What Is Central Sleep Apnea?
Central sleep apnea (CSA) is a sleep-related breathing disorder in which breathing repeatedly stops because the brain does not send consistent signals to the muscles that control breathing. During a central apnea, breathing effort stops temporarily. This differs from obstructive sleep apnea, where the airway becomes blocked despite continued breathing effort. The nervous system helps regulate breathing in response to carbon dioxide. In some forms of central sleep apnea, overbreathing lowers carbon dioxide enough to trigger a pause.
Central sleep apnea symptoms often overlap with other types of sleep apnea, but the underlying cause differs. A careful assessment identifies the cause, confirms the diagnosis, and guides central sleep apnea treatment.
If you or your bed partner notices pauses in breathing or disrupted sleep, seek an assessment. Quiet breathing pauses alone cannot distinguish central from obstructive sleep apnea. A sleep study helps identify your type.
Different Types of Central Sleep Apnea
Central sleep apnea syndromes have different triggers and treatment strategies. They are forms of sleep-disordered breathing, a group of sleep disorders characterised by abnormal breathing during sleep.
Primary CSA (Idiopathic)
Idiopathic central sleep apnea has no identifiable cause after assessment. Management focuses on tailored positive airway pressure treatment and close follow-up.
Cheyne–Stokes Breathing
A cyclical pattern of gradually deeper, then shallower breaths with central apneas (also known as Cheyne-Stokes respiration), most often seen in congestive heart failure or after a stroke. Treatment starts with the underlying medical condition. Support for Cheyne-Stokes breathing depends on your sleep study and heart function.
Medicine-Induced Apnea
Medicines that suppress breathing, especially opioids, can make breathing irregular and trigger central events. With chronic opioid use, your doctor may check whether you have developed central sleep apnea. Dose reduction or an alternative medicine may help, but your prescriber must supervise any changes. Do not stop prescribed medicines on your own.
High-Altitude Sleep Apnea
Unstable carbon dioxide control at altitude can lead to central sleep apnea, even in an otherwise healthy person. This is also called high-altitude periodic breathing, a cyclical, repetitive breathing pattern triggered by low oxygen levels at high elevations. Symptoms often resolve after descent; acetazolamide, supplemental oxygen, or PAP may be used during exposure if needed.
Treatment-Emergent Central Apnea
Central sleep apnea may emerge or persist after CPAP controls obstructive sleep apnea. This is called treatment-emergent central sleep apnea, sometimes referred to as complex sleep apnea. Events often settle over time with monitored CPAP use. Persistent events need specialist review before treatment changes.
Central Apnea Due to Other Medical Conditions
Stroke, brainstem disease and kidney failure can affect the brain’s ability to control breathing. Neuromuscular disorders affecting the breathing muscles may instead cause shallow breathing during sleep, called hypoventilation. Your sleep team distinguishes the abnormal breathing patterns in these sleep disorders because they may need different forms of support.
What Are the Common Symptoms of CSA?
Central sleep apnea symptoms include poor-quality sleep and excessive daytime sleepiness, sometimes without loud snoring. Other symptoms include:
- Persistent daytime drowsiness
- Morning headaches
- Dry mouth on waking
- Irritability or changes in mood
- Difficulty concentrating
- Brief pauses in breathing during sleep
- Abrupt awakenings with breathlessness
- Broken sleep with difficulty staying asleep
- Noisy breathing or snoring, particularly if obstructive sleep apnea also occurs
What Causes Central Sleep Apnea?
Central sleep apnea causes include heart failure with Cheyne-Stokes breathing, stroke or brainstem disease, opioid use, high altitude exposure and kidney failure. Sometimes no cause is found. Identifying the cause helps determine how to treat central sleep apnea.
What Are the Risk Factors
Older age, male sex, heart failure, atrial fibrillation (a type of irregular heartbeat), stroke, and opioid use are risk factors for central sleep apnea. High altitude exposure and treatment for obstructive sleep apnea can also trigger central events. Having a risk factor does not mean you have central sleep apnea, but it helps guide assessment.
Diagnosis
Central sleep apnea diagnosis starts with your symptoms, medical history, medicine review and physical examination. Depending on the findings, you may need assessment of heart function or a neurological review.
Doctors usually diagnose central sleep apnea with an overnight laboratory sleep study called polysomnography. It records respiratory signals, including airflow and breathing effort, along with sleep stages, heart rhythm, and blood oxygen levels. Pauses without breathing effort help distinguish central from obstructive events. The study counts total respiratory events and notes whether both types are present. The apnea-hypopnea index measures apneas and hypopneas per hour of sleep. Carbon dioxide monitoring may be added if hypoventilation is suspected.
Home sleep apnea testing is mainly used for selected adults with suspected obstructive sleep apnea. It is not usually the first choice for suspected central sleep apnea. Flexible nasoendoscopy or drug-induced sleep endoscopy may assess coexisting airway obstruction, but neither test diagnoses central sleep apnea.
When to See an ENT Specialist
Seek a consultation if you have persistent daytime sleepiness, witnessed pauses in breathing, or coexisting heart or neurological conditions with declining sleep quality. Avoid driving if sleepiness could cause you to fall asleep.
