Introduction to Central Sleep Apnea
According the American Sleep Apnea Association, approximately 22 million adults in the United States suffer from sleep apnea. Only 4.4 million adults or about 20% of these cases are central sleep apnea. The more common sleep apnea is Obstructive Sleep Apnea. However, central sleep apnea is increasing in the number of patients per year, and several cases of central sleep apnea go undiagnosed due to people not knowing the symptoms. It’s important for people to be able to recognize the symptoms of central sleep apnea and take the necessary actions to treat it.
What is Central Sleep Apnea?
Central sleep apnea (CSA) is when your brain temporarily forgets to breathe when you are asleep at night. This is typically demonstrated by a normal breathing pattern followed by a period of not breathing for long periods of times (up to 10+ seconds). This can happen several hundred times over the course of one night of sleep.
Central sleep apnea disrupts your normal night of sleep because of a malfunction in your brain. In short, your brain doesn’t send the right signals to your muscles to tell them to breathe. As a result, your body will breathe very abnormally or not breathe at all.
Central sleep apnea is very different than obstructive sleep apnea. Obstructive sleep apnea is when your upper respiratory pathways are blocked in your throat typically due to being overweight. On the other hand, central sleep apnea is when your brain “forgets” to breathe.
Diagnosis of Central Sleep Apnea
If you or a family member notice periods of non-breathing, shortness of breathe, or difficulty sleeping during the night, it is best to consult a doctor or your healthcare provide.
Typically, if a doctor suspects that you have sleep apnea, they are likely going to administer an overnight sleep test (polysomnogram) at a sleep unit / hospital, or give you an at home sleep test. The test will monitor several bodily functions during the night including:
- Electrical brain waves
- Oxygen levels from your blood
- Heart rate pulse through the night
- Breathing patterns
- Movements of eye and legs
The goal of the sleep test is to monitor your sleep patterns and record how long you sleep during the night. During a normal sleep test, your body will go through multiple sleep cycles during the night from non-rapid eye movement (NREM) and rapid eye movement (REM) about every 90 minutes. Central sleep apnea can severely disturb this sleep process and a sleep test will be able to detect it.
Symptoms of Obstructive Sleep Apnea
- Constantly waking up during the night with shortness of breathe
- Observed periods of non-breathing during the night
- Extreme difficulty sleeping (insomnia)
- Difficulty staying awake during the daytime (hyperinsomnia)
- Morning headache
- Dry mouth when waking up
- Irritated, sleepiness, and difficulty paying attention
Causes of Central Sleep Apnea
There are several reason that your brain is not transmitting the signals to your body to breathe. The most common reasons for central sleep apnea are existing health conditions. These medical conditions often times affect your brainstem (connection between brain and spinal cord), spinal cord, or heart which induces central sleep apnea.
- Cheyne-Stokes breathing from existing stroke, heart attack, or congestive heart failure. Cheyne-Stokes is a form of abnormal breathing patterns that is characterized by a series of deeper and faster breathing followed by a decrease in breathing. During the period of decreased breathing, there can be no air flow (sleep apnea). This is usually caused by existing medical conditions.
- Drug induced. Taking certain drug medications like opioids can induce central sleep apnea. Drugs can create an irregular breathing pattern that may prevent you from breathing. Common drugs that induce central sleep are:
- High Altitude / Pressured breathing. The change in oxygen levels due to the lower pressure at higher altitudes can create rapid breathing (i.e. hyperventilation) which can cause your brain to want to breath less. Alternatively, some patients develop central sleep apnea due to CPAP machines introducing too much air to their lungs which causes your brain to signal for less air. This is known as mixed sleep apnea (combination of obstructive sleep apnea and central sleep apnea).
- Neurological diseases like Parkinson’s disease, Alzheimer’s disease, and amyotrophic lateral sclerosis. These diseases exhibit cell loss of the brainstem that modulates respiration which causes dysfunction of the diaphragmatic muscles.
- Age. The older you are the more likely you are to develop central sleep apnea. A large amount of people with central sleep apnea are above the age of 65. However, central sleep apnea is typically a result of existing medical conditions correlating with high age.
- Male. Males are significantly more likely to develop to develop central sleep apnea than females.
Risks of Central Sleep Apnea
Central sleep apnea can have some serious side affects. These complications can include:
- Severe daytime fatigue. Centrals sleep apnea significantly disrupts your night time sleep. As a result central sleep apnea will cause daytime fatigue, irritable moods, and severe drowsiness.
- Depression. The lack of sleep has been highly correlated to depression and other physiological side effects.
- Hypertension. Approximately 50% of the people with sleep apnea have hypertension. Hypertension can result in heart disease, stroke, or death. Most people with hypertension have little to no signs or symptoms so it’s important to regularly check your blood pressure.
Treatment Options for Central Sleep Apnea
- Solve previous medical history problems. It’s likely that past medical conditions are causing your sleep apnea. Addressing your previous medical conditions in some form or fashion can cure your central sleep apnea. For instance, therapy for heart failure can address central sleep apnea.
- CPAP Machine. Continuous positive airway pressure (CPAP) machines apply positive air pressure to patients with central sleep apnea. CPAP machines essentially force air to the patients lungs via a constant pressure airway. The patient wears a mask and the CPAP machine delivers air to the mask through a hose. This is one of the most common ways to treat central sleep apnea.
- Reduce Opioids. If you are taking opioids, it’s best to reduce your opioid intake if you want to get ride of your central sleep apnea. Trying taking other medication that doesn’t give you central sleep apnea.
- Adaptive Servo Ventilation. (Not recommended for people with symtomatic heart failure). Like CPAP, Adaptive Servo Ventilation (ASV) delivers pressurized air to the lungs via a mask. ASV monitors and changes the air pressure on a breathe by breathe basis and can even inject air if it detects that a patient is not breathing.
- Bi-level Positive Air Pressure. Like CPAP and ASV,
Bi-level Positive Air Pressure (BPAP) forces air into the lungs via a mask. BPAP adjusts the air pressure to a higher level when you inhale and a lower level when you exhale on a breathe by breathe basis.
- Medications. Certain medications like acetazolamide (Diamox) or theophylline can stimulate breathing. These medications may also be prescribed to help your breathing if you can’t tolerate CPAP, ASV, or BPAP masks and machines. These medications may also be used to prevent central sleep apnea in high altitude.
Conclusion for Central Sleep Apnea
Central sleep apnea is a communication problem between your brain and your breathing muscles. It is the less common sleep apnea (Obstructive Sleep Apnea is the most common), but it can still have severe impacts on your everyday health. Central sleep apnea is typically caused from pre-existing health conditions like heart attacks or strokes. There are several ways that you can treat central sleep apnea with the most common approach being the CPAP machine. We hope your enjoyed our informative article on central sleep apnea.