Understanding Central Sleep Apnea & Treatment Options

What Is Central Sleep Apnea & How Is it Treated?

For many people, the fact that there are different types of sleep apnea is news. Obstructive sleep apnea is the type that people are most often familiar with; central sleep apnea is another type that presents the same dangerous health risks.

Emergent central sleep apnea is a subtype that can arise during treatment, and recognizing this variant is crucial for effective patient management and treatment strategies.

What Is Central Sleep Apnea?

Central sleep apnea (CSA) is a condition describing repeated interruptions in breathing during sleep because of irregular neurological signals that control respiration. When the brain does not send the right signals to the muscles, there is effort to breath is lessened or completely absent. This causes apneas that usually last 10 – 30 seconds. Disordered breathing can occur intermittently throughout the night or periodically in conjunction with sleep cycles.

Congenital central hypoventilation syndrome (CCHS) is a specific type of central sleep apnea with genetic factors, primarily affecting neonates.

Who Is at Risk for Central Sleep Apnea?

Sleep apnea, including CSA, can affect anyone although it is more common among men and people over the age of 65. It is linked to other medical conditions including obesity, stroke, high blood pressure, and cardiovascular problems.

What’s the Difference? – Obstructive Sleep Apnea vs. Central Sleep Apnea

Unlike obstructive sleep apnea, which is caused by something physically blocking respiration, central sleep apnea is usually caused by other health conditions. There is no physical barrier to breathing. Additionally, loud snoring is not a main sign or symptom associated with CSA, rather pauses in breathing while asleep are the noticeable sign of this disorder.

What Can Cause Central Sleep Apnea?

There are six different types of central sleep apnea that are differentiated by their cause.

• Medical Condition-Induced Apnea – CSA can be caused by brain damage from an injury or encephalitis affecting the lower brainstem, the area of the brain responsible for breathing. It can also be caused other serious illnesses, particularly Parkinson’s disease, Alzheimer’s, ALS, hypothyroidism, and chronic kidney disease.
• Cheyne-Stokes breathing – People affected by this type of CSA have an irregular breathing cycle in which respiration speeds up, slows down, then stops and restarts. The pattern can last between 30 seconds and two minutes. This kind of CSA and is often seen in patients who have had a stroke or heart failure.
• Treatment-Emergent Apnea – About 5% to 15% of people using CPAP therapy for obstructive sleep apnea develop treatment emergent central sleep apnea. It is important to monitor patients for new symptoms following treatment interventions.
• Narcotic-Induced CSA – This refers to disordered breathing caused by opioid medications.
• High-Altitude Periodic Breathing – Many people at high elevations above 2,500 meters (8,000 feet).
• Idiopathic (Primary) CSA – Describes central sleep apnea that cannot be traced to a clear cause.

What Are the Symptoms of Central Sleep Apnea?

As stated before, snoring is not one of the main symptoms of CSA. In addition to sleep apneas, signs of this condition include:

• Extreme daytime tiredness,
• Disrupted sleep and waking up throughout the night,
• Difficulty concentrating and remembering,
• Mood swings, and
• Difficulty doing regular exercise.

How Is Central Sleep Apnea Diagnosed?

Similar to OSA, people usually begin seeking a diagnosis for CSA because a bed partner has noticed the interruptions in breathing while asleep. Diagnosis of this sleep disorder requires a physical exam by your doctor and information about your medical and sleep history. A sleep study, specifically polysomnography, is the gold standard for diagnosing central sleep apnea. This study involves monitoring various physical functions during sleep, such as breathing patterns and heart activity, and is essential for evaluating and confirming the condition, as well as potentially ruling out other sleep disorders. A clinical sleep test, using a polysomnogram to monitor brain activity and breathing, can help confirm the diagnosis. CSA can be graded in terms of severity based on the number of apneas that occur during the test.

How is Central Sleep Apnea Treated?

Available treatment options will depend mostly on the cause of your CSA. In some cases, treating the underlying condition, or modifying medications, may also resolve the sleep apnea. There are also medications that can be prescribed to help manage the symptoms of CSA.

Lifestyle Modification

Lifestyle changes recommended to manage obstructive sleep apnea can also be helpful for those with CSA. These include:

• Losing weight,
• Avoiding alcohol, sleeping pills, and opioids,
• Quit smoking, and
• Change sleeping positions.

CPAP Therapy

Continuous positive airway pressure (CPAP) therapy can help people with all types of sleep apnea. It works by pushing air into the respiratory tract through the mouth or nose via tubing and a mask. The pressurized air helps keep the airway open and stimulate regular breathing. PAP devices like CPAP and BPAP are also used in the management and treatment of central sleep apneas, helping to stabilize sleep and suppress abnormal respiratory events.

Sometimes similar devices – adaptive servo-ventilation (ASV), automatic positive airway pressure (APAP), variable positive airway pressure (VPAP) or bilevel positive airway pressure (BPAP) – are more effective than standard CPAP for treating central sleep apnea.

