AZ Sleep

What Causes Central Sleep Apnea?

There are a few things in life we take for granted. The biggest thing might be that, given reasonable health, our bodies will continue to breathe all on their own. For most of us, this is true. Breathing is reflexive and automatic, requiring no active or conscious effort. For some, though, central sleep apnea changes this entire assumption. Here’s what you should know about this condition.

What is central sleep apnea?

Central sleep apnea is a type of sleep-disordered breathing that causes the sleeper to stop breathing for long periods of time. Breathing starts again with a sudden choking intake of air.

There are five different types of central sleep apnea (CSA). Each is characterized by the pattern of breathing and its cause. Types of central sleep apnea include:

  1. Primary central sleep apnea: This is the main type of CSA and is characterized by irregular periods of disrupted breathing and sudden inhalation
  2. Cheyne-Stokes breathing pattern: This pattern is more rhythmic in nature than primary CSA and has a medical cause unrelated to damage of the brainstem (e.g., heart condition or stroke)
  3. Medical condition (not Cheyne-Stokes): This pattern is similar to Cheyne-Stokes in its rhythmic quality but can also be caused by damage to the brainstem
  4. High-altitude periodic breathing: As the name suggests, this type of CSA occurs sometimes when sleeping above 15,000 feet and is also a rhythmic pattern
  5. Related to drugs: Sedatives and depressants (especially opioids) can dampen the response of the central nervous system and cause irregular breathing; may also be accompanied by obstructive sleep apnea

Approximately four to five million people suffer from this condition in the U.S, with millions more potentially undiagnosed.

Central vs. obstructive sleep apnea

Most definitions and treatments of sleep apnea usually focus on the most common form: obstructive sleep apnea. In this type of sleep apnea, the sleeper’s throat muscles and tissues relax, dropping back and blocking the airway. Approximately 80% of the estimated 25 million sleep apnea sufferers in the U.S. experience this type of sleep-disordered breathing.

On the other hand, central sleep apnea is the failure of the brain to send “breathe” signals to the lungs. When accompanied by obstructive sleep apnea, this is called complex sleep apnea.

Obstructive sleep apnea comes with tell-tale signs such as snoring and paradoxical breathing. Central sleep apnea does not always have these signs.

Central sleep apnea sufferers typically have slower blood flow than obstructive sleep apnea patients. This is especially true for people with sleep apnea caused by heart failure.

Although both types of sleep apneas can come with serious comorbid conditions, this type of sleep apnea is made more complicated when there is damage to the brainstem. This is the area of the brain that sends electrical signals that prompt reflexive breathing.

Central sleep apnea treatment is similar to treatment for obstructive sleep apnea, but there are a few key differences (see below for more on treatment options).

What causes central sleep apnea?

Primary central sleep apnea causes include anything that might affect the function of your central nervous system. These include:

  • Damage or injury to the brainstem
  • Overuse or prolonged use of painkillers (opioids) or other depressants (e.g., alcohol)
  • Obesity
  • Encephalitis
  • Parkinson’s disease
  • Surgery or radiation in the spine
  • Heart failure
  • Stroke
  • Kidney failure

While medical conditions such as heart failure or stroke don’t always lead to sleep apnea, damage to the brainstem comes with an increased risk of central sleep apnea.

10 central sleep apnea symptoms

As with other types of sleep disordered breathing, this condition comes with daytime sleepiness and general overall fatigue. Additionally, common central sleep apnea symptoms include:

  • Very shallow breathing
  • Shortness of breath upon awakening
  • Difficulty concentrating
  • Morning headaches

Some neurological causes of central sleep apnea have additional symptoms such as changes in the voice and speech patterns, general weakness in the body, and difficulty swallowing.

What are the risks of central sleep apnea?

There is incredible stress on the heart and the brain as blood oxygen levels drop and both have to work harder. This makes sleep apnea sufferers vulnerable to many different potentially fatal conditions. Untreated central sleep apnea carries with it the heightened risk of heart failurestrokedementia, and early death.

For patients with other chronic pain conditions, managing central sleep apnea and pain can be especially challenging.

Seeking comprehensive treatment for central sleep apnea can actually save your life, though.

How to treat central sleep apnea

The first step to treatment of central sleep apnea is a proper diagnosis. Your doctor will take a thorough medical history and conduct and medical exam. This rules out any other potential illness. A sleep study is a diagnostic tool, if necessary. An MRI of the head and spine can be used to diagnose any damage to the spine or brainstem that might be causing your disordered breathing.

For drug-related central sleep apnea, the solution may be fairly straightforward: stop taking the medications. For those who have become dependent or need the medication for another condition, this treatment is not as simple as it sounds, though. Reach out to your healthcare provider for resources to help you during this transition.

If your sleep issues are related to altitude, most people find relief when they move below 15,000 feet. For sleep apnea that persists, there are other treatments.

Several machines can help a sleeper get the oxygen they need. A continuous positive air pressure (CPAP) machine is usually recommended for obstructive sleep apnea but may not be as helpful for those with this condition. This is due to the variations in breathing patterns of central sleep apnea and the fact that not all sleepers stop breathing completely.

Bi-level positive air pressure (BPAP) machines are a variation on the CPAP, adjusting the air pressure when a sleeper inhales and exhales.

The most promising option is adaptive servo ventilation (ASV). Not only does this type of machine provide airflow to keep the airway open all night, but it also adjusts the delivery to the sleeper’s breathing patterns. The amount of air and the timing adapts to changes throughout the night. The ASV device waits for changes in the breathing pattern and then makes subtle adjustments.

AZ Sleep is a sleep apnea dentist that can help you better understand and treat your central sleep apnea. Get in touch today for a better sleep tonight!

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