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Central Sleep Apnea: Symptoms, Causes, Diagnosis & Treatments

Central Sleep Apnea: Symptoms, Causes, Diagnosis & Treatments

The disorder known as central sleep apnea (CSA) is one that disrupts a person’s breathing while they are sleeping. It should not be confused with obstructive sleep apnea (OSA), which is a condition that is far more prevalent and well-known.

The CSA is frequently associated with an underlying health issue, and if it is not treated, it can have a negative impact on an individual’s general health by causing sleep disruption, daytime sleepiness, cognitive difficulties, irritability, and exhaustion.

Central sleep apnea is a distinct condition, and it’s critical to understand it. Despite similarities in the causes, symptoms, and treatments of obstructive sleep apnea and central sleep apnea, central sleep apnea is a distinct illness.

In this guide, you’ll learn about the symptoms, causes, diagnosis, and treatment options that are most frequently used for central sleep apnea.

Central Sleep Apnea

Central sleep apnea is a disorder that is caused by interruptions in breathing that are brought on by a cessation of respiratory effort when the individual is sleeping. In contrast to obstructive sleep apnea, the intervals in breathing that occur throughout the night are caused either by a failure of the respiratory muscles to activate or by a failure of the brain to ask the respiratory system to activate. 

Both of these disorders are marked by a short supply of oxygen to the brain.

When we take a breath in, our brain triggers the diaphragm and the muscles in our rib cage to contract so that we may take that breath in. Inhalation occurs as a result of the muscle contractions in the diaphragm and the rib cage. 

Central sleep apnea is a consequence of a common breakdown in the connection between the respiratory muscles and the brain in order to govern breathing.

It is essential to keep in mind that only a few central apneas throughout the course of the night are believed to be normal. As we drop off to slumber or after we wake up, we frequently have brief moments in which we “forget to breathe.”

What Makes Central Sleep Apnea Dissimilar To Obstructive Sleep Apnea?

When a person has obstructive sleep apnea, they make a conscious attempt to breathe throughout the night, but their airway in the base of the neck remains clogged. Because of the obstruction at the back of the throat, our windpipe becomes constricted, which causes sleep disruption and throws off the body’s delicate oxygen balance.

The cause of the problem with central sleep apnea is not a clogged airway. Instead, these pauses in breathing result from abnormalities in the brain and the muscles that govern respiration. In contrast to obstructive sleep apnea (OSA), there is almost no normal respiratory action because of the condition.

Mixed sleep apnea is the name given to the condition in which both OSA and CSA are present at the same time. Although OSA and CSA are two independent disorders, they can occur together. Additionally, therapy of obstructive sleep apnea with continuous positive airway pressure (CPAP) can lead to central sleep apnea. This condition is referred to as treatment-emergent central sleep apnea.

How Prevalent Is Central Sleep Apnea?

How Prevalent Is Central Sleep Apnea?

Although the precise number of people who suffer from central sleep apnea is uncertain, it is believed that around 0.9% of people in the United States who are over the age of 40 are affected by the disorder. Even though it can affect both men and women, men (older than 65 years) are more likely to be affected by it than younger males. 

Central sleep apnea is more likely to occur in patients who have a history of using narcotics, have suffered a stroke, reside at high altitudes, or are currently being treated with CPAP.

Causes And Types Of Central Sleep Apnea

It is still unknown what exactly triggers central sleep apnea in patients. In a normal state, breathing is controlled by a region of the brain known as the respiratory control center. 

It is possible for breathing to become disordered if the levels of carbon dioxide drop below the usual range or if there is impairment to the brain circuits involved in the regulation of breathing. However, as was just discussed, in contrast to obstructive sleep apnea, the airway does not get obstructed with this condition.

Types Of Central Sleep Apnea

Central sleep apnea usually happens when a person is shifting between sleep and waking; however, it can also go on into the lighter periods of sleep, which are referred to as NREM. It is possible that it will happen after awakening, in which case it would be referred to as a post-arousal central.

There are two main categories of central sleep apnea, and within each of those categories, there are a number of subtypes

The Hypoventilation Type

The hypoventilation type is the first group that we shall discuss with you in more detail. When a person has this form of central sleep apnea, the brain is unable to deliver signals to the respiratory muscle in an efficient manner, which causes the person to stop breathing. In situations like this, carbon dioxide can frequently accumulate. The following subtypes fall under the umbrella of the hypoventilation-type of central sleep apnea:

1. Narcotic-Induced Central Sleep Apnea

The use of drugs like opioids can cause a kind of central sleep apnea known as narcotic-induced central sleep apnea. This form of central sleep apnea occurs when the brain’s capacity to correctly begin and control breathing is impaired.

