Sleep apnea is a serious medical condition where breathing stops and starts intermittently during sleep. Obstructive sleep apnea (OSA) is usually caused by an obstruction in the upper airways. Often this is due to muscles in the airway relaxing during sleep.
Central sleep apnea (CSA) is less common and occurs because the signal between the brain and muscles concerned with breathing is faulty. There are a number of reasons why this type of sleep apnea can occur.
Central Sleep Apnea: Possible Causes
- Unknown cause: this is called idiopathic central sleep apnea.
- Drug-related: medications (opioids) like morphine and methadone can cause irregular breathing patterns and temporary stoppages to breathing.
- Medical conditions: stroke and end-stage kidney disease, for example, can trigger CSA. Usually there is some damage to the brain stem involved.
- Cheyne-Stokes breathing is associated with stroke and congestive heart failure. This breathing pattern involves small and long breaths with long pauses – and can also occur when you are at high altitudes, due to changes in oxygen levels.
- 'Treatment emergent' CSA can occur during CPAP (continuous positive airway pressure) treatment in patients with obstructive sleep apnea. However, it usually resolves itself without further treatment.
Symptoms Similar to OSA
- Central sleep apnea shares many of the same symptoms as obstructive sleep apnea:
- Abnormal and interrupted breathing observed during sleep.
- Daytime fatigue
- Morning headaches
- Snoring, but excessively loud snoring is more common in obstructive sleep apnea
In addition, there may be:
- Night chest discomfort
- Difficulty sleeping and waking abruptly with shortness of breath.
Effects on Quality of Life
The effects of CSA are serious. Lack of quality sleep and constant fatigue leads to poor concentration, mood, and decision-making. This affects quality of life and can increase the risk of accidents.
In addition, the lack of oxygen or fluctuating oxygen levels can affect the heart. Central sleep apnea will make any underlying heart issue worse.
What Are the Risk Factors for CSA?
- CSA is more common in men, possibly related to testosterone levels.
- CSA risk increases with age. It is more common in the 65+ years group, however, this may be due to associated medical conditions too.
- Certain medical conditions increase the risk of CSA such as stroke, brain stem damage, metabolic disorders, heart disorders, and kidney failure.
- Medications like muscle relaxants, anti-depressants, anti-convulsants, some anti-platelet medications, opioids, and benzodiazepines increase the risk of developing CSA.
Diagnosing and Treating CSA
If you or your partner suspect some type of sleep issue, it's really important to see a doctor and get a proper diagnosis. Your doctor will discuss your symptoms, your medical history and examine you. They may suggest a sleep study (polysomnogram) which uses sensors to check sleep stages, airflow, heart rate, oxygen levels, and respiration during sleep.
Once the diagnosis has been made, your doctor can look at the best way to treat the symptoms or underlying cause. Other goals will be to 'normalize' your breathing pattern during sleep, improve sleep and minimize symptoms.
To treat abnormal breathing patterns, doctors have some options:
- Positive airway pressure therapy: this usually involves the use of a CPAP machine which pumps air through a mask to help you to breathe while you sleep.
- Oxygen therapy: some patients may need additional oxygen during sleep.
- Medication: in some cases, when other options are not suitable, medication is used to stimulate breathing.
- Surgery: where other options fail or are not suitable, phrenic nerve stimulation may be necessary, and a device is implanted to stimulate breathing.
If you have central sleep apnea, it's important to work with your healthcare providers. You will need to have regular follow-up appointments to make sure that your treatment is working effectively.
It's also a good idea to learn more about the condition and keep up to date with news, resources, and information about the condition and treatments. Some people find support groups helpful, and your healthcare provider may be able to help with resources and information about this.
You should also try to avoid any known triggers that could worsen your condition. Try to avoid using alcohol and sedatives. If you take any medication, particularly sedatives, you should discuss this with your doctor.
Some people experience relief once a diagnosis has been made. Whether you have obstructive sleep apnea – or idiopathic central sleep apnea – your doctor can help you understand your condition, get the treatment you need, and improve the quality of your life.
For more detailed information about central sleep apnea, follow the links below: