Central sleep apnea

Diagnosis

A primary care professional might evaluate your condition based on your symptoms. Or you may be referred to a sleep specialist in a sleep disorder center.

A sleep specialist can help you decide on your need for further evaluation. That might involve overnight monitoring of your breathing and other body functions during a sleep study called polysomnography.

During polysomnography, you're connected to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. You may have a full-night or split-night sleep study.

In a split-night sleep study, you're monitored during the first half of the night. If you're diagnosed with central sleep apnea, staff might wake you to start a therapy for the second half of the night. The therapy might be positive airway pressure or supplemental oxygen.

Polysomnography can help diagnose central sleep apnea. It also can help rule out other sleep disorders, such as obstructive sleep apnea, repetitive movements during sleep or narcolepsy. These other disorders can cause excessive daytime sleepiness but require different treatment.

Doctors trained in nervous system diseases, known as neurologists, and in heart diseases, known as cardiologists, and others might be involved in evaluating your condition. You might need imaging of your head or heart to look for contributing conditions.

Treatment

Treatments for central sleep apnea might include:

• Addressing associated medical problems. Possible causes of central sleep apnea include other disorders. Treating those conditions might help your central sleep apnea. For example, therapy for heart failure might improve central sleep apnea.
• Reduction of opioid medicines. If opioid medicines are causing your central sleep apnea, your health care team might reduce your dose of those medicines over time.

• Continuous positive airway pressure (CPAP). This method, also used to treat obstructive sleep apnea, involves wearing a mask over the nose or over the nose and mouth while asleep.

  The mask is attached to a small pump that supplies a continuous amount of pressurized air to hold open the upper airway. CPAP may prevent the airway closure that can trigger central sleep apnea.

  As with obstructive sleep apnea, in central sleep apnea it's important that you use the CPAP device only as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your health care team. Several types of masks are available. The air pressure also can be adjusted.

• Adaptive servo-ventilation (ASV). If CPAP doesn't effectively treat your condition, you might be given ASV. Like CPAP, ASV also delivers pressurized air.

  Unlike CPAP, ASV adjusts the amount of pressure breath-by-breath when you take a breath. This smooths out your breathing pattern. The device also might automatically deliver a breath if you haven't taken a breath within a certain number of seconds.

  ASV isn't recommended for people with symptomatic heart failure.

• Bilevel positive airway pressure (BPAP). Like ASV, BPAP delivers a set amount pressure when you breathe in and a different amount of pressure when you breathe out. Unlike ASV, the amount of pressure delivered when you breathe in is fixed rather than variable. BPAP also can be set to deliver a breath if you haven't taken a breath within a certain number of seconds.
• Supplemental oxygen. Using supplemental oxygen while you sleep might help if you have central sleep apnea. Various devices are available to deliver oxygen to your lungs.
• Medicines. Medicines such as acetazolamide have been used to stimulate breathing in people with central sleep apnea. These medicines might be prescribed to help your breathing as you sleep if you can't tolerate positive airway pressure.

Surgery or other procedures

A newer therapy for central sleep apnea is transvenous phrenic nerve stimulation. A device approved by the U.S. Food and Drug Administration known as Remede System delivers an electrical pulse to the nerve that controls the diaphragm during sleep. This causes you to take a breath. The system includes a battery-powered pulse generator that's implanted under the skin in the upper chest.

Used for moderate to severe central sleep apnea, this system produces a steady breathing pattern. More study is needed.

Preparing for your appointment

You're likely to start by seeing a member of your primary health care team. You might then be referred to a sleep specialist.

Here's some information to help you get ready for your appointment.

What you can do

• Bring results of prior sleep studies or other tests with you or ask that they be sent to your sleep specialist.
• Ask someone, such as a spouse or partner, who has seen you sleeping to come with you to your appointment. This person will likely be able to provide your doctor with additional information.
• Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began.
• Write down key personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements you take, including doses.
• Write down questions to ask your health care team.

For central sleep apnea, some basic questions to ask include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What tests do I need? Do these tests require special preparation?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• How will treating or not treating my central sleep apnea affect my health now and in the future?
• I have other health conditions. How can I best manage these conditions together?
• Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care team is likely to ask you a number of questions, such as:

• Have your symptoms been continuous or do they come and go?
• Can you describe your typical sleep schedule?
• How long do you sleep, and do you sleep soundly? How many times do you wake during the night?
• Do you know if you snore?
• How do you feel when you wake up? Are you short of breath?
• Do you fall asleep easily during the day?
• Has anyone ever told you that you stop breathing while you're sleeping?
• Are you short of breath when you wake up at night?
• Do you have heart problems? Have you had a stroke?