A condition in which recurrent breathing stops happen during sleep is called central sleep apnea. The primary cause of this condition is the brain that does not send proper signals to the muscles that control breathing. It is important to know that this sleep apnea type is different from obstructive sleep apnea. The second type of this disease is caused by throat muscles that relax and block the airway. However, obstructive sleep apnea occurs more frequently than central sleep apnea.
This sleep apnea type may happen due to other health problems including heart failure, stroke, and others. Some people experience it when sleep at a high altitude. The treatment goal is to treat underlying conditions and maintain a constant breath using a device or supplemental oxygen.
Symptoms
The most common symptoms of this disease include the following ones. For example:
- Insomnia (sleeping disturbances)
- Difficulty focusing
- Excessive daytime sleepiness (hypersomnia)
- Sudden awakening with shortness of breath
- Snoring
- Morning headaches
- Mood swings
Loud snoring is the most common symptom of sleep apnea. However, it mostly is associated with the obstructive type of sleep apnea, but it may happen in people with central type as well.
Do not hesitate to see a doctor if any of the following symptoms occur. Examples include:
- Shortness of breath
- Difficulty staying asleep
- Excessive daytime sleepiness may cause you to fall asleep while working, watching TV, or even driving
- Breathing pauses during sleep
Discuss with your healthcare professional about health conditions that cause regular extreme tiredness, sleepiness, and irritation. While previous symptoms are usually associated with obstructive sleep apnea, they can be caused by other health problems (such as narcolepsy).
Causes
Normally, the brainstem connects the brain to the spinal cord. It is responsible for multiple body functions such as heart rate, breathing, and others. Health conditions that negatively affect the ability of the brainstem to control breathing usually cause central sleep apnea. Check below some sleep apnea types according to the underlying cause:
- Cheyne-Stokes breathing – This central sleep apnea type often is associated with congestive heart failure or stroke. Moreover, a total lack of airflow may occur in people with Cheyne-Stokes breathing.
- Drug-induced apnea – In such cases, the condition occurs due to certain medicines such as opioids. These medicines are usually taken by mouth, shot, or injection. This apnea type happens usually due to Oxycodone, Codeine, or Morphine.
- High-altitude periodic breathing – At very high altitudes Cheyne-Stokes breathing may occur because of changes in oxygen. This process is also known as hyperventilation.
- Treatment-emergent central sleep apnea – This usually occurs when people with obstructive sleep apnea use continuous positive airway pressure (CPAP) for treatment and develop central sleep apnea. This disease means a person has a combination of central and obstructive sleep apnea.
- Medical condition-induced central sleep apnea – There are multiple health conditions that may lead to central sleep apnea. These include severe kidney disease, stroke, and others.
- Primary central sleep apnea (also known as idiopathic sleep apnea) – This sleep apnea type occurs quite rarely and the exact cause is not known.
Risk Factors
There are multiple factors that may elevate your risk of developing central sleep apnea. For example:
- Sex – Men are more likely to develop this sleep disorder than women.
- Age – This condition is mostly diagnosed in people older than 60.
- Heart diseases – People with heart problems are at higher risk of developing central sleep apnea. These include atrial fibrillation, irregular heartbeats, congestive heart failure, and others.
- Stroke, brain tumors, or brainstem problems – These health problems also may cause central sleep apnea.
- High altitude – People who sleep at high altitudes are at increased risk of developing sleep apnea. However, it often goes away within several weeks after returning to lower altitudes.
- Opioid use – This group of medicines may significantly increase your risk of developing central sleep apnea.
- CPAP – People who use this treatment for obstructive sleep apnea, may develop central sleep apnea at the same time. The condition in which both sleep apnea types occur is called treatment-emergent central sleep apnea.
What Are The Possible Central Sleep Apnea Complications?
Central sleep apnea is considered a serious health problem and without treatment may cause some complications. These include:
- Extreme tiredness (fatigue) – People with this sleep disorder frequently experience severe fatigue, daytime sleepiness, and irritability. Previous symptoms are caused by repeated awakening during sleep. Moreover, difficulty focusing and concentrating, falling asleep at work, while driving, or watching TV also may occur.
