Central Sleep Apnea: Causes, Symptoms, and Treatment Options
Central sleep apnea (CSA) is a sleep disorder in which the brain temporarily stops sending the signals needed to breathe, causing repeated pauses in breathing during sleep. Unlike obstructive sleep apnea, which is caused by a physical blockage in the airway, central sleep apnea originates in the brain’s respiratory control center. Episodes typically last ten to 30 seconds and can happen many times a night, lowering oxygen levels and fragmenting sleep.
Central sleep apnea is less common than obstructive sleep apnea, but it carries similar risks when left untreated, including daytime fatigue, difficulty concentrating, and added strain on the heart. It is closely linked to other health conditions such as heart failure, stroke, and opioid use, which means treatment usually starts with addressing the underlying cause alongside therapies like CPAP or Inspire Sleep Therapy.
Key Takeaways
- Central sleep apnea occurs when the brain fails to send proper signals to the muscles that control breathing, not from a physical blockage in the airway.
- CSA is less common than obstructive sleep apnea but shares many of the same health risks, including daytime fatigue and cardiovascular strain.
- Loud snoring is not a reliable sign of CSA; pauses in breathing noticed by a bed partner are the more common red flag.
- CSA is strongly linked to other health conditions, particularly heart failure, stroke, and opioid medication use.
- Polysomnography, an overnight sleep study, is the gold standard for diagnosing central sleep apnea.
- Treatment depends on the underlying cause and can include CPAP, adaptive servo-ventilation, Inspire Sleep Therapy, or treating the condition driving the CSA.
What Is Central Sleep Apnea?
Central sleep apnea (CSA) is a condition in which breathing repeatedly stops and starts during sleep because the brain does not send the signals needed to activate the muscles that control breathing, according to the National Heart, Lung, and Blood Institute. When those signals are delayed or absent, the effort to breathe is reduced or stops completely. This produces apneas that typically last ten to 30 seconds and can occur intermittently throughout the night or in a repeating pattern tied to sleep cycles.
Congenital central hypoventilation syndrome (CCHS) is a rare, genetically linked form of central sleep apnea that primarily affects newborns and is diagnosed separately from the adult-onset forms covered in this article.
Central vs. Obstructive Sleep Apnea: What’s the Difference?
The key difference is mechanical versus neurological. Obstructive sleep apnea happens when the throat muscles relax and physically block the airway. Central sleep apnea has no physical obstruction; instead, the brain fails to tell the breathing muscles to work. Because there is no blockage, loud snoring is not a reliable sign of CSA the way it is with OSA. Pauses in breathing that a bed partner notices are usually the first clue.
Who Is at Risk for Central Sleep Apnea?
Central sleep apnea can affect anyone, but it is more common in men and in adults over age 65. It is closely associated with several underlying health conditions, including:
- Heart failure or a history of stroke
- High blood pressure and other cardiovascular conditions
- Obesity
- Regular use of opioid medications
- Chronic kidney disease
What Causes Central Sleep Apnea?
Central sleep apnea is not one condition but a group of related patterns, each with a different underlying cause:
- Medical condition-induced apnea: brain injury, encephalitis, or diseases such as Parkinson’s, Alzheimer’s, ALS, hypothyroidism, or chronic kidney disease that affect the brainstem’s control over breathing.
- Cheyne-Stokes breathing: a cyclical pattern of speeding up, slowing down, then stopping breathing, most often seen after a stroke or with heart failure.
- Treatment-emergent central sleep apnea: CSA that develops in five to 15 percent of people using CPAP for obstructive sleep apnea. New symptoms after starting CPAP are worth reporting to your provider.
- Narcotic-induced CSA: disordered breathing caused by opioid medications.
- High-altitude periodic breathing: common at elevations above roughly 8,000 feet.
- Idiopathic (primary) CSA: central sleep apnea with no identifiable cause.
What Are the Symptoms of Central Sleep Apnea?
Because snoring is not a hallmark symptom, CSA is often noticed through its other effects:
- Pauses in breathing during sleep, usually noticed by a bed partner
- Sudden awakenings with shortness of breath
- Excessive daytime tiredness
- Difficulty concentrating or remembering
- Mood changes
- Trouble keeping up with regular exercise
How Is Central Sleep Apnea Diagnosed?
As with obstructive sleep apnea, most people pursue a diagnosis after a bed partner notices pauses in breathing during sleep. Diagnosis starts with a physical exam and a review of your medical and sleep history. Polysomnography, an overnight sleep study that monitors breathing patterns, heart activity, and other physical functions, is the gold standard for confirming central sleep apnea and ruling out other sleep disorders. Results are used to grade the severity of CSA based on how many apneas occur during the study.
