Central sleep apnea
Central sleep apnea can occur as a result of other conditions such as heart failure and stroke; sleeping at a high altitude can also cause central sleep apnea.
What is central sleep apnea? What causes central sleep apnea?
Central sleep apnea is a disorder in which breathing repeatedly stops and then starts again during sleeping. Central sleep apnea occurs because the brain doesn't send the proper signals to the muscles that control breathing - unlike obstructive sleep apnea, in which, breathing cannot be normal due to upper airway obstruction. Central sleep apnea is less common, accounting for less than 5% of sleep apnea cases.
Central sleep apnea can occur as a result of other conditions, such as heart failure and stroke. Sleeping at a high altitude can also cause central sleep apnea.
Treatments for central sleep apnea may solve using a breathing aid or supplemental oxygen.
Central sleep apnea symptoms
Common signs and symptoms of central sleep apnea include:
Stopping or abnormal breathing patterns during sleep.
Sudden awakening with difficulty breathing.
Shortness of breath that is relieved by sitting up.
Excessive daytime sleepiness (hypersomnia).
Although snoring indicates a degree of obstruction that increases airflow rate, snoring can also be heard in the presence of central sleep apnea. However, snoring may not be prominent with central sleep apnea because it is sleep apnea.
Consult a medical professional if you experience, in particular, any of the following signs or symptoms of central sleep apnea:
Shortness of breath that wakes you up from sleep.
Continuous pauses in breathing during sleep.
Excessive daytime sleepiness, which can cause falling asleep while working, watching television, or even driving.
Ask your doctor about any sleep problems that cause chronic fatigue, drowsiness, and irritability. Excessive daytime sleepiness (hypersomnia) can be caused by another disorder, such as narcolepsy or obstructive sleep apnea.
Central sleep apnea occurs when the brain fails to send signals to the respiratory muscles. Central sleep apnea can be caused by a number of conditions that affect the brain stem's ability to connect the brain to the spine and control many functions such as heart rate and breathing. Various causes of central sleep apnea types include:
Baseless. The cause of central sleep apnea is unknown.
Cheyne-Stokes: This type of central sleep apnea is often associated with congestive heart failure or stroke and is characterized by cycles of gradual increase in rhythm, and then decreased breathing. During the weakest breaths, lack of airflow (central sleep apnea) can occur.
The medical condition that causes sleep apnea: In addition to congestive heart failure and stroke, a number of medical conditions can lead to central sleep apnea. Damage of any part that controls breathing in the brain stem - can impair normal breathing.
The drug causes apnea: Certain drugs such as opiates, morphine, oxycodone, or codeine can cause irregular breathing, frequent up and down, or stops completely.
Height: Cheyne - Stokes can occur with sufficient altitude exposure, such as altitudes greater than 15,000 feet (about 4,500 meters). The change of oxygen in altitude causes tachypnea (increases by ventilation) and dyspnea.
Complex sleep apnea: Some people with obstructive sleep apnea develop central apnea during treatment with continuous positive airway pressure (CPAP) ventilation. This is called complex sleep apnea because it is a combination of obstructive and central sleep apnea (Central vs obstructive sleep apnea).
Sex: Men are more likely to develop central sleep apnea than women.
Age: Central sleep apnea in older adults is more common rather than central sleep apnea in children, possibly because of co-existing medical problems or sleep patterns that can cause central sleep apnea.
Heart disorder: People with atrial fibrillation or congestive heart failure are at increased risk of central sleep apnea. Central sleep apnea may be present in up to 40% of people with congestive heart failure.
Cerebrovascular accident or brain tumor: These conditions can reduce the brain's ability to regulate breathing.
Height: Sleeping at unfamiliar heights can increase the risk of sleep apnea. Altitude sleep apnea is no longer a problem when returning to lower altitudes.
Opioids: The use of opioids such as morphine, oxycodone, and codeine, increases the risk of central sleep apnea.
CPAP: Some people with obstructive sleep apnea develop central sleep apnea during treatment with CPAP (continuous positive airway pressure). This is called complex sleep apnea because it is a combination of obstructive and central sleep apnea. For some people, complicated sleep apnea continues with CPAP. Others may be treated with positive airway pressure (PAP) breathing.
Central sleep apnea is a serious medical condition. Some complications include:
Tired: The repeated awakenings associated with sleep apnea make it impossible to recover from normal sleep. People with central sleep apnea often experience severe daytime sleepiness, fatigue, and irritability. You may have trouble concentrating and falling asleep at work, watching TV, or even driving.
Cardiovascular problems: Sudden drops in blood oxygen levels that occur during central sleep apnea can affect cardiovascular health. If there is underlying heart disease, the repeat of low blood oxygen (hypoxia) worsens the prognosis and increases the risk of abnormal heart rhythms.
Tests and diagnostics
The doctor may perform an assessment based on your signs and symptoms or may refer you to a sleep disorder treatment center. There, a sleep specialist can help decide on the need for further assessment. Such an assessment usually involves overnight monitoring of breathing and other bodily functions during sleep.
In the polysomnography test, there's a connection to a device that monitors the heart, lungs, and brain activity, breathing patterns, arm and leg movements, blood oxygen levels during sleep.
Evaluation by a heart specialist (cardiologist) or a doctor who specializes in the nervous system (neurologist) may also be needed to find the cause of central sleep apnea.
Treatments and drugs
Solve medical problems: Possible causes of central sleep apnea include disorders, and treatment of those conditions can help with central sleep apnea. For example, appropriate treatment of heart failure can eliminate central sleep apnea.
Reduce opioid medications: If opioid medications cause central sleep apnea, your doctor may gradually reduce the dose of these medications.
Continuous positive airway pressure (CPAP): This method, also used to treat obstructive sleep apnea, involves wearing a mask over the nose during sleep. This mask is attached to a pump that supplies compressed air to keep the upper airway open. CPAP can prevent airway closure that can cause central sleep apnea. As with sleep apnea, it is important to use the device only as directed. If the mask is uncomfortable or feels too much pressure, talk to your doctor to make adjustments.
Breathing positive airway pressure (BPAP). Unlike CPAP, which supplies constant steady pressure to the upper airways during inhalation and exhalation, BPAP builds higher pressure on inhalation and lowers pressure on expiration. The purpose of this treatment is to promote the weak breathing pattern of central sleep apnea. Some BPAP devices can be set to automatically breathe if the device detects no breathing after a few seconds.
Adaptive Support Ventilation (ASV): Several studies have shown this ventilator to be more effective than CPAP or BPAP for treating central sleep apnea. ASV is designed to treat central sleep apnea and complex sleep apnea by monitoring normal breathing patterns and storing the information in a computer. After falling asleep, the machine uses pressure to correct breathing patterns and prevent pauses in breathing.
Oxygen supplement: Using supplemental oxygen during sleep may help in central sleep apnea. Different forms of oxygen are available as well as other devices to deliver oxygen to the lungs.
Medications: Several medications have been used to stimulate breathing in people with central sleep apnea. For example, some doctors prescribe acetazolamide to prevent central high-altitude sleep apnea.