- Cardiovascular problems – Heart problems may occur due to sudden drops in blood oxygen that often happen in people with central sleep apnea. Recurrent episodes of reduced blood oxygen may increase the risk of a dangerous heart condition called arrhythmia (irregular heart rhythm).
Diagnosis
Doctors often evaluate your disease by asking questions about your medical history and symptoms. If they suspect you may have a sleep disorder, you may be referred to a sleep specialist who decides if further evaluation is needed.
To confirm the condition sleep specialists usually perform a polysomnography. This test involves monitoring multiple body functions while you sleep. These include heart, lungs, brain activity, breathing, movements of the arms or legs, blood oxygen, and others. Sometimes, they may perform a split-night study in which you are monitored for the first half of the night and if you are diagnosed with central sleep apnea, they can wake you and begin the therapy for the second half of the night.
Furthermore, polysomnography can help exclude other conditions that cause similar symptoms to central sleep apnea. For example narcolepsy, repetitive movements during sleep, obstructive sleep apnea, and others. You also may be referred to a cardiologist, neurologist, or other specialist to identify the underlying condition.
Treatment
The treatments for people with central sleep apnea may be different. Check below some of them:
- Treatment for underlying conditions – Physicians may recommend medicines and other procedures for conditions that cause central sleep apnea. For example heart disease, kidney disease, and others.
- Dose reduction – Physicians may recommend gradually reducing the dose of medicines (such as opioids) if they cause sleep apnea.
- CPAP (continuous positive airway pressure) – This treatment also is used to treat obstructive sleep apnea. It involves a mask that covers the nose, mouth, or both during sleep. CPAP continuously delivers pressurized air that helps keep the upper airway open.
- ASV (adaptive servo-ventilation) – This treatment is usually recommended when CPAP does not work. ASV also delivers pressurized air. However, people with symptoms of heart failure should not use ASV.
- BPAP (bilateral positive airway pressure) – BPAP is similar to previous treatments (including CPAP and ASV). Unlike ASV, this treatment cannot deliver different amounts of pressure. The pressure that is delivered by BPAP is constant.
- Supplemental oxygen – People with central sleep apnea may need supplemental oxygen. However, there are multiple devices that deliver oxygen to the lungs.
- Medicines – Physicians may prescribe medications when previous treatments do not work. They usually recommend Acetazolamide.
Other Treatments
There is a device approved by the FDA (Food and Drug Administration) for people with central sleep apnea. It works by stimulating the intravenous phrenic nerve. The device is called Remede System and it delivers small electrical impulses to the nerve that controls the diaphragm, causing you to take a breath. Commonly, it is recommended for people with moderate to severe central sleep apnea.
Frequently Asked Questions
What are the causes of central sleep apnea?
- Neurological disorders (such as Parkinson’s disease, stroke, multiple sclerosis, and others)
- Idiopathic (sometimes it is not possible to determine the exact cause of the disease)
- Medicines (for example opioids, sedatives, and others)
- Heart disease (such as congestive heart failure, atrial fibrillation, arrhythmia, and others)
What is the primary symptom of central sleep apnea?
Generally, the main symptom of this sleep disorder is loud snoring. However, it may cause other symptoms as well. For example repetitive awakenings during sleep, headaches, difficulty concentrating or focusing, irritability, and others. If any of them occur, do not hesitate to see a doctor.
What are the central sleep apnea complications?
People who ignore the symptoms and do not get treatment for central sleep apnea may also experience some complications. For example:
- Severe fatigue
- Sudden fall asleep at work, while driving, or watching TV
- Cardiovascular problems
- Organ damage
- Insomnia (sleeping disturbances)
- Elevated risk of irregular heart rhythm
- Insulin resistance
- Cognitive changes
This document does not contain a full list of central sleep apnea complications. If you have additional questions, ask your healthcare provider.
