Obstructive vs. Central Sleep Apnea

July 07, 2021
6 Minute read

Because sleep affects your mental, physical, and emotional well-being, getting a good night's rest is crucial. But getting quality sleep isn't always easy. 

Many factors contribute to a good night's sleep. While your environment, eating habits, exercise routine, and mental health all contribute to your sleep quality, the way we breathe is definitely something that we shouldn't overlook.

Sleep apnea is a sleep disorder that affects our ability to breathe during the night. Around 22 million Americans suffer from sleep apnea. It is prevalent in all ages, from kids and teenagers to adults. With this condition, breathing is interrupted while sleeping through repetitive pauses, referred to as apneic events

Despite its commonality, sleep apnea is still not well-understood. Many don't even realize that there are different types of sleep apnea, and the importance of understanding the difference when it comes to treatment. The two most prominent types include obstructive sleep apnea (most common) and central sleep apnea.

Keep reading to learn more about the difference between obstructive sleep apnea (OSA) and central sleep apnea, the symptoms, causes, risk factors, and treatment options. 

Obstructive Sleep Apnea vs. Central Sleep Apnea

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is mainly characterized by irregular breathing due to blockage of the upper airways during sleep. This blockage occurs when the tongue collapses on the soft palate of your mouth, which further drops against the back of your throat.

This obstruction causes your chest muscles and diaphragm to put forth greater respiratory effort to open up the blocked airway and draw air into your lungs. Your brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

This pathophysiology of interrupted breathing repeats itself multiple times during the night, impairing your ability to reach the desired deep, restful phases of sleep, making you feel tired during your waking hours.

Common symptoms of obstructive sleep apnea (OSA) include:

Risk factors for obstructive sleep apnea (OSA)

  • Excess weight: excess weight around the neck, the upper airway, may obstruct breathing. 
  • Narrowed airways: naturally narrow airways or enlarged tonsils or adenoids can block your airway or create pulmonary restrictions.
  • High blood pressure (hypertension): obstructive sleep apnea is common in people with hypertension. Some people may also experience atrial fibrillation also known as irregular heartbeat. 
  • Chronic nasal congestion: congestion due to allergies, frequent cold, or narrowed airways increase the likelihood of OSA.
  • Smoking: people who smoke are more likely to have obstructive sleep apnea (OSA).
  • Diabetes: obstructive sleep apnea may be more common in people with diabetes.
  • Sex: In general, men are twice as likely as premenopausal women to have obstructive sleep apnea. 
  • Genetics: a family history of obstructive sleep apnea may increase the risk of developing obstructive sleep apnea.
  • Asthma: research has found an association between asthma and the risk of obstructive sleep apnea.

Treatment Options for Obstructive Sleep Apnea (OSA)

Treatment options include lifestyle changes and therapies. 

Lifestyle changes:

These measures are components of conservative nonsurgical treatment or may also serve as complements to an effective sleep apnea therapy protocol. If these lifestyle changes don't improve sleep or if the apnea is moderate to severe, then doctors may recommend other forms of treatments, usually involving specific devices that can help open up a blocked airway. In other cases, surgery may be necessary.

Therapies:

Positive airway pressure uses a machine to deliver pressurized airflow through a piece that fits into your nose or is placed over your nose and mouth while you sleep. Before prescribing CPAP therapy your sleep medicine specialist may choose to do a sleep study also known as polysomnography, so make sure you look into what that entails. 

With this treatment, the pressure of the air breathed is continuous, constant, and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This air pressure prevents obstructive sleep apnea and snoring.

Positive airway pressure reduces the number of respiratory events that occur as you sleep, reduces excessive daytime sleepiness, and improves your quality of life.

There are different types of positive airway pressure therapies, CPAP, BiPAP, APAP. 

Watch the video by the Sleeplay Respiratory Therapist to learn the differences. 

The most common type is called continuous positive airway pressure, or CPAP. This therapy can help you regulate breathing patterns, reduce the risk of other ailments like heart diseases, irregular heart rate,  diabetes, improve sleep quality, reduce insomnia and fatigue, and improve emotional stability and concentration. Another treatment option may be oral appliances. These look similar to mouth guards and will help your airway stay open as you sleep. 

However, it is crucial to find the best CPAP machine and a mask that fits you perfectly and adjust your setting accordingly to take full advantage of the incredible benefits of positive airway pressure.

The field of sleep apnea treatment has made immense progress. It continues to develop the latest innovative machines, masks, and accessories to make sleep apnea therapy more comfortable, effective, and easier to sustain in the long run. 

