Central Sleep Apnea: Symptoms, Causes and Treatments

One of the most common sleep disorders responsible for ruining a good night’s rest in people is sleep apnea. Typically, it is divided into three types, Obstructive Sleep Apnea (OSA), Central Sleep Apnea (CSA), and Mixed Sleep Apnea (MSA).

What is Central Sleep Apnea (CSA)?

Central sleep apnea (CSA) is a type of sleep disorder in which breathing repeatedly stops and starts during sleep due to a failure of the brain to signal the muscles to breathe. In contrast to Obstructive Sleep Apnea (OSA), which is caused by a physical obstruction in the airway, CSA is caused by a problem with the brain's respiratory control center.

Central sleep apnea (CSA) is different from other types of sleep apnea, such as obstructive sleep apnea (OSA), in terms of its underlying cause and the way it affects breathing during sleep. Unlike OSA, where the pauses are caused because of obstruction in the airway, in CSA, disrupted breathing occurs because the brain fails to send proper signals to the muscles that control the respiratory process.

Here is more information on the central sleep apnea causes, treatments, risk factors, and complications. Let’s have a look!

What are the symptoms of Central Sleep Apnea?

Because of the failure of the brain to send signals, the patient experiences pauses in breathing at night. These stops may repeat multiple times and cause people to wake up gasping for air. Besides the pauses in breathing, here are a few other symptoms associated with central sleep apnea:

• Snoring
• Morning headaches
  
• Mood changes
• Difficulty in staying asleep
• Abnormal breathing patterns
• Issues with concentration
• Excessive daytime sleeping
• Abrupt awakenings
  
  

What are the causes of Central Sleep Apnea (CSA)?

Central sleep apnea may develop because of the following reasons:

• Cheyne-Stokes respiration

This is a condition where people experience gradual increase and decrease in airflow. During this, a period comes when the airflow completely stops. This is an instance of central sleep apnea. The condition is concerning as this type of CSA is associated with congestive heart failure and stroke.

• Drug-induced central apnea

Central sleep apnea can develop because of taking certain medications. These drugs may cause the breathing to become irregular, come to a complete halt, or lead to an increase and decrease in regular patterns.

• Age

Age is another reason that may cause complex sleep apnea. In older individuals, because of changes in the respiratory control system, the risk of developing this condition is more.

• Health conditions

People with health problems like heart failure, kidney failure, multiple system atrophy, stroke, and Parkinson’s disease are more likely to develop central sleep apnea.

• Obesity

People with excess weight may experience changes in the way the body controls breathing. These alterations increase the likelihood of developing CSA.

• Low oxygen at high altitudes

Irregular breathing might also occur because of high altitudes or the limited availability of oxygen. The low O2 levels alternatively cause rapid breathing, called hyperventilation, and under breathing, referred to as hypoventilation and also results in central sleep apnea.

• Treatment-emergent CSA

A few obstructive sleep apnea patients may develop central sleep apnea when taking CPAP therapy for treating OSA. This condition where people have both CSA and OSA is known as complex sleep apnea.

• Idiopathic (primary) central sleep apnea

Aside from the reasons mentioned above, when CSA results from any other causes, it falls under this category. The cause of this type of central sleep apnea is unknown, but the symptoms are the same as any other type.

What are the risk factors of central sleep apnea?

Although central sleep apnea may affect anyone, certain factors increase its risk. These are:

• Males are at a higher risk of developing central sleep apnea when compared with women.
• Sleeping at a height that is more than what you are used to may increase the risk of central sleep apnea. This condition typically resolves when you return to normal altitude.
• Those with heart issues like irregular heartbeats or insufficient blood pumping by heart muscles are likely to have central sleep apnea.
• Taking opioid medications can increase the risk of central sleep apnea.
• In people using CPAP machines for treating OSA, the likelihood of developing CSA is more.
• In older adults, especially those aged above 60, central sleep is likely to develop. It is also because such people are likely to have medical conditions linked with central sleep apnea.
• People suffering from a brain tumour, stroke, or structural brainstem lesion may develop CSA because these health issues impair the brain’s ability to regulate the respiratory process.
  
  

What complications are associated with CSA?

Central sleep apnea is a concerning medical condition that can lead to the following complications:

• Fatigue

People dealing with CSA may experience repeated awakenings at night. Because of the lack of rest, they may complain of fatigue, irritability, and daytime drowsiness. This, in turn, may lead to problems like concentration issues. Also, you may experience daytime sleepiness and fall asleep at work, watching TV, or while driving.

• Cardiovascular problems

Because of disrupted breathing, people experience sudden drops in oxygen levels, which can affect heart health. These episodes can lead to abnormal heart rhythms and worsened prognosis in patients with an underlying heart condition.

How can you diagnose central sleep apnea?

For evaluating CSA, the doctor might start by asking questions about the patient’s signs and symptoms. If he senses some issues, he might recommend the person to see a sleep specialist. To determine what is wrong, experts may suggest undergoing a sleep study called polysomnography which involves overnight monitoring of breathing and other body functions.

In this test, equipment is attached to the body to oversee the heart, arm and leg movements, lung and brain activity, breathing patterns, and blood oxygen levels while resting at night. Doctors with experience in nervous system diseases, heart problems, and other fields can help evaluate CSA. They may suggest undergoing imaging of the head or heart to diagnose contributing conditions.

What are a few central sleep apnea treatment options?

A few central sleep apnea treatment options are mentioned below:

• Addressing underlying medical problems

One of the ways to treat central sleep apnea is to cure the underlying medical problem responsible for causing this condition. One example would be receiving therapy for heart failure to improve CSA.

• Lessening opioid medications

In patients where opioid medication is causing CSA, requesting the doctor to cut down on the dosage might help.

• Supplemental oxygen

Some patients are given supplemental oxygen while sleeping to help improve CSA. Several machines are available to provide this additional oxygen.

• Continuous Positive Airway Pressure (CPAP)

Continuous Positive Airway Pressure (CPAP) method involves wearing a mask over the nose, mouth, or both to assist with breathing. The machines send pressurised air to keep the upper airway open. In this way, the device prevents airway closure and enhances the condition.

• Adaptive servo-ventilation

If the CPAP machine is ineffective in treating CSA, patients should try ASV. It adjusts the amount of pressure with every breath and smoothens breathing patterns. The device is not recommended for patients with symptomatic heart failure.

• Bi-level positive airway pressure (Bi-PAP)

These machines deliver pressure at different amounts when you breathe in and out. The pressure is fixed during the inspiration rather than variable. A Bi-PAP device can be instructed to deliver a breath if you haven’t taken one in a few seconds.

• Medications

Certain sleep apnea medications can improve the condition by stimulating breathing in people. The drugs can be prescribed to assist with the respiratory process if the patient can’t bear the positive airway pressure.

• Surgery or other procedures

One therapy for managing central sleep apnea is transvenous phrenic nerve stimulation. An electric pulse to the nerve responsible for controlling the diaphragm assists with breathing in this method. For this, a battery-powered pulse generator is implanted under the skin of the upper chest.

To Sum Up

Central Sleep Apnea (CSA) is a concerning situation where breathing is hindered while resting. This can lead to complications like fatigue and cardiovascular problems. Diagnosing the condition by undergoing a polysomnography test and treating it soon is recommended to avoid serious health complications in future.

Disclaimer: The facts and information provided in this article are suggestive in nature. They do not necessarily reflect the opinions and beliefs of ResMed. The content is for informational purposes and should not be taken as medical advice. Consulting with your healthcare provider to get a proper diagnosis and treatment is recommended.