An ENT specialist can assess whether nasal or throat obstruction contributes to your symptoms or makes mask use difficult. A central sleep apnea specialist may assess you with a physician trained in sleep medicine, with respiratory, cardiac, or neurological input depending on the suspected cause.
Potential Risks & Complications
Central sleep apnea can cause repeated awakenings, called sleep fragmentation, and lower oxygen levels. This may cause daytime fatigue, concentration problems, and reduced quality of life. Sleepiness can also increase your risk of accidents.
Repeated oxygen dips may worsen existing heart problems, including abnormal heart rhythms and heart failure. Severe central sleep apnea needs prompt assessment, especially if you already have heart or blood vessel disease.
Treatment
Central sleep apnea treatment aims to restore normal breathing and improve sleep and daytime symptoms. Treatment depends on the cause, your sleep study, other medical conditions and heart function. Follow-up checks whether central events and symptoms improve, rather than relying only on how comfortable a device feels. Follow-up sleep studies may be needed if symptoms persist.
When patients ask how to treat central sleep apnea, the first step is to address causes, including a supervised medicine review where needed. Treatment options include:
Heart Failure Optimisation
If you have heart failure, your cardiac team reviews treatment for the heart condition. Improving heart function and fluid balance may reduce central sleep apnea episodes.
Positive Airway Pressure
Continuous positive airway pressure (CPAP) provides steady air pressure through a mask to aid breathing in selected central sleep apnea subtypes. Follow-up is needed to check for persistent central events and adjust the treatment plan.
Bilevel Positive Airway Pressure (BiPAP) with A Backup Rate
Provides different air pressures for inhalation and exhalation, with a backup rate that delivers breaths during pauses. It may help selected patients when CPAP is insufficient. Bilevel therapy without a backup rate can worsen central sleep apnea and is generally avoided.
Adaptive Servo-Ventilation (ASV)
Monitors each breath and adjusts air pressure to stabilise breathing patterns. Adaptive servo-ventilation needs specialist selection, including assessment of heart function. Some devices are unsuitable for particular heart failure patients. Use in heart failure with reduced pumping function requires an experienced centre, close monitoring and attention to device safety restrictions.
Low-Flow Oxygen
Supplemental oxygen may be prescribed during sleep for selected people with heart failure-related or high-altitude central sleep apnea. Monitor oxygen levels and treatment response.
Acetazolamide
May stimulate breathing in selected central sleep apnea subtypes, including altitude-related events. Your doctor will consider side effects, kidney function, and other medicines before prescribing it.
Transvenous Phrenic Nerve Stimulation
An implanted device stimulates the nerve that controls the diaphragm. It may be considered for selected adults with persistent moderate to severe central sleep apnea, including primary CSA or central sleep apnea associated with heart failure. Clinicians usually consider other options first because implantation is invasive and availability varies.
Surgery or Other Procedures
Nasal and throat surgery do not correct the breathing-control problem in central sleep apnea. If obstruction also occurs, procedures may improve nasal airflow, mask tolerance or the obstructive component. They do not replace treatment for central sleep apnea.
Septoplasty
Septoplasty straightens a deviated septum, while turbinoplasty reduces enlarged turbinates. These procedures may improve nasal breathing when a separate blockage is present.
Palate Treatments
May reduce snoring or treat a confirmed obstructive component in selected patients. A sleep study and airway assessment guide whether an airway procedure is appropriate.
How Dr Barrie Tan Can Help
At Barrie Tan ENT Head & Neck Surgery in Gleneagles Hospital, assessment includes a review of your medical history, symptoms and any nasal or throat obstruction. Dr Barrie Tan can arrange appropriate sleep testing and assess problems that make mask use difficult. Suspected central sleep apnea may require coordinated care with a sleep physician and other specialists to select and monitor treatment.
Contact Barrie Tan ENT Head & Neck Surgery for an assessment. Bring any previous sleep study reports and a list of your medicines to help guide the next steps. Your bed partner may be able to describe your breathing patterns.
Frequently Asked Questions
Is central sleep apnea the same as obstruction?
No. Obstructive events occur when the airway collapses despite breathing effort. During central apneas, breathing effort stops temporarily. Central sleep apnea is less common than obstructive sleep apnea, and a sleep study distinguishes between them.
Can central sleep apnea be temporary?
Yes. High-altitude periodic breathing usually resolves after descent, and treatment-emergent central sleep apnea often settles with monitored CPAP use. Persistent events need reassessment.
What if I do not snore?
You can still have central sleep apnea. Snoring is common in obstructive apnea, and central apnea can be quiet and still disruptive.
Is CPAP always the answer?
Not always. Some people need bilevel support with a backup rate, ASV or another treatment. The choice depends on the cause, sleep study and heart function. ASV is not suitable for every patient with heart failure.
How quickly will I feel better?
There is no fixed timeline. Some people notice better sleep or daytime alertness within days or weeks, while others need further adjustments to their treatment or management of an underlying medical condition.
What if CPAP dries my nose and mouth?
Heated humidification, attention to mask fit and leaks, and saline nasal care often help. If dryness persists, ask your sleep team to review the mask, humidifier and air pressure settings. Persistent nasal blockage may need a separate ENT assessment.
Can central sleep apnea return?
Central sleep apnea 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.