There are a variety of new machines that are smaller and less noisy, and there are a variety of sleek mask designs that adjust for individual comfort and needs.

Also, with some practice, most users learn to adjust the mask to obtain a comfortable and secure fit. You may need to try different types to find a suitable mask. Several options are available, such as nasal masks, nasal pillows, and full-face masks.

Central Sleep Apnea

Central sleep apnea (CSA) is less common than obstructive sleep apnea and is also characterized by breathing inefficiency; however, it's due to the brain's incoordination. It's not that you're not able to breathe (like when you have OSA), but rather your brain doesn't signal your muscles to breathe, and therefore, you don't try to breathe. 

Central sleep apnea can cause severe inefficiency in breathing at night due to a lack of controlled breathing. This type of sleep apnea is more common in people with underlying health conditions that can cause improper functioning of the brain. With newborns, CSA produces up to 20-second pauses in breathing.

Central sleep apnea falls into different types:

  • Narcotic-induced Sleep Apnea

Opioid-based medications like morphine and codeine can cause central sleep apnea.

  • High-Altitude Periodic Breathing

It is caused due to high altitude. The height is usually above 2,500 meters or 8000 feet approximately.

  • Cheyne-Stokes breathing

This type of breathing is mostly observed in patients who have experienced a stroke or heart failure.

  • Medical condition-induced apnea

Other medical conditions like Parkinson's disease, kidney failure, or cardiac-related diseases can cause central sleep apnea, too.

  • Idiopathic central sleep apnea

When the cause is unknown, this type of sleep apnea is referred to as Idiopathic central sleep apnea.

Common symptoms of central sleep apnea include:

  • Abnormal breathing patterns during sleep
  • Abrupt awakenings accompanied by shortness of breath
  • Shortness of breath that's relieved by sitting up
  • Insomnia
  • Excessive daytime sleepiness 
  • Chest pain at night
  • Difficulty concentrating
  • Mood changes
  • Headaches
  • Snoring

Risk factors for central sleep apnea:

  • Congestive heart failure
  • Hypothyroid disease
  • Kidney failure
  • Neurological diseases, such as Parkinson's disease, Alzheimer's disease, and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)
  • Damage to the brainstem from swelling (encephalitis), stroke, or injury

Treatment Options for Central Sleep Apnea (CSA)

Currently, there is no defined cure for central sleep apnea. However, there are ways to reduce its effects and get a restful night's sleep.

  • Treating associated medical conditions: if your CSA is a result of underlying diseases like cardiac problems, kidney issues, etc., it is better to treat that particular disease first. Once the overall effect of your disease diminishes, your sleep apnea gets treated, too.
  • Reduce or prevent opioid medications: morphine and codeine are known to cause central sleep apnea syndrome. Now, if that is the leading cause of your sleep apnea, you can either consult your doctor and change your medication or reduce its dose.
  • CPAP therapy: CPAP machines can help you breathe efficiently during the night using pressurized air to open your airways.
  • Adaptive Servo-Ventilation (ASV): some people struggle to adjust to a CPAP machine or mask. In this case, ASV also delivers pressurized air and can help regulate breathing patterns if it detects any abnormalities. Unlike CPAP, the ASV machine regulates the pressure for a more comfortable experience. Note: ASV treatment is not suggested for patients with symptomatic heart failure.
  • Medications: sleep apnea medications can help regulate breathing patterns.
  • Bilevel Positive Airway Pressure (BiPAP) Therapy: the pressure delivered to your lungs depends on inhalation or exhalation.
  • Phrenic nerve stimulation: a newly developed treatment to reduce the effects of central sleep apnea in adults. Phrenic nerve stimulation works by placing an implantable device in your chest that stimulates the phrenic nerve located within it. The phrenic nerve then signals the diaphragm to control breathing. This treatment can help you attain regular and effective breathing without wearing any mask or taking any extra medications.3 main differences betwen obstructive vs. central sleep apnea

Here is a general view to compare Obstructive vs. Central Sleep Apnea:

As you’ve probably noticed, there are main differences but also commonalities between the two types of sleep apnea. However, treatment may vary depending on your situation. Please consult your primary care provider if you are experiencing some of the previously mentioned symptoms or have questions regarding your condition.

You may also schedule a consultation with a Sleeplay Respiratory Therapist.

Schedule my consultation.

Let us know in the comments section if you have further questions or concerns and don’t forget to share this article with whomever is experiencing difficulty sleeping. 

Written by The Sleeplay Team

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