Central sleep apnea (CSA) is a disorder where breathing pauses during sleep because the brain’s signal to breathe drops. In this case, the failure to control breathing is not due to a blocked throat, as in other cases of sleep apnea. It occurs when the brainstem fails to respond adequately to changes in carbon dioxide levels.
Central sleep apnea symptoms often overlap with obstructive sleep apnea, yet the underlying driver is different. A careful workup identifies the cause, confirms the diagnosis, and guides central sleep apnea treatment that is both effective and sustainable in daily life in Singapore.
If you or a partner has noticed quiet pauses at night with broken sleep, the problem may be central rather than obstructive. The distinction shapes testing and therapy, so our ENT specialist will first focus on a precise diagnosis, before a plan you can follow.
Drugs that depress respiration, such as opioids or sedatives, can trigger central events. Patients on chronic opioid therapy should be monitored for the development of central sleep apnea. Dose reduction, alternative medicines, and appropriately set positive airway pressure (PAP) usually improve control.
Instability in carbon dioxide control at altitude leads to central apneas. This is also referred to as high-altitude periodic breathing, a cyclical, repetitive breathing pattern triggered by low oxygen levels at high elevations. Symptoms often resolve after descent; acetazolamide, oxygen, or PAP may be used during exposure if needed.
Central events appear after starting CPAP for obstructive apnea in some patients. This phenomenon may develop as a side effect of CPAP therapy. They frequently settle over several weeks; persistent cases may need pressure adjustments or ASV.
Brainstem disease, neuromuscular disorders, kidney failure and similar conditions can disrupt breathing. Examples of neuromuscular disorders that can lead to central sleep apnea include amyotrophic lateral sclerosis and spinal cord injuries. Care targets the primary illness alongside tailored PAP to stabilise sleep.
Barrie Tan ENT Head & Neck Surgery provides comprehensive care for snoring and all types of sleep apnea.
If you believe you or a loved one has sleep apnea, contact us today so that we can start working on a plan towards better sleep.
The typical picture is unrefreshing sleep and daytime sleepiness, sometimes without loud snoring. Other symptoms include:
Central sleep apnea causes include:
Since triggers differ, the ways for how to treat central sleep apnea vary.
Ageing, heart and neurological disease, opioid use, altitude exposure and changes during treatment for obstruction raise risk. Risk does not equal destiny, but these features flag who should be tested earlier and followed more closely after therapy begins.
Central sleep apnea is confirmed by a sleep study showing breathing pauses without effort, along with a clinic evaluation to identify causes. The diagnostic process includes a thorough medical history and physical exam. Central sleep apnea diagnosis typically involves an overnight sleep study called polysomnography.
Central sleep apnea diagnosis starts with history, medication review, and examination of the nose and throat, followed by an overnight home sleep test or a laboratory polysomnogram. During the sleep study, respiratory signals are monitored to detect abnormal breathing patterns. The total respiratory events, including apneas and hypopneas, are counted to help differentiate types of sleep apnea. Blood oxygen level is also monitored during the sleep study.
In Singapore, many adults complete home sleep testing that is read by sleep-trained specialists, which keeps the process convenient. When a mixed picture of apnea types is suspected, we add flexible nasoendoscopy in the ENT clinic and, occasionally, drug-induced sleep endoscopy to map any obstructive collapse.
When to See an ENT Specialist
Seek a consultation if you have persistent sleepiness, witnessed pauses in breathing, or co-existing heart or neurological conditions with declining sleep quality. An ENT will determine if obstruction contributes to your symptoms and ensure your positive airway pressure therapy is practical, comfortable and effective
Untreated central sleep apnea strains the heart and brain, impairs cognition, and reduces quality of life. Repeated interruptions in breathing may also damage blood vessels and affect breathing muscles over time.
Complications from these include memory lapses, mood change, reduced exercise tolerance, arrhythmias and worsening heart failure. These risks increase with severe central sleep apnea because oxygen dips and arousals recur throughout the night.