Inspire Sleep Therapy

There is also an effective long-term solution available for adults with CSA. This involves having the Inspire Therapy device implanted just below the skin where it tracks the patient’s breathing. When necessary, the device sends mild electrical stimulation to the muscles and stimulate breathing.

Managing Central Sleep Apnea

Managing central sleep apnea (CSA) requires a comprehensive approach that combines lifestyle changes, medical treatments, and device therapies. Here are some effective strategies to manage CSA:

• Lifestyle Changes: Maintaining a healthy weight, engaging in regular exercise, and avoiding alcohol and sedatives can significantly alleviate CSA symptoms. These changes help improve overall respiratory health and reduce the frequency of apneas.
• Sleep Position: Sleeping on your side instead of your back can help reduce the severity of CSA. This position prevents the tongue and soft tissues from collapsing into the airway, promoting better breathing.
• Elevating the Head of the Bed: Raising the head of the bed by 4-6 inches can also help reduce the severity of CSA. This elevation can prevent airway obstruction and improve breathing during sleep.
• Continuous Positive Airway Pressure (CPAP) Therapy: CPAP therapy is a common and effective treatment for CSA. It involves wearing a mask over the nose or mouth while sleeping, which delivers a constant flow of air pressure to keep the airways open and stimulate regular breathing.
• Adaptive Servo-Ventilation (ASV) Therapy: ASV therapy is a type of device therapy that adjusts the air pressure in the airways based on the individual’s breathing patterns. This adaptive approach can be particularly beneficial for those with complex sleep disordered breathing.
• Bilevel Positive Airway Pressure (BPAP) Therapy: BPAP therapy delivers two different levels of air pressure into the airways during sleep, one for inhalation and a lower one for exhalation. This can be more comfortable for some patients and help manage CSA more effectively.
• Oxygen Therapy: For individuals with CSA who have low oxygen levels in the blood, oxygen therapy may be prescribed. This involves using supplemental oxygen to ensure adequate oxygenation during sleep.
• Medications: Certain medications, such as acetazolamide and theophylline, may be prescribed to stimulate breathing and improve respiratory drive. These medications can help manage the symptoms of CSA and improve sleep quality.

When to Seek Medical Attention

Recognizing when to seek medical attention for central sleep apnea (CSA) is crucial for effective management and treatment. Here are some situations that warrant a visit to your healthcare provider:

• Excessive Daytime Sleepiness: If you find yourself experiencing excessive daytime sleepiness that interferes with your daily activities, it’s essential to seek medical attention. This could be a sign that your CSA is not well-managed.
• Restless Sleep: Experiencing restless sleep or frequent awakenings during the night can be a symptom of CSA. If you notice these patterns, it’s important to consult with a healthcare professional.
• Morning Headaches: Persistent morning headaches or fatigue upon waking can indicate that your sleep quality is being compromised by CSA. Seeking medical advice can help address these symptoms.
• Shortness of Breath: If you experience shortness of breath or difficulty breathing, especially during sleep, it’s crucial to seek medical attention immediately. This could be a sign of severe central sleep apnea.
• Chest Pain: Experiencing chest pain or discomfort, particularly at night, should not be ignored. Immediate medical attention is necessary to rule out any serious underlying conditions.

Living with Central Sleep Apnea

Living with central sleep apnea (CSA) involves making lifestyle adjustments and adhering to treatment plans to manage symptoms effectively. Here are some tips for living with CSA:

• Stay Compliant with Treatment: Adhering to your treatment plan, including using device therapies like CPAP or ASV and taking prescribed medications, is essential for managing CSA. Consistency is key to improving sleep quality and reducing symptoms.
• Maintain a Healthy Lifestyle: A healthy lifestyle, including a balanced diet and regular exercise, can help alleviate CSA symptoms. Maintaining a healthy weight and avoiding alcohol and sedatives are particularly important.
• Get Enough Sleep: Ensuring you get enough sleep each night is crucial for managing CSA. Establish a regular sleep schedule and create a restful sleep environment to improve sleep quality.
• Avoid Stimulants: Avoiding stimulants such as caffeine and nicotine, especially in the hours leading up to bedtime, can help reduce CSA symptoms and promote better sleep.
• Stay Hydrated: Staying well-hydrated can help alleviate CSA symptoms. Dehydration can exacerbate breathing difficulties, so make sure to drink plenty of water throughout the day.
• Manage Stress: Managing stress through relaxation techniques such as meditation, deep breathing exercises, and mindfulness can help alleviate CSA symptoms. Reducing stress can improve overall sleep quality and respiratory health.

By following these tips and working closely with your healthcare provider, you can effectively manage central sleep apnea and improve your quality of life.

Reliable Sleep Analysis – Sleep Health Solutions of Ohio

If you are having trouble sleeping, we can help. Sleep Health Solutions has a fully equipped sleep monitoring clinic to help confirm diagnosis and develop successful treatment plans for a wide variety of sleep disorders. Contact our office for more information.