Central sleep apnea

Overview

Central sleep apnea occurs when a person’s breathing repeatedly stops and starts during sleep. It happens when the brain fails to send signals to maintain the activity of the muscles responsible for breathing during sleep. Unlike obstructive sleep apnea, where the airway is blocked by relaxed neck muscles, central sleep apnea does not involve such obstructions. It’s worth noting that obstructive sleep apnea is more prevalent compared to central sleep apnea.

Heart failure and stroke are two more disorders that can lead to central sleep apnea. The act of sleeping at a high altitude is another potential factor.

The management of pre-existing diseases, the use of a breathing aid, or the use of supplemental oxygen are all possible treatments for central sleep apnea.

Symptoms

The following are typical signs and symptoms of central sleep apnea:

• Shortness of breath upon sudden awakening.
• Seen occurrences of not breathing while asleep.
• Headaches in the morning.
• Snoring.
• Problem with concentration.
• Mood swings.
• Insomnia, the inability to get asleep and stay asleep.
• Hypersomnia, which is an excessive amount sleeping at daytime.

Snoring can indicate varying degrees of airway obstruction, and in some cases, it may also be a symptom of central sleep apnea. However, when comparing central sleep apnea to obstructive sleep apnea, the former might not always be as prominently associated with snoring.

If you experience any central sleep apnea symptoms, or if your partner does, get medical attention, especially:

• Shortness of breath that causes you to be awakened from sleep.
• Difficulty sleeping.
• Pauses in breathing while you’re sleeping.
• Prolonged daytime sleepiness, which can cause you to nod off while working, watching television, or even driving.

If you frequently experience feelings of exhaustion, sleepy, and irritability, it is essential to discuss these sleep issues with a medical professional. Seeking an appropriate diagnosis is crucial since excessive daytime sleepiness could be attributed to various conditions. Among the potential causes are obstructive sleep apnea, insufficient sleep during the night, or narcolepsy, a condition characterized by unexpected and uncontrollable episodes of sleep. Consulting with your medical team will help identify the underlying cause and enable you to receive the necessary treatment and support.

Causes

When your brain fails to send instructions to your breathing muscles, central sleep apnea develops.

The brainstem connects the spinal cord to the brain. It regulates a variety of processes, including breathing and heart rate. Numerous medical problems that impair the brainstem’s ability to regulate breathing can contribute to central sleep apnea.

There are numerous causes of central sleep apnea, including:

• Heart failure.
• Hypoxia, or low blood oxygen levels, brought on by high altitude.
• Damage to the nervous system, particularly in the brainstem (which controls respiration) or spinal cord regions.
• Using CPAP to treat obstructive sleep apnea in the beginning (this usually goes away with regular CPAP use).
• Disorders of the nervous system like Lou Gehrig’s disease (ALS, also known as amyotrophic lateral sclerosis).

Depending on the type of central sleep apnea you have, several causes apply. Types consist of:

• Cheyne-Stokes breathing. The two conditions most frequently linked to this type of central sleep apnea are congestive heart failure and stroke.

Breathing effort and airflow progressively increase and then decline during Cheyne-Stokes breathing. At the point of the most minimal breathing effort, a complete absence of airflow can take place.

• Drug-induced apnea. The breathing may become erratic or stop altogether for a brief period of time after taking some medications, such as opioids. These medications can be administered orally or by injection. They consist of codeine, oxycodone, and morphine.
• High-altitude periodic breathing. If you’re at an extremely high altitude, a Cheyne-Stokes breathing pattern could appear. At high altitudes, the oxygen content might fluctuate, leading to quick breathing (hyperventilation) and then insufficient air intake.
• Treatment-emergent central sleep apnea. Some patients who are treated with Continuous Positive Airway Pressure (CPAP) for obstructive sleep apnea also develop central sleep apnea. This illness is referred to as “treatment-emergent central sleep apnea”. It combines obstructive and central sleep apneas.
• Medical condition-induced central sleep apnea. Central sleep apnea can be caused by a number of illnesses, such as stroke and end-stage kidney disease. Cheyne-Stokes breathing is not included in this kind of sleep apnea.
• Primary central sleep apnea. The cause of this uncommon type of central sleep apnea is not known. Another term used for this is idiopathic sleep apnea.

Risk factors

The exact cause of this unique type of central sleep apnea remains unknown.

• Gender. In comparison to women, men are more likely to acquire central sleep apnea.
• Age. Older persons, especially those over the age of 60, are more likely to experience central sleep apnea. This might be because those over 60 are more likely to have additional health issues or sleep patterns associated with central sleep apnea.
• Heart problems. People with heart issues are more likely to develop central sleep apnea. Atrial fibrillation, an erratic heartbeat, can raise the danger. Congestive heart failure, or inadequate blood pumping from the heart muscles, can further increase the risk.
• Brain conditions. Having stroke, brain tumor or a structural problem with the brainstem may impair a person’s capacity to control their breathing.
• High altitude. Your chance of developing sleep apnea may rise if you spend the night at an altitude higher than you are used to. After returning to a lower altitude for a few weeks, high-altitude sleep apnea resolves.
• Opioid use. The risk of central sleep apnea may rise as a result of opioid medications.
• CPAP. While using continuous positive airway pressure (CPAP), a small percentage of persons with obstructive sleep apnea develop central sleep apnea. The term “treatment-emergent central sleep apnea” refers to this condition. It combines central and obstructive sleep apneas.

With continued usage of their CPAP machine, some persons with complicated sleep apnea experience improvement. Positive airway pressure therapy of a different kind might be used to treat other patients.