Central Sleep Apnea

Overview

Central sleep apnea is a disorder in which breathing repeatedly stops and starts during sleep due to the brain not sending proper signals to the muscles that control breathing. This condition is different from obstructive sleep apnea, which occurs when the throat muscles relax and block the airway. Central sleep apnea is less common than obstructive sleep apnea and can result from other conditions such as heart failure and stroke or sleeping at a high altitude. Treatments for central sleep apnea may involve managing existing conditions, using a device to assist breathing, or using supplemental oxygen. Common symptoms include observed episodes of not breathing during sleep, sudden awakenings with shortness of breath, insomnia, excessive daytime sleepiness, trouble focusing, mood changes, morning headaches, and snoring. If you or your partner notice any symptoms of central sleep apnea, consult a medical professional.

Understanding the disease

Symptoms

Common symptoms of central sleep apnea include observed episodes of not breathing during sleep, sudden awakenings with shortness of breath, trouble staying asleep, excessive daytime sleepiness, mood changes, morning headaches, and snoring. Snoring is not as prominent in central sleep apnea as it is in obstructive sleep apnea. Consult a medical professional if you or your partner notice these symptoms, particularly shortness of breath that awakens you from sleep, pauses in breathing during sleep, trouble staying asleep, or excessive daytime drowsiness.

Risk Factors

Risk factors for developing central sleep apnea include being male, being older than 60, having heart disorders, and having a stroke, brain tumor, or structural problem with the brainstem that affects breathing regulation.

Development

Central sleep apnea can develop due to various causes, including:

1. Primary central sleep apnea (idiopathic sleep apnea): This type of central sleep apnea has no known cause.
2. Medical condition-induced central sleep apnea: Certain medical conditions, such as end-stage kidney disease, stroke, and other brain disorders, can lead to central sleep apnea.
3. Treatment-emergent central sleep apnea: This type of central sleep apnea occurs in people with obstructive sleep apnea who develop central sleep apnea while using continuous positive airway pressure (CPAP) therapy. It is important to identify the underlying cause of central sleep apnea to provide appropriate treatment and manage potential complications.

Assessment and Diagnosis

Triage

You should see a doctor if you or your partner notice any symptoms of central sleep apnea, particularly shortness of breath that awakens you from sleep, pauses in breathing during sleep, and trouble staying asleep. Excessive daytime drowsiness, which may cause you to fall asleep during work or other activities, is also a reason to consult a medical professional.

Diagnosis

To diagnose central sleep apnea, you may start with a primary care professional who evaluates your condition based on your symptoms. If necessary, you will be referred to a sleep specialist in a sleep disorder center. The sleep specialist can help decide if further evaluation is needed, which might involve a sleep study called polysomnography. During polysomnography, you'll be monitored while you sleep to observe your heart, lung, and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels. If you're diagnosed with central sleep apnea, you might be given therapy such as positive airway pressure or supplemental oxygen. Imaging of your head or heart might also be conducted to identify contributing conditions, and specialists like neurologists or cardiologists may be involved in your evaluation.

Management and Treatment

Complications

Complications of central sleep apnea can include fatigue, trouble focusing, daytime drowsiness, excessive daytime sleepiness, mood changes, morning headaches, and snoring. Central sleep apnea can also lead to cardiovascular problems, including an increased risk of irregular heart rhythms and high blood pressure, which may increase the risk of heart disease.

Prevention

Central sleep apnea is often caused by underlying medical conditions or structural problems with the brainstem, and in some cases, it may be related to the use of certain medications. As a result, it can be challenging to prevent central sleep apnea entirely. However, some general measures that might help reduce the risk include:

1. Treating underlying medical conditions: If central sleep apnea is caused or exacerbated by another medical condition, such as heart failure, treating that condition may help alleviate the sleep apnea symptoms.
2. Avoiding high-altitude environments: Sleeping at high altitudes may increase the risk of central sleep apnea. If you plan to travel to high-altitude areas, it's essential to be aware of the potential risks and take necessary precautions.
3. Monitoring medication use: Some medications, such as opioids, may increase the risk of central sleep apnea. Consult your healthcare provider to discuss alternative treatments or discuss the potential risks and benefits of using these medications.
4. Maintaining a healthy lifestyle: Maintaining a healthy weight, avoiding smoking, and limiting alcohol consumption may help reduce the risk of developing sleep apnea. It's important to note that these measures may not necessarily prevent central sleep apnea, but they can help reduce the risk or alleviate some of the associated symptoms. If you suspect you or someone you know has central sleep apnea, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

Treatment

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

1. Managing underlying conditions: Central sleep apnea can result from other medical conditions, such as heart failure, stroke, or sleeping at high altitude. Treating these underlying conditions may help alleviate central sleep apnea symptoms.
2. Positive airway pressure therapy: Continuous positive airway pressure (CPAP) devices can help manage central sleep apnea in some cases. These devices deliver pressurized air through a mask worn during sleep, keeping the airway open and promoting healthy breathing.
3. Bilevel positive airway pressure (BiPAP): BiPAP machines provide two levels of air pressure, one for inhalation and another for exhalation. This may be an alternative option for people who do not respond well to CPAP therapy.
4. Adaptive servo-ventilation (ASV): ASV is a type of ventilation therapy that helps normalize breathing patterns during sleep. It can be effective in treating central sleep apnea, especially in cases associated with heart failure or other conditions.
5. Supplemental oxygen: In cases where there is a decrease in oxygen levels during sleep, supplemental oxygen can be used to maintain proper oxygenation levels and improve sleep quality. It is important to consult a medical professional for a proper diagnosis and personalized treatment plan for central sleep apnea.

Preparing for medical consultation

To prepare for an appointment for central sleep apnea, you should:

1. Gather relevant information: 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.
2. Bring results of prior sleep studies or other tests: If you have any previous sleep studies or test results, bring them to your appointment or request that they be sent to your sleep specialist.
3. Invite a bed partner: Ask a spouse, partner, or someone who has seen you sleeping to accompany you to the appointment. They can provide valuable information about your sleep patterns.
4. Record your symptoms: Note down any symptoms you've been experiencing, including those that may not seem related to sleep apnea.
5. Prepare a list of questions: Compile a list of questions to ask your healthcare team, such as the most likely cause of your symptoms, possible treatment options, and how treating or not treating central sleep apnea may impact your health.
6. Be ready to discuss other health conditions: Prepare to discuss any other health conditions you have, and how they can be managed together with central sleep apnea. Remember to be honest and open with your healthcare team about your sleep patterns, symptoms, and any concerns you may have. This will help them provide you with the most appropriate care and guidance.