Central sleep apnea is a breathing disorder that causes your body to decrease or stop the effort of breathing during sleep. This occurs in an off-and-on cycle. It is a result of a problem in the brain or heart. It is different from obstructive sleep apnea (OSA) because the problem is not caused by a blockage of the airway.

The brain and heart normally interact to direct, monitor, and change the amount of air that we breathe. The problem in central sleep apnea syndromes (CSA) is that the brain and heart move an abnormal amount of air into the lungs. CSA syndromes in adults are divided into these five categories:

  • Primary Central Sleep Apnea — Cause is not known. The breathing pattern consists of the repetitive absence of breathing effort and air flow
  • Cheyne-Stokes Breathing Pattern — Cause is heart failure, stroke, and possibly kidney failure. The breathing pattern consists of a rhythmic increase and decrease of the breathing effort and the amount of air flow
  • Medical Condition Not Cheyne-Stokes — CSA caused by medical conditions, but without the typical Cheyne-Stokes breathing pattern. It is caused by heart and kidney problems. It may also result from a problem in the base of the brain where breathing is controlled
  • High-Altitude Periodic Breathing — Caused by sleeping at altitudes higher than about 15,000 feet. The breathing pattern is similar to the Cheyne-Stokes Breathing Pattern. The difference is that there is no history of heart failure, stroke, or kidney failure. Also, the cycle time is shorter
  • Due to Drug or Substance — Caused by the use of drugs, mainly pain medicines in the opioid category. Breathing may stop completely or increase and decrease in a regular pattern. Breathing can also be quite irregular. It can even have elements of obstruction such as the breathing that is seen in OSA.

Symptoms

Almost all people with CSA have the following problems:

  • Disrupted sleep with frequent awakenings
  • Difficulty falling asleep
  • Daytime sleepiness

Other problems often seen include the following:

  • Snoring
  • Pauses in breathing
  • Waking up short of breath

A bed partner often can tell how often you snore and whether or not you stop breathing.

Many people with CSA are sleepy during the day. They find that they are still tired even after a nap. When you stop breathing, your body wakes up. It happens so quickly, you aren’t even aware of it. This disrupts your sleep process. You can stop breathing hundreds of times in one night. This will make you feel very tired the next day.

Medical conditions related to some types of CSA can also worsen the problems with sleeping and daytime sleepiness.

Risk Factors

  • Primary Central Sleep Apnea — Not known, but it appears to be quite rare and occurs in the middle-aged or elderly. Men seem to be affected more than women. There may be a tendency for inheritance. Some neurological conditions may increase the risk. These include multi-system atrophy and Parkinson disease
  • Cheyne-Stokes Breathing Pattern — Occurs mainly in men aged 60 or older. It is seen in 25% to 40% of men with chronic congestive heart failure. It is also found in 10% of men who have had a stroke. It is rarely seen in women and does not appear to be inherited
  • Medical Condition Not Cheyne-Stokes — Occurs rarely in patients with a variety of medical conditions. These include heart or kidney problems and abnormalities of the base of the brain where breathing is regulated
  • High-Altitude Periodic Breathing — Not known, but it appears to be more common in men. This is because men are more responsive to changes in the level of oxygen and carbon dioxide in their blood. This responsiveness is thought to be partially inherited. Some people sleeping at altitudes higher than 15,000 feet (about 5,000 meters) will have this disorder. Anyone sleeping above 25,000 feet (about 7,600 meters) will be affected
  • Due to Drug or Substance — Appears to occur in anyone taking long-acting opioids for longer than two months. There are no other characteristics known.

Diagnosis

Sleep specialists have training and expertise in this area. The doctor will review your medical history and symptoms. In the case of high-altitude periodic breathing, the detailed history alone should be enough to detect the problem. If needed, the doctor will schedule you for an overnight sleep study. This kind of study is called a polysomnogram. The sleep study will help the doctor to evaluate your problem.

Most of the causes of CSA are serious conditions that should be evaluated and treated. A sleep specialist can put together a treatment plan just for you. First, he or she must evaluate the causes of CSA and look for other conditions that create similar problems with sleeping. These include the following:

  • Another sleep disorder
  • A medical condition
  • Medication use
  • A mental health disorder
  • Substance abuse

The doctor will need to know your symptoms and how long you have had them. He or she will also want to know if your symptoms began at the same time as other medical problems or when you slept at a high altitude.

Get information from those who sleep with you or have seen you sleep. This includes spouses, relatives, friends, teammates and roommates. You will also need to provide a complete medical history.

Keep a sleep diary for two weeks. Include the following information:

  • What time you went to bed each night
  • What time you got up in the morning
  • How many times you awoke during the night
  • Whether you felt rested when you woke up
  • If you took naps during the day
  • Whether you felt sleepy or rested throughout the day

The sleep diary will help the doctor see your sleeping patterns. This information gives the doctor clues about what is causing your problem and how to correct it.

If your doctor thinks that you have a problem with breathing during sleep, you will need to do an overnight sleep study. This study is called a polysomnogram. It will chart your brain waves, heart beat, and breathing as you sleep. It will also record how your arms and legs move. This will reveal if you have CSA. It will also show how bad the problem is.

If you have CSA, you may be asked to return to the sleep center for a second polysomnogram. This visit will include a CPAP study. You will be given positive airway pressure (PAP) treatment as you sleep.

Treatment

Positive airway pressure (PAP) is the treatment most often used for CSA. It is delivered through a mask that you wear over the nose or face. The air gently blows into the back of the throat. This keeps the airway open so you are able to keep breathing as you sleep.

The amount of air pressure needed is different for each person. A CPAP study will show what level is right for you. Often a variation of PAP, called BPAP, is used.

A thorough evaluation and treatment of underlying medical conditions need to be done. Heart failure or kidney failure needs specific treatment. Stroke may require special care such as rehabilitation.

In the case of high-altitude periodic breathing, no specific treatment may be needed. But other problems that occur at high altitude may need to be addressed. Some of these may respond to medication. Others require avoiding high altitudes.

In the case of CSA due to drug or substance, a change of medication may be needed.