Central Sleep Apnea

Written by Erica Roth | Published on July 12, 2012
Medically Reviewed by George Krucik, MD

What Is Central Sleep Apnea?

Central sleep apnea is a sleep disorder in which you briefly stop breathing during sleep. The moments of apnea can occur repeatedly throughout the night. The interruption of your breathing happens may indicate a problem with your brain’s signaling. Your brain momentarily “forgets” to tell your muscles to breathe.

Central sleep apnea is not to be confused with obstructive sleep apnea. Obstructive sleep apnea is the interruption of breathing due to blocked airways. People who have central sleep apnea do not have blockages in their airways. The problem is in the connection between the brain and the muscles that let you breathe.

Central sleep apnea is much less common than obstructive sleep apnea. The American Sleep Apnea Association (ASAA) estimates that less than 20 percent of people with sleep apnea suffer from central sleep apnea. (ASAA)

What Causes Central Sleep Apnea?

Underlying health conditions are the cause of most cases of central sleep apnea. During a central sleep apnea episode, your brainstem does not signal your breathing muscles to function properly. Your brainstem is the section of your brain that connects to your spinal cord. Medical conditions that affect your brainstem, spinal cord, or heart can cause you to develop central sleep apnea.

Examples of related conditions include:

  • stroke
  • heart attack
  • congestive heart failure
  • a weak breathing pattern called Cheyne-Stokes breathing
  • encephalitis (an inflammation of the brain)
  • arthritis in the cervical spine
  • Parkinson’s disease (an age-related deterioration of certain nerve systems that affects movement, balance, and muscle control)
  • surgery or radiation treatments in the spine

Medication use can also cause a type of central sleep apnea called drug-induced apnea. Opioid drugs are powerful painkillers that can lead to irregular breathing patterns. In some cases, you may temporarily stop breathing as part of this irregular pattern.

Drugs that can contribute to central sleep apnea include:

  • codeine
  • morphine
  • oxycodone

If the cause of your central sleep apnea cannot be identified, it is called idiopathic central sleep apnea.

Central Sleep Apnea Symptoms

The primary observed symptom of central sleep apnea is short periods during sleep when breathing stops. Some people exhibit very shallow breathing instead of an actual stoppage of breathing. The lack of oxygen can cause you to wake up briefly and frequently throughout the night. You may wake up feeling short of breath. The apnea episodes can cause insomnia, too.

Other symptoms associated with central sleep apnea occur during the day, as a result of an interrupted night’s sleep. You may feel very sleepy during the day, have trouble concentrating or focusing on tasks, or have a headache when you wake up.

Central sleep apnea caused by Parkinson’s disease or other neurological conditions can be characterized by additional symptoms, including:

  • swallowing difficulties
  • changes in speech patterns
  • voice changes
  • generalized weakness

Diagnosing Central Sleep Apnea

Your doctor will order a sleep study test called polysomnography to diagnose central sleep apnea. During polysomnography, your oxygen levels, brain activity, breathing pattern, heart rate, and lung function are monitored. You will be outfitted with a series of electrodes on your head and body to measure each function. The test is administered overnight as you sleep in a special sleep center.

Your doctor, a neurologist, and sometimes a cardiologist will view the results of your polysomnography. The results can help determine the underlying cause of your apnea.

A head or spinal magnetic resonance imaging (MRI) scan may also be used to diagnose central sleep apnea. MRI uses radio waves to generate images of your organs. The test may reveal structural abnormalities in your brainstem or spine that are causing central sleep apnea.

Treating Central Sleep Apnea

Management of underlying medical conditions is the first line of treatment for central sleep apnea. Congestive heart failure, Parkinson’s disease, and other heart or nervous system conditions can be controlled with medications. You may need to wean yourself off of opioid medications if these drugs are causing your breathing to stop during sleep. Your doctor may also prescribe medications such as acetazolamide to stimulate your breathing mechanism.

Oxygen supplementation and the regulation of air pressure during sleep are effective treatments for many people with central sleep apnea. These include:

  • CPAP, or continuous positive air pressure, provides a steady source of pressure in your airways as you sleep. You wear a mask over your nose and mouth that delivers pressurized air throughout the night. CPAP is used to treat obstructive sleep apnea, but can also be beneficial for people with central sleep apnea.
  • BPAP, or bi-level positive air pressure, adjusts the air pressure to a higher level when you inhale and a lower level when you exhale. BPAP is also delivered through a facemask.
  • ASV, or adaptive servo-ventilation, monitors your breathing as you sleep. The computerized system “remembers” your breathing pattern. The pressurized system regulates the breathing pattern to prevent apnea episodes.

Outlook for Central Sleep Apnea

Those who suffer from idiopathic central sleep apnea most often respond well to treatment. The overall benefits of treatment for central sleep apnea vary according to the exact cause of the condition.

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