Central Sleep Apnea
Central Sleep Apnea: What Is It?
Those who stop breathing while they are asleep have a sleep disorder called central sleep apnea. The moments happen on a regular basis throughout the night and is often due to a problem with the way your brain is signaling during the night. For brief periods of time, your brains forgets that the body needs to breathe and doesn’t pass the message to breathe to the muscles.
This is different to obstructive sleep apnea, where the interruption happens due to the airways blocking. If you have central sleep apnea, your airways will not block. The problem when it comes to central sleep apnea is your brain telling the muscles that you need to breathe.
Obstructive sleep apnea is more common than this type. About 20% of those suffering with sleep apnea have central sleep apnea, estimated by the American Sleep Apnea Association (ASAA).
The Causes of Central Sleep Apnea
There are usually underlying health reasons that affect your central sleep apnea. During the periods that you stop breathing, your brain has failed to send the message to your muscles that you need to breath. This is due to a problem at the brainstem, which connects the spinal cord and the brain. Any medical conditions that cause problems for your heart, spinal cord or brainstem can lead to central sleep apnea.
Some of the related conditions are:
- Heart attack
- Congestive heart failure
- Encephalitis (the brain inflaming)
- Cheyne-Stokes breathing (a weak pattern)
- Cervical spine arthritis
- Surgery/radiation on the spine
- Parkinson’s disease – deterioration related to age of the nerves that affect muscle control, balance and movement.
Some medications can cause this disorder too and it is known as drug-induced apnea. Some of the more powerful painkillers, like opioid drugs, are linked to causing irregular patterns in breathing and can cause you to stop breathing temporaily.
Some of the drugs causing this include:
When the cause of the disorder is not evident, you will have idiopathic central sleep apnea.
Symptoms of Central Sleep Apnea
The main symptom is the short periods where you will not breathe during your sleep. However, there are others and one of those is having shallow breathing instead of actually stopping. You may wake up during the night briefly due to not enough oxygen passing around the body and may wake feeling like you are short of breath. Some people with this may also struggle with insomnia.
Additional symptoms may be evident when Parkinson’s disease and other neurological conditions cause the central sleep apnea. These symptoms could be:
- Speech pattern changes
- Changes in the voice
- Difficulty swallowing
- A general weakness
Central Sleep Apnea Diagnosis
The first stage to diagnose central sleep apnea is usually a polysomnography, which is a sleep study. You are monitored for your breathing pattern, lung function, heart rate, brain activity and oxygen levels by placing a series of electrodes around your body and head to measure the various functions. This is an overnight test and conducted in a special center.
Your doctor and a neurologist, along with a cardiologist at times, will look over the results from the study and determine the reason for your apnea. They want to know the underlying cause.
A spinal or head MRI scan can also be used for diagnosing the sleep apnea. MRI scans use radio waves as a way to generate an image of the organs. This can show if there are any abnormalities in the structures of your spine or brainstem that can cause the central sleep apnea.
Central Sleep Apnea Treatment
The first treatment is to manage the underlying conditions. Medication is used for any problems that affect the nervous system or hear, such as Parkinson’s disease and congestive heart failure. If you take opioid drugs and they are the cause then you will need to stop taking them. You may also be given acetazolamide drugs by your doctor for stimulating the mechanism to breathe.
Some patients find that regulating the air pressure and oxygen supplementation are effective to help control their central sleep apnea. These types of treatments include:
- Continuous positive air pressure (CPAP): this offers a steady pressure source into the airways while you sleep. It is also used for obstructive sleep apnea but is beneficial for both types.
- Bi-level positive air pressure (BPAP): this will adjust the pressure of air from high when inhaling to low when exhaling. This can be done through a mask over the face.
- Adaptive servo-ventilation (ASV): this will monitor your breathing while you sleep. The computer will remember the breathing pattern and then regulates it through a pressurized system to prevent the episodes of not breathing.
The Future for Central Sleep Apnea Patients
More often than not, those with idiopathic central sleep apnea will respond well to the different types of treatment. The benefits do differ between patients though depending on the reason for the condition.