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Last Updated on June 24, 2022 by Peter

Central Sleep Apnea 101

All those who are lucky enough to have a good night’s sleep do not even know how many different disorders can negatively affect the quality and duration of a night’s sleep. But once the problems start to pile up, you will want to learn more about the different sleep disorders, and one of them is sleep apnea.

Sleep is an essential function of our body, and during sleep our brain and body rest. That strengthens your immunity, overall health and alertness, which is why it is recommended that you sleep as much as possible after illness or surgery. Sleep is equally important when you are healthy. During childhood and adolescence, most people sleep well.

But as the years go by due to unhealthy lifestyle and natural aging process more and more people are experiencing some of the sleep disorders. In some cases, it is very easy to solve the problem, but often sleep disorders require a complete change of habit, as well as patience and perseverance until you notice improvements. 

Most people have heard of sleep apnea, and in this article by The Sleep Advisors you can learn all about central sleep apnoea which is not as common as obstructive sleep apnea.

Table of Contents
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    What is central sleep apnea?

    Sleep apnea in general is a pause in breathing during sleep. As the body needs to breathe constantly, all pauses in breathing are very harmful to health, especially in the long run unless you are trained diver.

    an image of a woman cannnot sleep due to man's snoring

    You’ve probably never thought about how breathing works, because breathing is an act we do from the first to the last minute of our lives without paying attention to it. The brain and muscles are in charge of breathing. To be more precise – rib cage muscles and diaphragm which is a thin skeletal muscle that separates the abdomen and chest. The brain sends constant signals that you need to breathe and the muscles contract, so you inhale and exhale. Breathing speed mainly depends on whether you are at rest or physically active, and those who suffer from apnea have pauses in breathing that last over 10 seconds, and sometimes even over half a minute.

    Central sleep apnea is a disorder that occurs when the connection between the brain and the muscles responsible for breathing fails. It can either happen that the brain “forgets” to send signals while you sleep or that the muscles do not react to those signals.

    Obstructive sleep apnea VS central sleep apnea

    When it comes to sleep apnea, most people are actually talking about obstructive sleep apnea which is up to 10 times more common than central sleep apnea but both are sleep related breathing disorders. Unlike central sleep apnea which occurs due to neurological problems, obstructive sleep apnea is a consequence of blocked airways. A person suffering from obstructive sleep apnea tries to breathe but the air cannot pass.

    an image of a man sleeping on his back and snoring

    Some of the most common causes of obstructive sleep apnea are weakened throat muscles, smoking, alcohol, obesity and asthma. Since the cause is mostly different than in central sleep apnea, the treatment is approached differently. There is another type of sleep apnea, which is very rare, and that is mixed or complex sleep apnea. Although obstructive and central sleep apnea are different disorders, they can occur at the same time and then it is called mixed sleep apnea.

    The symptoms of central sleep apnea

    The symptoms of both central and obstructive sleep apnea are similar. Also, all of these symptoms, like excessive daytime sleepiness, may be related to some other disorders and illnesses, so if you notice any of them it does not necessarily mean that you suffer from sleep apnea. However, if you notice more symptoms, then you probably suffer from this disorder.

    Abnormal breathing patterns while sleeping

    It is virtually impossible to notice on your own abnormal breathing patterns while sleeping. This is something your partner will notice. Abnormal breathing patterns are very easy to notice when you are awake and the other person is asleep. If your partner points out that this is a recurring occurrence, visit the doctor.

    An image of a man suffering from sleep apnea.

    Abrupt awakenings

    It happens to everyone to wake up abruptly from sleep. Maybe you had a nightmare or some noise made you wake up suddenly. If after abrupt awakening you feel as if you have emerged from the water and are trying to catch your breath, then sleep apnea is probably the cause of abrupt awakenings.

    Excessive snoring

    Sometimes we catch a cold without even knowing it, so we snore. We also snore when we have the flu or allergies. Then the mucous membrane in the nose and throat is swollen, and snoring occurs. There are ways to prevent it. Excessive snoring is one of the main symptoms of obstructive sleep apnea, but sometimes patients with central sleep apnea also notice snoring.

    An image of a woman having problems with a man who snores in bed.

    Frequent mood changes

    Frequent mood changes are a symptom that occurs after suffering from central sleep apnea for some time. Mood changes are the result of poor night’s sleep and lack of oxygen in the body and brain during the night. That is why brain fog is also one of the common symptoms.

    An image of A man suffering from less creativity and bad mood due to lack of sleep.

