Various devices are available to deliver oxygen to your lungs.
- Medications: Medications such as acetazolamide have been used to stimulate breathing in people with central sleep apnea. These medications might be prescribed to help your breathing as you sleep if you can’t tolerate positive airway pressure.