Central sleep apnea treatment uses tailored positive airway pressure or adjuncts to stabilise breathing during sleep. Positive airway pressure treatment is a cornerstone of therapy for central sleep apnea, as it helps improve oxygen saturation and manage breathing irregularities during sleep.
When patients ask how to treat central sleep apnea, the first step is to address causes. Some treatment strategies include:
Heart Failure Optimisation
Careful medication review and acclimatisation after altitude travel all reduce the risk of central events.
Positive Airway Pressure
The most commonly used technology. CPAP helps in several subtypes by maintaining a slight, steady pressure.
Bilevel Positive Airway Pressure (BiPAP) with Backup Rate
Provides a set breath rate to prevent prolonged pauses. It is instrumental in treating central sleep apnea when standard CPAP is insufficient or poorly tolerated.
Adaptive Servo-Ventilation (ASV)
Monitors each breath and adjusts support in real time to maintain steady ventilation.
Low-Flow Oxygen
Can be added in select cases, especially where heart failure or altitude is involved. Supplemental oxygen can be used during sleep to help individuals with central sleep apnea, especially at high altitudes.
Acetazolamide
Can help with altitude-related central events and, in some cases, has proven benefits.
Transvenous Phrenic Nerve Stimulation
Can restore a regular breathing rhythm in refractory cases.
Surgery does not cure central sleep apnea, but it can improve airflow or treat combined obstruction, thereby improving therapy outcomes. Procedures at Barrie Tan ENT at Gleneagles Hospital are designed to support, not replace, the core therapy.
Straightens a deviated septum, and turbinoplasty reduces enlarged turbinates, which are nasal ridges that swell.
May reduce snoring vibration, and when testing shows a combined pattern suggesting obstruction is contributing to the problem, targeted airway surgery can help.
At Barrie Tan ENT Head & Neck Surgery in Gleneagles Hospital, we arrange home or lab sleep studies, review results, and adjust nasal therapy or structure to improve mask tolerance. Our sleep clinicians coordinate on CPAP, BiPAP, or ASV, and schedule timely follow-up so changes can be made quickly rather than after months of frustration. This integrated approach suits busy Singapore routines and helps maintain results.
If you want a clear, experienced opinion and a plan that fits your life, we can help. Contact Barrie Tan ENT, for a consultation.
No. Obstructive events occur when the airway collapses, and central events occur when breathing effort fades. Central sleep apnea is less common than obstructive sleep apnea, and testing distinguishes between them.
Yes. High altitude central events usually resolve on return to sea level, and treatment of emergent central apnea often settles as therapy is fine-tuned.
You can still have central sleep apnea. Snoring is common in obstructive apnea, and central apnea can be quiet and still disruptive.
Not always. Some subtypes respond better to BPAP with a backup or ASV. Choice depends on your sleep study and medical background.
Many improve within the first fortnight once breathing is stable. Early review fixes mask leaks, dryness or pressure discomfort so progress continues.
Heated humidification, nasal care, and the right mask usually solve this. If a structure blocks airflow, a small nasal procedure may help.
It can fluctuate with heart health, medicines and altitude. Ongoing review keeps therapy aligned with your needs and answers how to treat central sleep apnea over time.
Senior Consultant ENT Specialist
MBBS (Singapore), MMed (ENT) (Singapore)
MRCS (Edinburgh, UK), FAMS (Otolaryngology)
Dr Barrie Tan is a dedicated ENT specialist with over 20 years of experience and a keen focus on hearing loss and cochlear implants, among others. Prior to setting up his own practice, Dr Tan was the Head of the ENT Department at the Singapore General Hospital (SGH) – the largest ENT department in Singapore – as well as the Director of the Centre for Hearing and Ear Implants at SGH.Â
Dr Tan was a President’s Scholar and completed his subspeciality Fellowship in Otology, Hearing Implant, Neurotology and Skull Base Surgery at the Ear Science Institute in Australia. Today, Dr Tan remains actively involved in the ENT fraternity, holding several leadership positions and being engaged in the nurturing of the next generation of ENT surgeons. He has organized numerous ENT conferences and continues to devote his time towards meaningful volunteer work and medical missions.
