What is Central Sleep Apnea?
Dr. Angel Rivera
Central sleep apnea, or CSA, is a sleep disorder that affects the central nervous system and is caused by problems with the signals your brain sends that control breathing.
Central sleep apnea can occur in people of any age, but it is more common in older adults.
It can cause you to stop breathing for short periods of time while you sleep and also cause snoring and other problems that may affect your health and quality of life.
Please continue reading this article to find out more about central sleep apnea, its symptoms, how it is diagnosed, and how to treat it.
Sleep apnea is a sleep disorder that causes you to stop breathing during sleep. It is due to a blockage in the airway, usually when the soft tissues in the back of the throat collapse and obstruct breathing or from your brain not sending the correct signal to your body to breathe.
These pauses in breathing are called apneas and can lead to a number of health problems, including high blood pressure, heart disease, and stroke.
It can affect both men and women at any age, although it is most common in older adults who are men.
There are three main types of sleep apnea, central sleep apnea or CSA, obstructive sleep apnea or OSA, and complex sleep apnea which is also called mixed sleep apnea or MSA.
It is important to know which type of sleep apnea you have because they can be treated differently.
Central sleep apnea
Central sleep apnea occurs when the central nervous system doesn’t send the right signals to the muscles that control your breathing, which causes you to stop breathing during sleep, even though your airway isn't blocked.
While central and obstructive sleep apnea are the most typical types of sleep apnea, central sleep apnea is a much less common form.
Obstructive sleep apnea
Obstructive sleep apnea is a type of sleep apnea that occurs when the airway becomes blocked or narrowed during sleep, preventing air from flowing into the lungs.
This is usually caused by the collapse of soft tissues in your throat, such as the respiratory muscles and soft palate, and is the most common form of sleep apnea.
Mixed sleep apnea
Complex or mixed central sleep apnea is a combination of both obstructive sleep apnea and central sleep apnea. This is the rarest form of sleep apnea.
The most common symptom of sleep apnea is loud snoring which you may not know about unless a bed partner or someone you live with tells you about it.
Another common symptom of central sleep apnea is breathing pauses during sleep which may lead to gasping or choking for air after these apnea episodes.
If you have sleep apnea you may also experience disturbed or restless sleep, fatigue, and morning headaches.
Insomnia, or the inability to get back to sleep, can disrupt your sleep patterns and is also a common problem after waking up due to difficulty in breathing.
Feeling excessive daytime sleepiness or EDS also happens and can lead to issues in concentrating, irritability, and mood swings due to poor sleep quality.
What are the risk factors for central sleep apnea?
There are a number of risk factors for central sleep apnea syndrome, including the following:
Central sleep apnea becomes more common with increasing age, especially after age 60.
Men are more likely to get central sleep apnea than women.
If you have cardiovascular or heart problems, such as congestive heart failure (CHF), high blood pressure (hypertension), and atrial fibrillation (irregular heartbeat), you are at higher risk of central sleep apnea.
Certain brain conditions like stroke, brain tumors, brain stem issues, and brain lesions can also lead to central sleep apnea due to your brain's inability to regulate breathing.
If you are unused to higher altitudes this may also lead to sleep apnea. This type of central sleep apnea generally goes away after returning to normal altitudes.
People who are taking prescription opioids for pain relief may also be at risk for central sleep apnea.
CPAP, or constant positive airway pressure machines are the most common treatment option for sleep apnea.
However, when using a CPAP machine you are slightly more likely to develop central sleep apnea, too. This is called treatment-emergent sleep apnea and is a form of mixed sleep apnea.
Central sleep apnea can be a side effect if you have hypothyroidism or low thyroid function.
When your kidneys fail, this can lead to metabolic acidosis. This means that your body has too much acid which can lead to central sleep apnea.
There are many different causes of central sleep apnea that we will go into detail below to explain how each can cause central sleep apnea.
The Cheyne-Stokes breathing pattern, also called Cheyne-Stokes respiration, is a central sleep apnea disorder that can attribute pauses during the cyclical pattern of breathing while you sleep. This usually occurs in people who have had heart failure or stroke.
High altitude periodic breathing
High altitude periodic breathing is a form of Cheyne-Stokes respiration that occurs at higher altitudes due to the low oxygen levels.