    Insomnia

    Insomnia is the most common sleep disorder and is therefore sometimes used as a synonym for all sleep disorders, although it is very imprecise. If the insomnia is a consequence of childbirth or stress, there are treatments such as massage of pressure points. But if central sleep apnea is the cause of insomnia then different treatment is needed.

    Hypersomnia

    Hypersomnia is mainly associated with a sleep disorder called sleep drunkenness. Equally often, sleep apnea is the culprit for hypersomnia. Those who suffer from hypersomnia generally need much more sleep than the average person, they feel lethargic, drowsy and find very difficult to pay close attention to anything. Hypersomnia is sometimes classified as a mental illness.

    An image of a woman suffering from sleep drunkenness, wearing sleep mask.

    Problems with concentrations

    We have already mentioned problems with concentrations in the previous paragraph where we talked about hypersomnia. Such problems are very common when you do not get enough sleep, and central sleep apnea certainly impairs the quality and duration of sleep. Poor concentrations are a big problem for all types of professions as well as for day to day life.

    An image of a young man suffering from lack of concentration.

    Headaches upon awakening

    There are dozens of reasons why you may wake up with a headache so this is certainly not a symptom that is exclusive to central sleep apnea. But since you are deprived of oxygen during parts of night when you are not breathing properly, then it is possible that you will often wake up with a headache.

    The main causes of central sleep apnea

    When obstructive sleep apnea is diagnosed, it is necessary to find cause of blocked airways, and a medical doctor can often determine the cause as soon as he or she sees the patient. The causes of central sleep apnea are usually complex and require more examination. According to two reputable medical institutions, Cleveland Clinic and Mayo Clinic, these are the most common causes of central sleep apnea.

    Drug abuse

    Both legal and illegal drugs can lead to sleep apnea. You should stay away from illegal drugs for many reasons, and when we talk about medications, they can also be the culprits. The most common are opioids and similar medications that affect the central nervous system. If central sleep apnea occurs after you start taking a particular medication, tell your doctor immediately.

    An image of a man refusing drug use.

    High altitude breathing

    Many hikers report central sleep apnea after climbing high altitudes, usually above 3,000 meters. At high altitudes, the concentration of oxygen is significantly reduced, so when climbing Mount Everest, for example, you must carry an oxygen bottle. But if you don’t, your breathing pattern will change and this can disrupt the signals the brain sends to the body.

    An image of a hiker on top of a mountain.

    Kidney diseases

    Kidney stones and similar kidney problems although very painful cannot lead to central sleep apnea. What it can bring to it is end-stage renal disease and this is a condition where the kidneys completely lose their function. Then transplantation and dialysis are the only solutions.

    An image of a man suffering from kidney disease.

    Stroke

    Stroke can be both a consequence and a cause of sleep apnea. If sleep apnea is left untreated, it will lead to high blood pressure and potentially stroke. Also, if a part of the brain is severely damaged after stroke, then the brain may no longer be able to send the necessary signals to the diaphragm.

    An image of an older man suffering from a stroke.

    Cheyne-Stokes breathing pattern

    The so-called Cheyne-Stokes breathing pattern is a rare disorder and is characterized by changes in the breathing pattern, usually during sleep, but sometimes in the waking state. It most commonly affects people who have heart disease. Congestive heart failure and atrial fibrillation are conditions associated with it. Patients recovering from stroke may experience this breathing pattern as well.

    An image of a young woman wears a breathing mask.

    What are the main risk factors that lead to central sleep apnea?

    Many studies have been conducted on central sleep apnea. Large sample has shown that there are certain risk factors that in most cases lead to this serious sleep disorder. Those risk factors are among others sex, age and heat disorders.

    Sex

    Men are almost twice as likely to develop central sleep apnea compared to women. This number cannot be determined exactly, but it is certain that men should be more careful and act immediately when they notice symptoms. Although women are less likely to develop sleep apnea, they should not underestimate the symptoms.

    Stroke or brain tumor

    We have already mentioned strokes, but there is another reason why the brain can fail to perform its function and constantly send breathing signals. And that reason is a brain tumor. If the brain tumor presses on a certain part of the brain, and especially if it presses on the medulla, the part of the brain at the bottom of the brainstem in charge of breathing, then central sleep apnea is very likely to occur. Doctors will probably examine brainstem for structural lesions too.

    Age

    Central sleep apnea almost always affects people over the age of 50. It is very rare for young people to experience central sleep apnea, while it is not uncommon for young people who are very obese to have obstructive sleep apnea. Infants may have apnea related to Congenital central hypoventilation syndrome. Central sleep apnea is characteristic of the elderly because other medical conditions are present that can cause this sleep disorder.

