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Central Sleep Apnea - Causes, Symptoms, Diagnosis, and Treatment

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The process of breathing does not take place during sleep. Read the article below to learn about the causes, diagnosis, and treatment of central sleep apnea.

Written by

Dr. Saberitha

Medically reviewed by

Dr. Abhishek Juneja

Published At October 7, 2022
Reviewed AtFebruary 8, 2023

Introduction

Central sleep apnea is associated with a sleeping disorder. A person with central sleep apnea does not breathe during sleep. The patient is unable to inhale oxygen and exhale carbon dioxide. This causes an increase in blood carbon dioxide levels. This disorder continues to take place repeatedly during the night. This indicates the problem in the brain signals and arouses the person from sleep. The brain stops sending signals to the respiratory muscles for breathing. The person gasps for breath after a halt in the respiratory pattern.

What Are the Causes of Central Sleep Apnea?

The existing systemic diseases affect the brain and cause central sleep apnea. During the disorder, the brainstem fails to control the functions of the respiratory muscles. The brainstem is a part of the brain which attaches to the spinal cord. The medical conditions that influence the brainstem and spinal cord are as follows;

  • Stroke - It impairs the functions of the brain and disrupts the breathing pattern.

  • Congestive Heart Failure - In the case of congestive heart failure, the cardiac muscles are unable to deliver adequate blood to the organs. This causes oxygen demand and results in central sleep apnea. There is an increase and decrease in the breathing pattern. This alteration in the breathing effort and the airflow leads to a lack of oxygen. This condition is called Cheyne-stoke breathing.

  • Atrial Fibrillation - The patient has irregular heartbeats in atrial fibrillation. They are at higher risk for central sleep apnea.

  • Tumor - The brain tumor or lesion in the brainstem damages the parts of the brain responsible for motor reflex. So the brain fails to send signals to the respiratory muscle.

  • High Altitude - There is a decreased oxygen level at higher altitudes. This changes the respiratory pattern as under breathing and causes central sleep apnea.

  • Drugs - The drugs like Codeine and Morphine affect the breathing mechanism. It temporarily stops breathing and results in central sleep apnea.

  • Age and Gender - Central sleep apnea occurs in older individuals above 60 years old. In general, the sleeping pattern is reduced in older individuals. Males are more prone to central sleep apnea than females.

  • Obesity - The bronchi (airway) are narrowed due to the excess tissue present in obese people. It affects the breathing sequence.

What Are the Symptoms of Central Sleep Apnea?

  • The most common symptom is a short pause between each breathing cycle.

  • Few people do shallow breathing instead of complete breathing.

  • During the night, there is a disturbed sleeping pattern because of a lack of oxygen supply. This can lead to shortness of breath and insomnia.

  • Due to improper sleep, the person has headaches and is tired during the day. The person is unable to focus on regular work.

  • Few individuals get excess sleep during the day. This condition is called hypersomnia.

  • Central sleep apnea associated with neurological disorders or parkinsonism disease has symptoms like difficulty in swallowing food. The person experiences a difference in the normal voice. There is an alteration in the speech pattern.

  • Due to the nervous disorder, the motor reflex is diminished, and the person cannot do activities like driving and running.

  • Insomnia affects the diet and causes generalized weakness in individuals with central sleep apnea.

  • The person usually snores during sleep because of an abnormal breathing pattern. The patient has mood shifts every day.

What Are the Diagnostic Procedures of Central Sleep Apnea?

  • Polysomnography: It is a diagnostic test used to study sleep patterns. The patient affected by central sleep apnea must stay in a special sleep center. The sleep pattern of the concerned person is observed overnight in the sleep center. The person should wear electrodes connecting the head and the body. These electrodes are used by medical professionals to measure the level of oxygen in the body, the reflex mechanism in the brain, and breathing patterns. It is also used to observe the heart rate and lung function during inspiration and expiration. The results obtained from the polysomnography study are reviewed by a neurologist and cardiologist. The underlying cause is determined by these specialists.

  • MRI (Magnetic Resonance Imaging) Scan: This scan is used to diagnose the abnormalities in the head and spinal cord. This scan utilizes radio waves to produce images of the brain and spinal cord. The results obtained may reveal the defects in the nervous system that causes central sleep apnea.

How Is Central Sleep Apnea Treated?

  • Medications are prescribed by medical professionals for congestive heart failure and neurological disorders like parkinsonism. These conditions are kept under control to avoid complications.

  • Drugs like Acetazolamide are prescribed for central sleep apnea disorder to stimulate the breathing process.

The air pressure is regulated with the help of supplemental oxygen therapy. They are as follows;

  • Continuous Positive Air Pressure (CPAP): The patient should wear a mask above the nose or mouth. The pressurized air is delivered into the airways to facilitate breathing. It is considered a safe method to deliver constant air pressure.

  • Bi-Level Positive Air Pressure (BPAP): The air pressure can be adjusted in bi-level positive air pressure therapy. During the inhalation and exhalation through the facemask, the air pressure is at a higher level and lower level, respectively.

  • Adaptive Servo-Ventilation: The respiratory pattern of the person affected by central sleep apnea is observed with adaptive servo-ventilation. It is stored as computerized data. This system regulates the pressurized air depending on the breathing pattern.

Conclusion

Central sleep apnea is a less common sleep disorder, but severe untreated cases are life-threatening. Central sleep apnea is usually interpreted in individuals with other serious medical conditions like obesity, heart failure, and Cheyne stokes. Appropriate treatment, usually a combination of two to three treatments, must be given to manage systemic disease and central sleep apnea. This helps in the recovery of central sleep apnea faster. Multiple approaches from sleep specialists, cardiologists, and pulmonologists are necessary. The prognosis of central sleep apnea depends on how well the medical condition responds to the treatment. Prognosis is better and favorable for individuals with central sleep apnea due to idiopathic causes.

