Central Sleep Apnea

overview

Central sleep apnea is a sleep disorder in which you briefly stop breathing during sleep. Moments of apnea can occur repeatedly throughout the night as you sleep. The interruption of your breathing may indicate a problem with your brain’s signaling. Your brain momentarily “forgets” to tell your muscles to breathe.

Central sleep apnea isn’t the same as obstructive sleep apnea. Obstructive sleep apnea is the interruption of breathing due to blocked airways. People who have central sleep apnea don’t have blockages in their airways. The problem is in the connection between the brain and the muscles that control your breath.

Central sleep apnea is much less common than obstructive sleep apnea. The American Sleep Apnea Association (ASAA) estimates that central sleep apnea accounts for about 20 percent of all sleep apnea cases.

Causes

Underlying health conditions cause most cases of central sleep apnea. During a central sleep apnea episode, your brainstem doesn’t tell your breathing muscles to function properly. Your brainstem is the section of your brain that connects to your spinal cord. Medical conditions that affect your brainstem, spinal cord, or heart can cause you to develop central sleep apnea.

Examples of these conditions include:

• stroke
• heart attack
• congestive heart failure
• a weak breathing pattern called Cheyne-Stokes breathing
• encephalitis (inflammation of the brain)
• arthritis in the cervical spine
• Parkinson’s disease (an age-related deterioration of certain nerve systems that affects movement, balance, and muscle control)
• surgery or radiation treatments in the spine

Some medications can also cause a type of central sleep apnea called drug-induced apnea. Opioid drugs are powerful painkillers that can lead to irregular breathing patterns. In some cases, you may temporarily stop breathing as part of this irregular pattern.

Drugs that can contribute to central sleep apnea include:

• codeine
• morphine
• oxycodone

If your doctor can’t identify the cause of your central sleep apnea, then you have idiopathic central sleep apnea.

Symptoms

The most common symptom of central sleep apnea is short periods during sleep when breathing stops. Some people exhibit very shallow breathing instead of actually stopping breathing. You may wake up feeling short of breath. The lack of oxygen can cause you to wake up frequently throughout the night, and can lead to insomnia.

Other symptoms associated with central sleep apnea occur during the day as a result of an interrupted night’s sleep. You may feel very sleepy during the day, have trouble concentrating or focusing on tasks, or have a headache when you wake up.

Central sleep apnea caused by Parkinson’s disease or other neurological conditions can be characterized by additional symptoms, including:

• difficulty swallowing
• changes in speech patterns
• changes in voice
• generalized weakness

Diagnosis

Your doctor will order a sleep study test called a polysomnography to diagnose central sleep apnea. The test occurs overnight as you sleep in a special sleep center. During a polysomnography, you’ll wear electrodes on your head and body to measure your oxygen levels, brain activity, breathing pattern, heart rate, and lung function.

Your doctor, a neurologist, and sometimes a cardiologist will monitor you and review the results of your polysomnography. The results can help determine the underlying cause of your apnea.

A head or spinal MRI scan may also diagnose central sleep apnea. MRI uses radio waves to generate images of your organs. The test may reveal that structural abnormalities in your brainstem or spine are causing central sleep apnea.

 Treatment

Managing underlying medical conditions is the first line of treatment for central sleep apnea. Medications can help control congestive heart failure, Parkinson’s disease, and other heart or nervous system conditions.

You may need to stop using opioid medications if these drugs are causing your breathing to stop during sleep. Your doctor may also prescribe medications such as acetazolamide to stimulate your breathing mechanism.

Oxygen supplementation and the regulation of air pressure during sleep are effective treatments for many people with central sleep apnea.

Continuous Positive Air Pressure (CPAP)

CPAP provides a steady source of pressure in your airways as you sleep. You wear a mask over your nose and mouth that delivers pressurized air throughout the night. CPAP treats obstructive sleep apnea, but can also be beneficial for people with central sleep apnea.

Bi-level Positive Air Pressure (BPAP)

This treatment adjusts the air pressure to a higher level when you inhale and a lower level when you exhale. BPAP also uses a face mask.

Adaptive Servo-Ventilation (ASV)

ASV monitors your breathing as you sleep. The computerized system “remembers” your breathing pattern. A pressurized system regulates the breathing pattern to prevent apnea episodes.

Outlook

People with idiopathic central sleep apnea most often respond well to treatment. The overall benefits of treatment for central sleep apnea vary according to the exact cause of the condition.