2. Central Sleep Apnea Caused by a Medical Condition

This particular kind of central sleep apnea typically develops as a consequence of a brain-related medical condition such as a stroke, tumor, or head injury. In most cases, the brain stem is compromised. It is a part of the brain that is involved in the control of breathing and has a role in its regulation.

3. Syndrome of Congenital Central Hypoventilation (CCHS)

CCHS is a relatively rare genetic illness that most commonly affects infants or very young kids. However, the condition can also affect older adults. During alertness and sleep, there is an absence of the signal to breathe.

4. Central Sleep Apnea Because of a Neuromuscular Condition

Central sleep apnea is a condition that manifests itself as a result of a significant weakening in the respiratory muscles. This condition is most frequently observed in people who have amyotrophic lateral sclerosis (ALS) or multiple sclerosis.

The Hyperventilation Type

The second kind of central sleep apnea is characterized by hyperventilation, which is defined as taking short, deep breaths often during the night, followed by brief pauses in breathing. This particular form of central sleep apnea is brought on by abnormal pacing and regulation of breathing during sleep. The following subtypes fall under the category of the hyperventilation-type of central sleep apnea:

1. Cheyne-Stokes Breathing

Cheyne-Stokes Breathing

Cheynes-Stokes breathing is a special form of central sleep apnea that is typically observed in individuals who are suffering from cardiac issues. Cardiac arrest and atrial fibrillation are the two cardiovascular diseases that are seen most frequently in patients who have Cheynes-Stokes breathing. 

The sequence of breaths is unique from all of the other varieties of central sleep apnea that have been discussed, and it consists of an alternation of little and big breaths followed by extended pauses in breathing.

2. Altitude-Induced Periodic Breathing

This type of central sleep apnea can occur quickly after a person has risen in altitude, such as over 8,000 feet, where the air has a reduced percentage of oxygen. This can cause a person to have periodic breathing as they sleep. As a direct result of the reaction, a person’s breathing would become both faster and more profound than normal. This might result in pauses in breathing while the individual is asleep.

3. Treatment-Emergent Central Sleep Apnea

This condition, formerly known as complex sleep apnea, is a kind of central sleep apnea that begins to manifest after a person begins therapy for obstructive sleep apnea (OSA) using continuous positive airway pressure (CPAP). However, the majority of the time, this particular kind of CSA becomes resolved on its own.

4. Idiopathic Central Sleep Apnea

Idiopathic denotes that the condition does not have a known cause; hence, this type of CSA occurs without an easily discernible reason.

Symptoms Of Central Sleep Apnea

The result of having central sleep apnea is the same, despite the fact that the cause is slightly different. The word “apnea” originates from Greek and literally translates to “no breath.” Consequently, it is linked to decreases in the quantities of oxygen found in the blood. 

The brain is able to recognize this, and when it does, it makes an effort to rouse the individual so that they may resume breathing normally. During the night, witnesses could hear loud or irregular breathing, or they might even detect pauses in the subject’s breathing. 

The apneic event causes a momentary awakening from sleep each time it occurs. Because this keeps happening throughout the night, it causes sleep to become more disorganized and shallower than usual.

The following is a list of typical symptoms of central sleep apnea:

  • During sleep, bouts of not breathing or irregular breathing patterns
  • Abrupt awakenings that were followed by a feeling of being out of breath
  • Trouble falling or staying asleep (insomnia)
  • Increased daytime sleepiness (hypersomnia)
  • Having trouble concentrating on things
  • Alterations in mood
  • Headaches in the morning
  • Snoring

Diagnosis Of Central Sleep Apnea

Diagnosis Of Central Sleep Apnea

Your issue might be diagnosed by your primary care physician based on the signs and symptoms you’re experiencing, or you could be sent to a sleep expert at a clinic that treats sleep disorders.

A sleep specialist is the best person to advise you on whether or not you require additional assessment. In the course of a sleep study known as polysomnography, your breathing and other bodily processes may be monitored continuously for the duration of the night.

During a polysomnogram, you will be attached to several pieces of equipment that, while you sleep, will track the activities of your heart, lungs, and brain and also your breathing rate, arm and leg motions, and blood oxygen levels. You could undergo a half-night sleep study or a full-night one instead.

Central Sleep Apnea Symptoms & Treatment

During the first part of the night of a split-night sleep study, you will be under continuous observation. During the second half of the night, if you have been diagnosed with central sleep apnea, the medical team may choose to wake you up and administer positive airway pressure.

Your doctor may use polysomnography in order to aid in the process of diagnosing central sleep apnea. Additional sleep issues, such as obstructive sleep apnea, repetitive movements in sleep (periodic limb movements), or abrupt assaults of sleep (narcolepsy), which could also cause extreme daytime drowsiness but require different treatment, can also be ruled out with the use of this test by your doctor.