How Is Central Sleep Apnea Treated?
Treatment for CSA depends largely on its underlying cause. In some cases, treating the condition driving the CSA, or adjusting medications, resolves the sleep apnea on its own.
Lifestyle Modification
- Losing weight
- Avoiding alcohol, sleeping pills, and opioids
- Quitting smoking
- Changing sleep position
CPAP and Related Devices
CPAP therapy is a first-line treatment for most types of sleep apnea. It delivers pressurized air through a mask to keep the airway open and encourage regular breathing. For central sleep apnea specifically, related devices such as adaptive servo-ventilation (ASV), automatic positive airway pressure (APAP), and bilevel positive airway pressure (BPAP) are often more effective than standard CPAP because they adjust pressure in response to your breathing pattern.
Inspire Sleep Therapy
For adults with CSA who need a long-term solution beyond a mask-based device, Inspire Sleep Therapy is an implanted device placed just below the skin. It tracks breathing patterns and delivers mild electrical stimulation to the muscles involved in respiration when needed.
Managing Central Sleep Apnea Day to Day
Alongside medical treatment, these day-to-day habits support better breathing and sleep quality:
- Maintain a healthy weight and stay physically active to support overall respiratory health
- Sleep on your side rather than your back. While central sleep apnea is a neurological issue, studies have shown that sleeping on your back increases frequency of sleep disruptions.
- Elevate the head of the bed four to six inches to help keep the airway open
- Avoid alcohol, sedatives, and stimulants such as caffeine and nicotine, especially close to bedtime
- Stay consistent with any prescribed device or medication, since gaps in use are one of the most common reasons symptoms return
Sleep position plays a meaningful role in managing CSA. Our guide to the best sleeping position for your health covers how to train a new position if side sleeping does not come naturally.
When to Seek Medical Attention
Contact your healthcare provider if you notice any of the following:
- Excessive daytime sleepiness that interferes with work, driving, or daily activities
- Restless sleep or frequent nighttime awakenings
- Persistent morning headaches
- Shortness of breath or difficulty breathing during sleep
- Chest pain or discomfort, particularly at night, which warrants immediate medical attention
FAQ
What is central sleep apnea?
Central sleep apnea (CSA) is a sleep disorder in which the brain does not send the signals needed to breathe, causing repeated pauses in breathing during sleep. It differs from obstructive sleep apnea, which is caused by a physical blockage in the airway rather than a signaling problem in the brain.
What is the difference between central and obstructive sleep apnea?
Obstructive sleep apnea happens when the throat muscles relax and physically block the airway during sleep. Central sleep apnea has no physical obstruction; instead, the brain fails to send the signals needed to trigger breathing. Loud snoring is common with obstructive sleep apnea but is not a reliable sign of central sleep apnea.
What causes central sleep apnea?
Central sleep apnea has several possible causes, including heart failure, stroke, high altitude, opioid medications, and health conditions that affect the brainstem’s control over breathing. It can also develop in people using CPAP therapy for obstructive sleep apnea, a pattern known as treatment-emergent central sleep apnea. Some cases have no identifiable cause.
Is central sleep apnea dangerous?
Left untreated, central sleep apnea can lead to daytime fatigue, difficulty concentrating, and added strain on the heart. Because CSA is closely linked to conditions such as heart failure and stroke, untreated cases can worsen those underlying conditions. Central sleep apnea is treatable once it is properly diagnosed.
How is central sleep apnea diagnosed?
Central sleep apnea is diagnosed with polysomnography, an overnight sleep study that monitors breathing patterns, heart activity, and other physical functions. Most people pursue testing after a bed partner notices pauses in breathing during sleep.
How is central sleep apnea treated?
Treatment depends on the underlying cause and can include lifestyle changes, CPAP or related devices such as adaptive servo-ventilation, Inspire Sleep Therapy, or addressing the medical condition driving the CSA. Many people need a combination of approaches to manage symptoms effectively.
Does CPAP work for central sleep apnea?
Yes, CPAP can work for central sleep apnea, and doctors often try it first to help stabilize a patient’s breathing patterns. However, its effectiveness depends entirely on the underlying cause of the condition, so it may not work for every individual.
Getting Help for Central Sleep Apnea
Central sleep apnea can look different from person to person, which is why an accurate diagnosis matters. If you or a bed partner have noticed pauses in breathing, gasping, or unrefreshing sleep, a sleep study is the clearest way to identify what is happening and find the right treatment path.
Sleep Health Solutions offers comprehensive sleep testing and treatment planning for central sleep apnea and other sleep disorders. Call (330) 923-0228 or contact us to schedule a consultation.
