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Knowledge Base

Sleep Apnea

What is central sleep apnea?

The central sleep apnea is a sleep disorder in which you stop breathing briefly during sleep. During sleep, apnea moments can occur repeatedly. Interrupting your breathing may indicate a problem with the signal transmission of your brain. Your brain “forgets” for a moment to tell your muscles to breathe.

Central sleep apnea is not the same as obstructive sleep apnea. Obstructive sleep apnea is the interruption of breathing due to clogged airways. People with central sleep apnea have no blockages in their airways. The problem lies in the connection between the brain and the muscles that control your breath.

Central sleep apnea is much rarer than obstructive sleep apnea. It is estimated that central sleep apnea accounts for about 20 percent of all cases of sleep apnea.

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What are the symptoms of sleep disorders?

The most common symptom of central sleep apnea is short sleep phases when breathing stops. Some people breathe very flat rather than actually breathing. You can wake up with shortness of breath. Lack of oxygen can cause you to wake up frequently all night and lead to insomnia.

Other symptoms associated with central sleep apnea occur during the day as a result of a sleep interruption. You may feel very sleepy during the day, have trouble concentrating or focusing on tasks, or you may have headaches when you wake up.

Central sleep apnea caused by Parkinson’s disease or other neurological diseases may be characterized by additional symptoms, including:

  • Swallowing
  • Changes in language patterns
  • Voice changes
  • general weakness

What causes central sleep apnea?

The underlying health conditions cause most cases of central sleep apnea. During a central sleep apnea episode, your brain stem does not instruct your breathing muscles to function properly. Your brain stem is the section of your brain that is connected to your spinal cord. Diseases that affect your brain stem, spinal cord or heart can cause you to develop a central sleep apnea.

Examples of these conditions are:

  • Stroke
  • Heart attack
  • Heart failure
  • a weak breathing pattern called Cheyne-Stokes breathing
  • Encephalitis (inflammation of the brain)
  • Arthritis in the cervical spine
  • Parkinson’s disease (an age-related deterioration of certain nervous systems that affects movement, balance and muscle control)
  • Surgery or irradiation in the spine

Some drugs can also cause a type of central sleep apnea called drug-induced apnea. Opioid drugs are powerful painkillers that can lead to irregular breathing patterns. In some cases, as part of this irregular pattern, you may temporarily stop breathing.

Medications that can contribute to central sleep apnea include:

  • Codeine
  • Morphine
  • Oxycodone

If your doctor cannot identify the cause of your central sleep apnea, you will have idiopathic central sleep apnea.

How is central sleep apnea diagnosed?

Your doctor will perform a sleep study test called polysomnography to diagnose central sleep apnea. The test takes place overnight when you sleep in a special sleep center. During polysomnography, you carry electrodes on your head and body to measure your oxygen content, brain activity, breathing pattern, heart rate and lung function.

Your doctor, a neurologist and sometimes a cardiologist will monitor you and check the results of your polysomnography. The results can help determine the underlying cause of your apnea.

A head or spinal MRI can also diagnose central sleep apnea. The MRI uses radio waves to produce images of your organs. The test may show that structural abnormalities in your brain stem or spine cause central sleep apnea.

What are the treatments for central sleep apnea?

Treatment of the underlying diseases is the first line of treatment for central sleep apnea. Medications can help control heart failure, Parkinson’s and other diseases of the heart or nervous system.

You may need to stop using opioid medications if these drugs cause your breathing to stop during sleep. Your doctor may also prescribe medications such as acetazolamide to stimulate your breathing mechanism.

Oxygen supplementation and the regulation of air pressure during sleep are effective treatments for many people with central sleep apnea.

Continuous positive air pressure (CPAP)

CPAP provides a steady source of pressure in your airwayswhile you sleep. They wear a mask over their nose and mouth, which provides compressed air throughout the night. CPAP treats obstructive sleep apnea, but can also be beneficial for people with central sleep apnea.

Adaptive Servo Ventilation (ASV)

ASV monitors your breathing during sleep. The computer system “remembers” your breathing pattern. A pressurized system regulatesthe breathing pattern to prevent apnea episodes.

Two-stage positive air pressure (BPAP)

This treatment adjusts the air pressure when inhaled to a higher level and when exhaling to a lower level. BPAP also uses a face mask.

What is the long-term outlook?

People with idiopathic central sleep apnea are most likely to respond well to treatment. The general benefits of treating central sleep apnea vary depending on the exact cause of the disease.

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