    Can central sleep apnea cause more problems?

    Both types of sleep apnea can cause many other health problems. Therefore, sleep apnea must not be left untreated, otherwise it will trigger a chain reaction that will be very difficult to stop. To prevent sleep apnea from affecting your health, as soon as you notice symptoms, consult a doctor and start treating underlying medical cause and thus sleep apnea. Idiopathic central sleep apnea is the only type of central sleep apnea that occurs without a cause, but is fortunately very rare.

    issues with snoring pillow

    Cardiovascular problems

    When you do not breathe properly, your heart is under great stress. Over time, the heart learns to compensate for the lack of oxygen in the bloodstream, but this will cause various damage to the heart over time. Once the heart is damaged, that is the point of no return and numerous cardiovascular problems will appear.

    Excessive fatigue

    You will constantly be tired, even after the necessary 8 hours of sleep. But those 8 hours were interrupted and sleep was shallow so you didn’t get enough rest. Fatigue can be the result of many other things, including stress, but the potential of sleep apnea should not be overlooked.

    How to treat central sleep apnea?

    It is estimated that over 100 million people in the world suffer from some type of sleep apnea. This ranks sleep apnea among the most common sleep disorders and because of that much attention is paid to research on the treatment of this disorder. Following are some of the most common treatments.

    Continuous Positive Airway Pressure (CPAP)

    Continuous Positive Airway Pressure, abbreviated CPAP, is a machine that should provide ventilation and the pressure should be greater than atmospheric pressure. You should wear a mask that will prevent upper respiratory tract collapse. CPAP is certainly one of the most effective ways to treat both types of sleep apnea, even severe central sleep apnea, but it will take time for you to get used to wearing the mask. So be patient and don’t give up after first night.

    Stop opioid consumption

    We mentioned that central sleep apnea is one of the side effects of opioids that affect the central nervous system to tranquilize you or reduce pain. If this is the cause, then everything should return to normal as soon as you stop taking that opioid.

    Solving other health problems that may lead to CSA

    Most sleep disorders are actually just a consequence of some other health problem. That is why most doctors and sleep experts believe that the treatment of sleep disorders should begin with a detailed examination of the body to find the underlying cause. Once you solve other health problems, CSA will disappear.

    An image of a doctor in a white coat.

    Adaptive Servo Ventilation (ASV)

    Adaptive Servo-Ventilation, abbreviated ASV, is a device similar to Continuous Positive Airway Pressure (CPAP). Unlike CPAP, ASV adjusts the air pressure while you breathe to make the breathing pattern more natural. It also allows for more breaths if necessary as the device adapts to your pattern and not just follows its own pattern like CPAP. However, people with heart problems should stick with CPAC instead of ASV.

    Supplemental oxygen treatment

    Oxygen therapy is an increasingly popular type of therapy. You can use it at home. If you have not undergone oxygen therapy so far, consult your doctor to see if this is the right choice for you and to get advice on which device to use. Oxygen therapy is useful not only for treating sleep apnea but also other disorders such as asthma.

    An image of a young man using oxygen therapy to overcome sleep apnea.

    Bilevel Positive Airway Pressure (BPAP)

    Bilevel positive airway pressure, abbreviated BPAP, is the third device we mention. In terms of functioning, it is more similar to ASV than CPAP, because it is adaptive and opens the lungs with positive pressure ventilation. You will wear either mask or nasal plugs. Same as ASV, it is not recommended to people with heart failure.

    Using specialized medications

    You might expect sleep medicine, but Acetazolamide, one of the carbonic anhydrase inhibitors, is recommended. It is a drug used for ophthalmic problems such as glaucoma because it reduces the production of fluid inside the eye, but also for epilepsy. Although treating central sleep apnea is not the primary purpose of this drug, studies have confirmed that it can be helpful.

    When is the time to visit the doctor to treat central sleep apnea?

    Although it is not necessary to go to a sleep clinic as soon as you sleep poor for a few nights, sleep apnea is not something you should leave untreated for a long time. As soon as the symptoms start to recur, it is time to visit the doctor to treat central sleep apnea.

    The doctor will probably first order a complete medical check-up and the results will determine further steps in treatment. Central sleep apnea can be even more dangerous than obstructive sleep apnea, so if you have symptoms for more than 10 days or two weeks, our advice is to make an appointment with a doctor as soon as possible.

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