Central Sleep Apnea: Causes, Symptoms, and Treatments

Central sleep apnea causes brief interruptions in breathing during sleep because the brain doesn’t signal the respiratory muscles properly. This affects sleep quality and can lead to health problems.

Unlike obstructive sleep apnea, which involves physical blockages, central sleep apnea is neurological.

In this article, we’ll discuss its symptoms, causes, and treatments.

What Is Central Sleep Apnea?

Central Sleep Apnea

Central Sleep Apnea (CSA) is a sleep disorder in which patients experience repeated stops in breathing during sleep due to an inability of the brain to send appropriate signals to the muscles that control breathing.

Unlike Obstructive Sleep Apnea (OSA), where the airway is physically blocked, CSA occurs because the brain does not properly regulate the breathing process during sleep. This medical condition is less common, accounting for about 20% of sleep apnea cases according to the ASAA.

What Causes Central Sleep Apnea?

Central sleep apnea happens when the brain doesn’t control breathing properly. Unlike obstructive sleep apnea, the airway isn’t blocked. It often occurs during the transition between sleep and wakefulness or in light sleep stages.

It can be linked to neurological conditions like Parkinson’s disease or stroke, and to Cheyne-Stokes breathing seen in heart failure patients.

It might also happen after using opioid pain medications, but stops when the medication is stopped.

Sometimes, it can occur due to high pressure from CPAP machines, known as complex sleep apnea, but usually resolves with time and continued treatment.

Risk Factors for Central Sleep Apnea

Central sleep apnea (CSA) is more common in people over 65 years old and in males. Medical conditions like heart failure, abnormal heart rhythms, kidney failure, hypothyroidism, stroke, brain infections, brain tumors, and certain genetic conditions can increase the risk.

Moreover, medications such as prescription opioids, illegal opioids like heroin, alcohol, benzodiazepines, antidepressants, seizure medications, muscle relaxants, and blood thinners can contribute to or worsen CSA.

If you are concerned about the risk of CSA, speak with your doctor before adjusting the dosage of your medication.

What Are the Symptoms of Central Sleep Apnea?

Central sleep apnea (CSA) can be hard to spot, with some people showing no symptoms. But when they do occur, they might include:

  • Feeling overly tired during the day
  • Having trouble sleeping well
  • Trouble falling asleep (insomnia)
  • Difficulty focusing or staying attentive
  • Waking up suddenly short of breath
  • Morning headaches
  • Chest discomfort at night


Complications of central sleep apnea can be serious:

  • Fatigue: The constant awakenings lead to poor sleep, causing severe tiredness, daytime drowsiness, and irritability.
  • Difficulty focusing: You may struggle to concentrate and might even nod off at work, while watching TV, or when driving.
  • Cardiovascular issues: Drops in blood oxygen levels can harm the heart, increasing the risk of irregular heartbeats, especially if you already have heart disease.

How Is Central Sleep Apnea Diagnosed?

Diagnosing central sleep apnea involves:

  1. Noticing Symptoms: A family member or partner might observe your breathing pauses while asleep.

  2. Doctor’s Evaluation: Your doctor will conduct a physical exam, discuss your medical history, and inquire about your sleep habits.

  3. Sleep Study (Polysomnogram): You’ll likely undergo a sleep study, monitoring various aspects of sleep, including brain activity, eye movement, muscle activity, heart rate, breathing, airflow, and blood oxygen levels. This study helps assess the severity of apnea by counting breathing interruptions.

  4. Lab Setting: Typically, sleep studies are conducted in a specialized lab, although at-home tests are more common for obstructive sleep apnea and may not be as effective for diagnosing central sleep apnea.

What Are the Treatments for Central Sleep Apnea?

Central sleep apnea can be managed with various treatments:

  1. Address Underlying Conditions: Managing medical conditions like congestive heart failure or Parkinson’s disease is crucial.

  2. Medications: Some medications, such as acetazolamide, can help stimulate your breathing.

  3. Oxygen Therapy: Supplemental oxygen can be provided to improve breathing during sleep.

  4. Continuous Positive Airway Pressure (CPAP): CPAP machines deliver steady air pressure through a mask worn over the nose and mouth, helping to keep airways open.

  5. Bi-level Positive Airway Pressure (BPAP): BPAP adjusts air pressure levels, delivering higher pressure when inhaling and lower pressure when exhaling, also using a mask.

  6. Adaptive Servo-Ventilation (ASV): ASV devices monitor breathing patterns and adjust pressure levels to maintain regular breathing, reducing apnea episodes.

For mild cases of sleep apnea, you may consider using some anti-snoring devices or anti-snoring mouthpieces.

Living with Central Sleep Apnea

If you’ve been diagnosed with central sleep apnea (CSA), it’s a mix of relief and challenge. Here’s how to cope:

  1. Learn about CSA: Understand the condition by checking reliable sources and joining support groups for info and advice.
  2. Avoid triggers: Stay away from sedatives like alcohol and opioids that can worsen breathing problems.
  3. Keep in touch with your doctor: Regular check-ins are key to ensuring your treatment works well and to address any concerns or side effects. Your doctor can also connect you with helpful resources.

Need professional help to diagnose and address your sleep problems? Schedule an online consultation with sleep specialist Dr. John Williams.

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