The diagnosis of your problem may entail input from medical professionals with specialized training in areas such as the cardiovascular system (cardiologists) and the neurological system (neurologists). You might get imaging done on your brain or heart to search for issues that could be contributing to your symptoms.

Treatment Of Central Sleep Apnea

Treating any underlying variety of medical conditions that have the potential to bring about central sleep apnea is essential to a successful treatment plan for the illness. The classification and subtype of central sleep apnea both have a role in determining the therapeutic approach that is used for the condition. 

For instance, there are things that may be done to lessen the effects of congestive heart failure. Those who are using opioids or other drugs for respiratory depression have the option to progressively reduce their dosage or perhaps stop taking the meds altogether. If the person is at a high altitude, they can hike their way down to sea level.

In many instances, concentrating on the secondary issue helps alleviate or get rid of the irregular breathing that occurs during sleeping.

Other treatment options include:

1. Continuous Positive Airway Pressure (CPAP)

While you sleep, you will need to wear a mask that covers either your nose or your mouth and nose in order to benefit from this treatment for obstructive sleep apnea. 

Your upper airway is kept open by a tiny pump that is linked to the mask. It continuously provides a supply of pressurized air to keep the mask in place over your face. A possible benefit of CPAP treatment is that it helps avoid the airway obstruction that can lead to central sleep apnea.

It is essential that you follow the instructions for using the device exactly as they are written, just as it is with obstructive sleep apnea. Talk to your healthcare provider if the mask you’re using is bothersome or if the pressure seems excessively high. There is a diverse selection of masks available for purchase. The air pressure can also be adjusted by the doctors.

2. Adaptive Servo-Ventilation (ASV)

You may be prescribed ASV if it is determined that CPAP is not an appropriate treatment for your ailment. ASV also provides pressured air delivery, much like CPAP does.

In contrast to CPAP, ASV smoothes out your breathing pattern by adjusting the amount of pressure that is applied during intake on a breath-by-breath basis. If you haven’t taken a breath for a predetermined amount of time, the apparatus may also be programmed to give one for you automatically.

People who are experiencing symptoms of heart failure are not good candidates for ASV treatment.

3. Bilevel Positive Airway Pressure (BPAP)

In the same way, as ASV does, BPAP provides a certain amount of pressure while you take a breath and a different amount when you breathe out. In ASV, the pressure level applied during inspiration can vary, but in ASV, it remains constant. BPAP can also be programmed to administer a breath to the patient in the event that they have not taken a breath within a predetermined amount of time.

People who have heart failure and use BPAP may have a worsening of their central sleep apnea. If you already have heart failure, you should discuss the BPAP’s possible dangers with your physician.

4. Supplemental Oxygen

Supplemental Oxygen

If you suffer from central sleep apnea, it is recommended that you use supplemental oxygen while you are sleeping. There is a diverse selection of equipment available to transport oxygen to your lungs.

5. Medications

Medications

A number of different medications, including acetazolamide, have been used in the past in an effort to promote breathing in those who suffer from central sleep apnea. If you are unable to tolerate positive airway pressure, your doctor may recommend that you take these drugs to assist with your breathing while you are sleeping.

6. Transvenous Phrenic Nerve Stimulation

Transvenous Phrenic Nerve Stimulation

Transvenous stimulation of the phrenic nerve is one of the more recent treatments for central sleep apnea. During sleep, a system called the remedy System sends an electrical pulse to the phrenic nerve, which is the nerve that regulates the diaphragm and wakes you up to take a breath. 

This system has been authorized by the Food and Drug Administration of the United States. In this procedure, a pulse generator that is powered by a battery is implanted beneath the skin in the upper chest area of the patient.

This method maintains a regular breathing rhythm and is effective for treating moderate to severe cases of central sleep apnea. Additional research is required.

Final Thoughts

When a person has central sleep apnea, the brain will cease transmitting instructions to the respiratory muscles, which will result in a momentary cessation of airflow. It is common for health disorders such as congestive heart failure, being overweight, and stroke to be the root cause of this, which can continue for 10 seconds or longer at times. 

Central sleep apnea is quite common in people who have heart failure. This condition is known to hasten the course of the disease and raise the chance of death.

The most important and necessary activity for the brain’s restoration is sleep. It aids in the storage of memories, the processing of feelings, and the trying out innovative new ideas. Sleeping helps us keep our moods, energy levels, and motivation stable. It also enhances our ability to manage our impulses, which can make us feel less anxious.

You should make an appointment with your primary doctor if you find that you are unable to sleep soundly or that you have fatigue during the day. Modifications to your lifestyle can be helpful, but if you suffer from a sleep issue, you will need to undergo medical treatment in order to get better sleep.

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