Drug-induced central sleep apnea
Central sleep apnea can be caused when taking some medications, especially opioids for pain relief if they are not used correctly or taken in high doses. Drugs such as oxycodone, morphine, and codeine can cause this condition.
Treatment-emergent central sleep apnea
As mentioned previously, central sleep apnea can sometimes develop when using a CPAP machine for treating obstructive sleep apnea. This is called treatment-emergent central sleep apnea and it is a form of mixed sleep apnea.
Medical-condition induced central sleep apnea
There are a number of medical conditions that can lead to central sleep apnea. These include:
- Congestive heart failure (CHF) which is also known as chronic heart failure
- Parkinson's disease
- Kidney failure
Idiopathic (primary) central sleep apnea
This is when there is no known cause for central sleep apnea.
What are the complications of central sleep apnea?
If you have any form of sleep apnea then you are at a higher risk of certain other medical conditions.
Central sleep apnea has been associated with an increased risk of death in people who have had a stroke
. It is also linked to cardiovascular problems such as high blood pressure (hypertension), heart attack, and an irregular heartbeat.
Obesity and diabetes are also complications when you have sleep apnea.
Lastly, due to repeated waking up throughout the night and the inability to go back to sleep, you may also experience fatigue which can lead to sleepiness during the day and even increase your risk of accidents.
There are two main ways of diagnosing sleep apnea although one is more accurate than the other. The first way is a sleep study which will usually involve an overnight stay in a sleep lab or sleep center. This is where you will wear different sensors while you sleep to measure your breathing, heart rate, and brain activity. A sleep specialist will monitor you and interpret your findings.
The second way to diagnose central sleep apnea is by doing a home test. There are different types of home tests that can be used and your doctor will decide which is best for you. These tests usually involve wearing a device that monitors your breathing while you sleep. The results will then be uploaded to your sleep specialist for interpretation. These tests are very convenient but may be less accurate.
There are many different treatment options for central sleep apnea, but the most common is using a CPAP machine. Below we will detail CPAP machines and other treatment options for central sleep apnea.
CPAP (continuous positive airway pressure) machines
A CPAP machine is a common treatment for central sleep apnea. It works by providing pressurized air through a face mask that you wear while sleeping.
The air pressure helps to keep your upper airways open and prevent them from collapsing during breathing which can then cause central sleep apnea episodes.
ASV (adaptive servo-ventilation) machines
Adaptive servo-ventilation machines are a newer treatment for central sleep apnea and are usually used when CPAP therapy is not effective.
They work by providing different levels of air pressure depending on your breathing pattern. This helps to keep your airways open and prevent them from collapsing during breathing.
Other positive airway pressure machines
BiPAP, or bilevel positive airway pressure, machines and APAP, or automatic positive airway pressure, machines can also be used and are similar to adaptive servo-ventilation machines in that they provide different air pressures while you are asleep based on your breathing patterns or respiratory effort.
Reducing opioid medications
If you are taking opioid medications then your doctor may want to lower the dose or even stop them altogether. Opioids can cause central sleep apnea and so reducing or stopping these medications can help improve your central sleep apnea symptoms.
Addressing other medical conditions
If you have any other medical conditions such as diabetes or heart disease then addressing these conditions can also help improve your symptoms. These issues may be the cause of central sleep apnea and by addressing them, you may help your symptoms.
This involves using an oxygen tank and mask to increase the amount of oxygen in your blood which may help with your sleep apnea.
There are many different types of surgery that can be done for central sleep apnea including:
- Uvulopalatopharyngoplasty (UPPP)
These involve removing excess soft tissue from the back of your throat to help promote normal breathing.
Nerve stimulation surgeries are also available and work by stimulating the nerves that control your breathing through a device implanted in your chest.
There are some medications available, such as acetazolamide, that promote breathing while you sleep. Your doctor may prescribe them as an alternative to positive airway pressure therapies.
Central sleep apnea is a disorder in which breathing stops during sleep due to central nervous system issues.
It can be caused by different things such as heart disease, opioid use, and age among other factors. The main symptoms are snoring, gasping for air while sleeping, and waking up with shortness of breath although there are several others.
There is a wide range of treatment options including using a CPAP machine, adaptive servo-machine machine, or other positive airway pressure machines to surgery and medications.
If you are experiencing any of the symptoms of central sleep apnea or have more questions, please talk to your doctor or healthcare provider.
References and Sources:
Saudi Journal of Kidney Diseases and Transplantation