Central sleep apnea

Overview

Central sleep apnea is a disorder in which breathing repeatedly stops and starts during sleep.

Central sleep apnea occurs because the brain doesn't send proper signals to the muscles that control breathing. This condition is different from obstructive sleep apnea, in which breathing stops because the throat muscles relax and block the airway. Central sleep apnea is less common than obstructive sleep apnea.

Central sleep apnea can result from other conditions, such as heart failure and stroke. Another possible cause is sleeping at a high altitude.

Treatments for central sleep apnea might involve managing existing conditions, using a device to assist breathing or using supplemental oxygen.

Symptoms

Common symptoms of central sleep apnea include:

• Observed episodes of not breathing during sleep.
• Sudden awakenings with shortness of breath.
• Not being able to stay asleep, known as insomnia.
• Excessive daytime sleepiness, known as hypersomnia.
• Trouble focusing.
• Mood changes.
• Morning headaches.
• Snoring.

Although snoring suggests some degree of a blocked airway, snoring also can occur in people with central sleep apnea. However, snoring may not be as prominent with central sleep apnea as it is with obstructive sleep apnea.

When to see a doctor

Consult a medical professional if you have — or if your partner notices — any symptoms of central sleep apnea, particularly:

• Shortness of breath that awakens you from sleep.
• Pauses in your breathing during sleep.
• Trouble staying asleep.
• Excessive daytime drowsiness, which may cause you to fall asleep while you're working, watching television or even driving.

Ask a member of your health care team about any sleep problem that leaves you regularly fatigued, sleepy and irritable. Excessive daytime drowsiness can be due to other disorders, so it's important to get an accurate diagnosis. Sleepiness during the day may be caused by obstructive sleep apnea, by not allowing yourself time to get enough sleep at night or by sudden attacks of sleep, known as narcolepsy.

Causes

Central sleep apnea occurs when your brain doesn't transmit signals to your breathing muscles.

The brainstem links the brain to the spinal cord. It controls many functions, including heart rate and breathing. Central sleep apnea can be caused by a number of conditions that affect the ability of the brainstem to control breathing.

The cause varies with the type of central sleep apnea you have. Types include:

• Cheyne-Stokes breathing. This type of central sleep apnea is most commonly associated with congestive heart failure or stroke.

  During Cheyne-Stokes breathing, breathing effort and airflow gradually rise and then lessen. During the weakest breathing effort, a total lack of airflow can occur.

• Drug-induced apnea. Taking certain medicines such as opioids can cause breathing to become irregular or stop completely for a short time. These medicines can be taken by mouth or by shot, also called injection. They include morphine (MS Contin, Mitigo, others), oxycodone (Roxicodone, Oxycontin, others) and codeine.
• High-altitude periodic breathing. A Cheyne-Stokes breathing pattern can occur if you're at a very high altitude. The change in oxygen at a high altitude can cause fast breathing, known as hyperventilation, followed by taking in too little air.
• Treatment-emergent central sleep apnea. Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP) for treatment. This condition is known as treatment-emergent central sleep apnea. It is a combination of obstructive and central sleep apneas.
• Medical condition-induced central sleep apnea. Several medical conditions, including end-stage kidney disease and stroke, may lead to central sleep apnea. This type of sleep apnea doesn't involve Cheyne-Stokes breathing.
• Primary central sleep apnea, also known as idiopathic sleep apnea. The cause of this uncommon type of central sleep apnea is not known.

Risk factors

Certain factors put you at increased risk of central sleep apnea:

• Sex. Males are more likely to develop central sleep apnea than are females.
• Age. Central sleep apnea is more common among older adults, especially those older than age 60. This could be because people older than 60 are likely to have other medical conditions or sleep patterns that are linked to central sleep apnea.
• Heart disorders. Heart problems put people at higher risk of central sleep apnea. An irregular heartbeat, known as atrial fibrillation, can increase the risk. Having heart muscles that don't pump enough blood for the body's needs, known as congestive heart failure, also can raise the risk.
• Stroke, brain tumor or a structural problem with the brainstem. These brain conditions can affect the brain's ability to regulate breathing.
• High altitude. Sleeping at an altitude higher than you're used to may increase your risk of sleep apnea. High-altitude sleep apnea resolves a few weeks after returning to a lower altitude.
• Opioid use. Opioid medicines may increase the risk of central sleep apnea.

• CPAP. Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP). This condition is known as treatment-emergent central sleep apnea. It is a combination of obstructive and central sleep apneas.

  For some people, complex sleep apnea goes away with continued use of their CPAP device. Other people may be treated with a different kind of positive airway pressure therapy.

Complications

Central sleep apnea is a serious medical condition. Some complications include:

• Fatigue. The repeated awakenings associated with sleep apnea make restorative sleep impossible. People with central sleep apnea often have severe fatigue, daytime drowsiness and irritability.

  You might have trouble focusing. You also may find yourself falling asleep at work, while watching television or even while driving.

• Cardiovascular problems. Sudden drops in blood oxygen levels that occur during central sleep apnea can affect heart health.

  If you have heart disease, repeated episodes of low blood oxygen increase the risk of irregular heart rhythms.