What is Central Sleep Apnea (CSA)

Central sleep apnea (CSA) is a condition in which you repeatedly stop breathing throughout the night because your body ceases sending signals to your lungs to breathe. 

When this happens, you have to then wake up to begin breathing again (called an “apnea” or “apnea event”). Due to CSA, you may have anywhere from 40 to 100+ apnea events per night. The most common scale used to measure the severity of sleep apnea is number of apneas per hour:

• Mild sleep apnea: 5-14 apneas per hour of sleep
• Moderate sleep apnea: 15-30 apneas per hour of sleep
• Severe apnea: 30+ apneas per hour of sleep

Both mild and severe CSA can lead to a high degree of sleep deprivation and all of the associated health problems that are associated with sleep deprivation. CSA is relatively uncommon compared to obstructive sleep apnea (OSA).

Forms/Risk Factors of Central Sleep Apnea

Central sleep apnea has several disorders that fall underneath it: 

• Primary Central Sleep Apnea: cause is not known
• Cheyne-Stokes Breathing Pattern: an irregular breathing pattern that results in a temporary breathing cessation, and mainly occurs in men aged 60 years or older
• Narcotic-Induced CSA: this type of CSA occurs in people who are on chronic narcotic therapy (i.e., chronic pain, or drug abuse)
• Medical Condition: medical conditions such as heart or kidney problems and abnormalities of the base of the brain where breathing is regulated (rare)

Risk factors include [Mayo Clinic]:

• Being older
• Being male
• Heart disorders
• Using narcotics
• Stroke

Central Sleep Apnea vs. Obstructive Sleep Apnea

The primary difference between obstructive sleep apnea and central sleep apnea is the effort to breathe. In OSA, you try to breathe, but can't because of an obstruction. In CSA, there is no signal, therefore there is no effort to breathe. 

This difference can be difficult to identify in actual clinical practice. OSA is much more common and has a greater number of potential cause, but for the most part, both have a lot of overlap. 

Symptoms and Diagnosis of Central Sleep Apnea

Symptoms of CSA include [WebMD]:

• Frequent pauses in breathing at night (reported by another person)
• Gasping for air during sleep
• Morning headaches
• Excessive daytime sleepiness
• General, chronic irritability
• Difficulty staying asleep
• Chronic dry mouth at night
• Snoring (though more common in OSA)

The main symptoms is frequent pauses throughout sleep, but this entails having a bed partner to report this. Otherwise, you. may have to rely on certain symptoms or observations to help you and your doctor come to the conclusion that you have sleep apnea. This includes feeling excessively tired, waking up with headaches, worsening health problems despite active management, and potentially even recording yourself at night to see if you snore excessively. Your physician also will have to have a high index of suspicion to order a sleep study and rule in or out CSA. 

Side Effects of Central Sleep Apnea

Untreated sleep apnea generally results in:

• Lower quality of life
• Lower life expectancy
• Risks of medical conditions such as:
  • Heart disease
  • High blood pressure
  • Diabetes
  • Depression
  • Mood disorders

These risks stem from chronic sleep deprivation.

Treatment Options for Central Sleep Apnea

Fortunately, treatment options for CSA are generally very successful, and often includes some forms of positive airway pressure therapy, such as CPAP therapy (continuous-PAP) or lifestyle changes.

If you live in Alaska, and are concerned that you or a loved one has sleep apnea or has already been diagnosed, please consult with our sleep specialists about any questions you have. You may also start with taking a free online sleep test by clicking below!