Frequently Asked Questions

1.

How Serious Is Central Sleep Apnea?

Central sleep apnea is a life-threatening medical condition. Normal, restorative sleep is unattainable due to the frequent awakenings caused by sleep apnea. These frequent breathing pauses might impair sleep quality and lead to major health issues. Even while sleep apnea therapy frequently eliminates health problems associated with it, the condition can be fatal if ignored. Numerous studies have shown a connection between sleep apnea and various illnesses like type 2 diabetes, heart attacks, strokes, and even a shortened life span.

2.

What Causes Central Sleep Apnea Primarily?

Since the brain fails to properly communicate with the breathing muscles, central sleep apnea occurs. This disorder is distinct from obstructive sleep apnea, in which the upper airway is blocked and one is unable to breathe normally. A significant condition, especially one that affects the lower brainstem, which regulates breathing, is frequently the cause of central sleep apnea.

3.

How Is Central Sleep Apnea Managed and Cured?

By addressing the underlying medical issues, such as:
- Heart failure. 
- Opioid medication reduction.
- Continuous positive airway pressure (CPAP) entails wearing a mask over the nose or both the nose and mouth while sleeping.
- Adaptive servo-ventilation (ASV), which delivers pressurized air.
- Bilevel positive airway pressure (BPAP), which delivers pressure when breathing in and a different amount of pressure when breathing out.
Additional oxygen, and medication such as naltrexone are some of the ways to treat central sleep apnea. Yet there is presently no cure available for central sleep apnea.

4.

Can Someone With Central Sleep Apnea Lead a Normal Life?

The diagnosis of central sleep apnea may seem frightening at first, but fortunately, it can be effectively managed. Many people who have central sleep apnea can lead regular lives. Patients who receive therapy are more likely to live longer and experience fewer additional health issues than people who do not.

5.

Is There a Natural Treatment for Central Sleep Apnea?

Since it is a result of the nervous system and brain functions, central sleep apnea has also been known to resolve on its own without therapy. Home remedies like:
- Elevating the head at night.
- Changing the posture in which one sleeps.
- Using a humidifier.
- Abstaining from alcohol and smoking.
- Keep the weight in check.
- Adopting a healthier lifestyle has the potential to reduce the frequency of apnea episodes. 
- In the case of moderate or severe sleep apnea, it is advisable for individuals to seek medical attention. They'll probably need to use continuous positive airway pressure (CPAP) equipment to assist with breathing.

6.

Can Physical Exercise Treat Central Sleep Apnea?

Regular, moderate exercise can assist weight loss and enhance brain function, which may help treat or even prevent sleep apnea symptoms. Moving the body also makes one look and feel better.

7.

Which Type of Doctor Manages Central Sleep Apnea?

Central sleep apnea might be treated by medical professionals with specialties in ENT, pediatrics, heart disease, neurology, psychiatry, neurology, and lung, and breathing disorders.

8.

Should Someone Visit a Neurologist for Central Sleep Apnea?

The best way to treat neurological conditions such as central sleep apnea, narcolepsy, insomnia, and restless legs syndrome is by a neurologist.

9.

What Are the Sleep Apnea Warning Signs?

Excessive drowsiness during the day, snoring loudly, instances of halted breathing while sleeping, sudden awakenings with choking or gasping, waking up with a painful throat or dry mouth early in the day, and difficulty concentrating during the day are some of the warning signs of central sleep apnea.

10.

Can Brain Damage Result From Sleep Apnea?

When the brain briefly stops delivering instructions to the breathing muscles, central sleep apnea develops. These pauses in breathing can hinder the body from giving the brain enough oxygen. In extreme circumstances, this oxygen deprivation might cause brain injury. Memory issues, difficulty concentrating, and moodiness are symptoms of this impairment.

11.

Can Central Sleep Apnea Be Caused by Anxiety?

Many mental illnesses, such as melancholy, anxiety, posttraumatic stress disorder, psychosis, and bipolar disorders, have been linked to sleep apnea. Lack of sleep results in a sleep debt that makes it harder for the brain to handle stress, worsening any anxiety disorders that already exist. And since anxiety can make it harder to obtain the rest one needs, sleep apnea may worsen as a result.

12.

Is Central Sleep Apnea a Common Condition?

Central apneas can occur up to 40% of the time in healthy people during the sleep-wake transition. The central apneas happen while the chemoreceptors are resetting and the breathing control system is unstable. The majority of the time, they are brief and not significantly oxygen desaturated. 0.9% of American adults, according to sleep research, have central sleep apnea.

13.

What Makes Central Sleep Apnea Worse?

Central sleep apnea risk factors include opioid drugs, as well as diseases including congestive heart failure, high blood pressure, and type 2 diabetes.

14.

What Is the Most Recent Therapy Available for Central Sleep Apnea?

Transvenous phrenic nerve stimulation (TNPS) is a relatively novel treatment for central sleep apnea. People can breathe regularly once more with the aid of an implantable device that stimulates the phrenic nerve in the chest, which subsequently transmits signals to the diaphragm. The battery-operated gadget is implanted by a cardiologist in the right or left pectoral region, using local anesthesia. By the activation of a single phrenic nerve, TPNS stabilizes breathing by causing the diaphragm to contract throughout the night, creating a negative pressure in the chest that mimics natural breathing.
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Dr. Abhishek Juneja
Dr. Abhishek Juneja

Neurology

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