Central Sleep Apnea

Central sleep apnea is a condition in which the breathing pauses during sleep due to disruption of signaling from brain to the breathing muscles. As against obstructive sleep apnea in which the breathing is disrupted due to airway passage obstruction, in central sleep apnea the person does not breathe as there are no signals for breathing to the muscles. It is not a common form of sleep apnea and is usually associated with other medical conditions.

Central sleep apnea decreases the quality of sleep and this causes excessive sleepiness during day. Diagnosis of this condition is done with the help of sleep study. Treating the underlying condition helps to alleviate symptoms of sleep apnea. Positive airway pressure therapies and oxygen therapy are also useful.

The most common symptom of central sleep apnea is the pause in breathing for a short duration. In some people, it is noted as shallow breathing for a short duration. This is usually followed by shortness of breath which awakens the person.

Shortness of breath is relieved by sitting, but it affects the quality of sleep. The person may find it difficult to sleep continuously, resulting in insomnia. The body tries to compensate for the lost sleep by sleeping in the daytime, leading to excessive sleepiness in the daytime.

Patients with central sleep apnea face problem in concentrating and are quiet irritable. Morning headaches are common among them. Some patients have snoring as a characteristic symptom of central sleep apnea, it may not be as prominent as in the case of obstructive sleep apnea.

Failure of the brain to send signals to the breathing muscles cause central sleep apnea. It is often associated with a number of conditions that affect the functioning of brain stem. Brain stem controls vital functions like heartbeat and breathing. There are different types of central sleep apnea, each one caused by a different factor:

• Cheyne-Stokes breathing – this is characterized by rhythmic increase and decrease in breathing effort and airflow. It is commonly associated with congestive heart failure.
• Drug-induced apnea – this is caused by certain medications like morphine sulfate, oxycodone, or codeine sulfate. In this condition, the breathing may stop temporarily or have a rhythmic increase and decrease in breathing pattern.
• High-altitude periodic breathing – this is caused by exposure to high altitude. Change in oxygen availability causes alternate breathing pattern, with rapid breathing followed by slow breathing.
• Complex sleep apnea – this is seen associated with obstructive sleep apnea in people who use continuous positive airway pressure (CPAP).
• Medical condition-induced central sleep apnea – this is associated with certain medical conditions.
• Primary central sleep apnea – the actual cause of this type of sleep apnea is not known. This is characterized by repeated breathing pauses.

Central sleep apnea is more commonly seen in males in people above 65 years. Some of major risk factors of this condition include heart disorders, stroke, brain disorder, high altitude, opioid use, and CPAP.

Diagnosis of Central sleep apnea is based on signs and symptoms. Overnight monitoring of breathing pattern, airflow, and other functions is done through polysomnography. In this method, and equipment connected to the body evaluates and monitors activities of vital organs, breathing patterns, arm and leg movements, and oxygen levels in blood.

This may be done in two ways – split-night study or full-night study. In split-night study, the person is monitored during the first half of the night. If obstructive sleep apnea is diagnosed, CPAP is applied for the second half of the night. Polysomnography is helpful in differentiating other sleep disorders like narcolepsy.

Central sleep apnea is associated with several medical conditions, and treating the condition helps to alleviate symptoms of the disorder. Sleep apnea caused by heart problems can be relieved by controlling the cardiovascular issues.

Gradually reducing opioid medications control the apnea caused by the drug. CPAP is a method in which a mask placed over the nose helps to provide continuous supply of pressurized air that opens the airway. This helps to reduce the obstruction of airway passage that is seen in central sleep apnea.

Adaptive servo-ventilation (ASV) is a device which stores the breathing pattern of a person in a digital format and uses the information to control air pressure during sleep, preventing sleep apnea. ASV is recommended for improving central sleep apnea. Bilevel positive airway pressure (BiPAP) is a device that creates a higher pressure during inhalation and lowers it during exhalation. This helps to improve the weak sleeping pattern of central sleep apnea.

Oxygen therapy uses supplemental oxygen to control the deficiency during sleep. This can be delivered using devices. Breathing can be stimulated by certain medications like theophylline or acetazolamide. Medications are prescribed if positive airway pressure cannot be taken off.

Treating the underlying conditions is the best way to prevent the occurrence of central sleep apnea.

Depending on the specific symptoms and causes of sleep apnea, homeopathic remedies like Arsenicum album, Lachesis, opium, sambucus, spongia, and Sulphur are recommended.

Flower remedy or essence therapy is sometimes suggested for improving sleep and to control sleep pauses. Behavioral treatments including breathing techniques help to alleviate the symptoms to certain extent.

Lifestyle modifications are necessary in order to control symptoms of sleep apnea.

Self-management is the most ideal way to control symptoms of sleep apnea. This includes losing excess weight, exercise, avoiding alcohol and certain medications, and quitting smoking.

Central sleep apnea is considered to be a serious condition and it may cause complications like excessive fatigue and cardiovascular problems.