Central Sleep Apnea: Causes, Symptoms & Treatment

Central sleep apnea (CSA) is a type of sleep apnea where your brain fails to send the proper signals to the muscles that control breathing during sleep. Unlike obstructive sleep apnea, central sleep apnea is not caused by a physical blockage — it's a neurological issue.

According to sleepapnea.org, around 22 million Americans suffer from sleep apnea. While there is no outright cure, several treatments — including CPAP therapy — can significantly reduce symptoms and improve sleep quality.

What Is Central Sleep Apnea?

Central sleep apnea occurs when your brain temporarily stops sending signals to the breathing muscles during sleep. This results in repeated pauses in breathing throughout the night, leading to poor oxygen levels and disrupted rest.

CSA is more common in people with underlying health conditions that affect brain function, such as heart failure, stroke, or kidney disease.

How Central Sleep Apnea Differs from Obstructive Sleep Apnea

Sleep apnea falls into three categories:

• Obstructive Sleep Apnea (OSA): Breathing stops because the airway becomes physically blocked when the tongue collapses against the soft palate, which then presses against the back of the throat.
• Central Sleep Apnea (CSA): Breathing stops because the brain fails to signal the muscles responsible for breathing — there is no physical blockage.
• Complex Sleep Apnea: A combination of both obstructive and central sleep apnea.

Types of Central Sleep Apnea

Central sleep apnea is further classified based on its underlying cause:

• Cheyne-Stokes Breathing: A pattern of gradually increasing and decreasing breathing effort, most commonly observed in patients with heart failure or stroke.
• Narcotic-Induced Sleep Apnea: Opioid-based medications such as morphine and codeine can suppress the brain's respiratory drive and trigger CSA.
• High-Altitude Periodic Breathing: Occurs at elevations above approximately 2,500 meters (8,000 feet) due to lower oxygen levels.
• Medical Condition-Induced Apnea: Conditions like Parkinson's disease, kidney failure, or cardiac disease can cause CSA.
• Idiopathic Central Sleep Apnea: CSA with no identifiable underlying cause.

Central Sleep Apnea Symptoms

If you are suffering from central sleep apnea, you may notice the following symptoms:

• Excessive daytime fatigue and sleepiness
• Frequent nighttime awakenings and disturbed sleep
• Morning headaches
• Difficulty concentrating
• Mood swings and irritability
• Abnormal breathing patterns during sleep
• Insomnia
• Snoring (though less common than with OSA)

If you experience these symptoms regularly, consult a doctor. A home sleep test can help determine whether you have sleep apnea.

Best Treatments for Central Sleep Apnea

While there is no outright cure for central sleep apnea, several treatments can significantly reduce its effects and help you get restful sleep.

Treat Underlying Medical Conditions

If your CSA is caused by an underlying condition — such as heart failure, kidney disease, or a neurological disorder — treating that condition first is essential. In many cases, resolving the root cause can reduce or eliminate the sleep apnea.

Reduce or Change Opioid Medications

If opioid medications like morphine or codeine are causing your CSA, work with your doctor to reduce the dosage or switch to an alternative medication.

CPAP Therapy

CPAP (Continuous Positive Airway Pressure) therapy is the most widely used treatment for central sleep apnea. A CPAP machine delivers a steady stream of pressurized air through a mask to keep your airway open and regulate breathing while you sleep.

Benefits of CPAP therapy for central sleep apnea include:

• Regulates breathing patterns throughout the night
• Reduces the risk of related conditions like heart disease and diabetes
• Improves overall sleep quality
• Reduces daytime fatigue and insomnia
• Improves focus, mood stability, and emotional health
• Helps regulate heart rate

To get the most out of CPAP therapy, it's important to find the right machine and a CPAP mask that fits properly. Not sure which mask is right for you? Try our mask finder quiz.

Adaptive Servo-Ventilation (ASV)

ASV is an advanced form of positive airway pressure therapy. Unlike CPAP, which delivers a constant pressure, ASV automatically adjusts pressure breath-by-breath — providing higher pressure during inhalation and lower pressure during exhalation for greater comfort.

Note: ASV is not recommended for patients with symptomatic heart failure.

BiPAP Therapy

BiPAP (Bilevel Positive Airway Pressure) machines are another option for treating central sleep apnea. Like ASV, BiPAP delivers two different pressure levels — a higher pressure when you inhale and a lower pressure when you exhale — making it more comfortable for patients who find CPAP difficult to tolerate.

Medications

In some cases, doctors may prescribe medication to stimulate breathing and reduce CSA episodes. This may be an option if PAP therapy is not suitable for you.

Phrenic Nerve Stimulation

Phrenic nerve stimulation is a newer treatment for moderate to severe central sleep apnea in adults. A small device is surgically implanted in the chest that stimulates the phrenic nerve, which signals the diaphragm to contract and regulate breathing.

This treatment allows you to breathe normally during sleep without wearing a mask or taking additional medications.

Frequently Asked Questions

What is the main cause of central sleep apnea?

Central sleep apnea is primarily caused by the brain's failure to send proper signals to the muscles that control breathing. Common underlying causes include heart failure, stroke, kidney disease, and the use of opioid medications.

Can central sleep apnea be cured?

There is no permanent cure for central sleep apnea, but treatments like CPAP therapy, BiPAP, ASV, and treating underlying conditions can effectively manage symptoms and improve sleep quality.

What is the difference between central and obstructive sleep apnea?

Obstructive sleep apnea is caused by a physical blockage of the airway, while central sleep apnea is caused by the brain failing to send breathing signals to the muscles. Both disrupt sleep, but the underlying mechanism is different.

Is CPAP effective for central sleep apnea?

Yes, CPAP therapy is one of the most common and effective treatments for central sleep apnea. It delivers steady air pressure to regulate breathing throughout the night.