Central sleep apnea: What to know

Central sleep apnea is a condition which causes a person’s breathing short delays while they sleep. This is because the brain temporarily stops breathing signaling to the respiratory muscles.

These breathing pauses can occur many times throughout the night, which can affect the quality of the sleep and put a person at risk for other health problems.

Central sleep apnea is not the same as the more severe obstructive sleep apnea. The latter is associated with obstructive respiratory problems and is often associated with obesity, while central sleep apnea is a neurological condition.

Keep on reading to learn more about the symptoms, causes and treatments of central sleep apnea.

What is central sleep apnea?

A CPAP machine may help treat central sleep apnea.
A CPAP machine may help treat central sleep apnea.

Sleep apnea is a relatively common condition, and while most people are familiar with obstructive apnea for sleep, central apnea for sleep is less known. It causes similar symptoms although the causes are quite different.

In each case, a thorough diagnosis is important to start treatment for the underlying cause which could reduce the risk of long-term problems.

Sleep apnea generally causes a person to experience pauses in his or her breathing pattern while asleep. The length and severity of these pauses varies. That is caused by all forms of sleep apnea. The sections below go into more detail on some different types of sleep apnea.

Obstructive sleep apnea

The most common form of sleep apnea is obstructive sleep apnea, affecting about 9–38 percent of the adult population.

Breathing delays occur in obstructive sleep apnea due to physical blockage in the upper airway. This can be due to additional tissue in the region (being overweight or obesity) or weakened tissue (because of older age).

Some other causes, including inflamed tonsils and abnormal growths in the neck, may cause physical blockages in the airways.

Central sleep apnea

There is no physical blockage present in the upper airways for people with central sleep apnea. Instead, sleep pauses occur because the brain does not send the correct signals to the muscles in the respiratory system.

The result is a change in breathing patterns, or a complete respiratory pause, called apnea.

Mixed sleep apnea

Many people may have mixed apnea for sleep too. This is a type of obstructive and central sleep apnea where the symptoms are caused by both physical and neurological causes.

Symptoms

Pauses in a person’s breathing as they sleep are the primary signs of central sleep apnea. While some people may not notice this symptom, others may do, 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

Though this is more generally a symptom of obstructive sleep apnea than central sleep apnea, the individual may also snore.

Anyone who develops symptoms can see a full diagnosis from a healthcare provider.

Diagnosis

Diagnosis of central apnea for sleep usually starts with a physical exam. The doctor will ask the person what their symptoms are, and how often they occur.

They will also ask questions about the medical history of the person including any medications they are taking at the moment and any issues they may have.

If a doctor believes a person has central sleep apnea, a few tests will be done to confirm the diagnosis.

Tests that may help diagnose or eradicate central sleep apnea 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

Treatment

To reduce the risk of other disorders it is necessary to receive treatment for central sleep apnea. The primary purpose of treatment is to address the underlying cause of sleep apnea.

For example, if a person has had a major heart event— such as heart failure— which triggers their central apnea for sleep, a doctor may work to treat the heart failure itself.

Having said that, a doctor may also prescribe one or more medications during treatment for the underlying cause to help control the symptoms of sleep apnea. These examples include:

Continuous positive airway pressure machines

In many cases of sleep apnea, physicians would prescribe first line treatment using a continuous positive airway pressure (CPAP) system.

CPAP machines transfer air through a mask and into the airways of the person. This may help to reduce the risk of sleep apnea, as air force helps to keep the airways open and air circulating into them.

That being said, CPAP machines may not work for people with central sleep apnea. A research in the American College of Cardiology Journal states this CPAP only functions in about 50 per cent of people with central sleep apnea.

If symptoms do not improve with CPAP, it is important to look for an alternative treatment option.

Adaptive servo ventilation

Flexible servo ventilation (ASV) is a less invasive method of providing oxygen to the body.

ASV measures the person’s breathing constantly to help identify and provide the optimal air pressure to alleviate symptoms. It makes the therapy highly flexible and provides greater flexibility when using the computer.

Oxygen supplementation

The absorption of oxygen includes the application of extra oxygen to the lungs during sleep.

In general, this is done by injecting oxygen through the nose and into the night airways. This can help ensure the body has adequate oxygen, thereby reducing the risk of sleep apnea events.

Medication

A doctor may also often recommend specific medicines to help the body manage its breathing patterns.

Adjusting current medications can, in other cases, help to treat sleep apnea. Of example, people who are taking medications or opioids of pain relief might need to lower their dose to control sleep apnea symptoms.

Phrenic nerve stimulation

The phrenic nerve guides the diaphragm, and the breathing cycle itself. The treatment will regulate several central sleep apnea symptoms by stimulating the main nerve during sleep.

Causes

The direct cause of central sleep apnea is a brain failure during sleep to relay the signals needed for the proper breathing to happen.

The underlying cause of that failure will vary depending on a person’s type of central sleep apnea. Several examples may include:

Cheyne–Stokes breathing

Cheyne–Stokes breathing is a pattern of deep and rapid breathing followed by a series of short, shallow breaths leading to apnea.

This is very common in people who have experienced cardiovascular events such as heart failure or stroke.

High-altitude apnea

High-altitude apnea is a variation of the breathing pattern Cheyne– Stokes that occurs when a person is at a very high altitude. This happens because differing levels of oxygen can also induce breathing changes.

Drug-induced apnea

A number of drugs can in some way interact with the nervous system or muscles, potentially leading to apnea for central sleep.

Drugs such as opioid pain prescription products can cause breathing changes. In particular, they may cause the breath to become erratic or shallow, or to stop completely for a short period of time.

Apnea from other medical conditions

Certain disorders, such as late stage kidney disease, severe obesity or stroke, may also cause central sleep apnea.

Treatment-emergent sleep apnea

Many people who may develop central sleep apnea use CPAP devices for obstructive sleep apnea. If this occurs, a person can need continuous care or a medication change.

Idiopathic central sleep apnea

There is no underlying cause for idiopathic central sleep apnea. This form is also known as central apnea for sleep.

Outlook

The outlook can in any case 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 like CPAP and oxygen machines can take some to get used to, but with time they may improve a person’s symptoms.

Therapy for sleep apnea is particularly important, since the disorder can lead to a number of long-term health issues without therapy.

Sleep apnea can perturb a person’s sleep significantly. Sleep should be restful, and a period when brain and body activity reduces, allowing for recharge. Sleep apnea events also increase brain activity and body stress levels.

Sleep apnea thus constitutes a risk factor for a number of other issues, such as:

  • inflammation
  • oxidative stress
  • vascular dysfunction
  • issues with metabolism
  • changes in the nervous system

Without treatment, these issues can increase the risk of other conditions, including:

To avoid these serious complications, the detection and treatment of the underlying cause of sleep apnea is crucial. The overall outlook would depend on the underlying cause being handled and those complications prevented.

When a doctor can find and treat the underlying cause properly, a person’s sleep apnea symptoms are likely to greatly improve or completely stop.

Sleep apnea occurs when a person periodically stops breathing the entire night. It happens in central sleep apnea due to faulty brain signals which do not tell the respiratory muscles to breathe properly.

There are several possible causes and the proper diagnosis of the cause is the key to finding the best form of treatment.

Getting prompt and early treatment for central sleep apnea can help reduce the risk of complications in the long term.

In many cases, proper treatment of the underlying cause of central sleep apnea will avoid the apnea itself or greatly reduce it.

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