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Central Sleep Apnea



Introduction

Central sleep apnea is a disorder in which your breathing repeatedly stops and starts during sleep due to lack of respiratory effort. Unlike obstructive sleep apnea, in which you try to breath normally but can't because of upper airway obstruction, central sleep apnea occurs when your brain doesn't send proper signals to the muscles that control your breathing. Central sleep apnea is much less common than other types, accounting for less than 10 percent of diagnosed sleep apneas.

Central sleep apnea may occur as a result of other conditions, such as heart failure and conditions that affect your nervous system (neurological conditions) such as stroke or Shy-Drager syndrome. Sleeping at a high altitude also may cause central sleep apnea. Signs and symptoms of central sleep apnea include difficulty staying asleep, abrupt awakenings accompanied by shortness of breath and daytime sleepiness.

Treatments for central sleep apnea may involve using a device to keep your airway open or using supplemental oxygen.

Signs and symptoms

The most common signs and symptoms of central sleep apnea include:
  • Observed episodes of stopped breathing or abnormal breathing patterns during sleep.
  • Abrupt awakenings accompanied by shortness of breath.
  • Difficulty staying asleep (insomnia).
  • Excessive daytime sleepiness (hypersomnia).
  • Momentary shortness of breath at night.
  • Difficulty concentrating.
If your central sleep apnea is caused by a neurological condition, you may experience other signs and symptoms such as:
  • Lightheadedness on standing up from a sitting or lying position.
  • Difficulty swallowing.
  • Weakness, or numbness throughout your body.
You may also snore if you have central sleep apnea, although this may not be as prominent as it is in those who have obstructive sleep apnea.

Causes

Central sleep apnea occurs when your brain fails to transmit signals to your breathing muscles. Central sleep apnea can be caused by a number of conditions that affect the ability of your brainstem — which links your brain to your spinal cord and controls many functions such as heart rate and breathing — to control your breathing. The cause varies with the type of central sleep apnea you have. Types include:
  • Idiopathic central sleep apnea. The cause of this uncommon type of central sleep apnea isn't known. It results in repeated pauses in breathing effort and airflow.
  • Cheyne-Stokes respiration. This type of central sleep apnea is most commonly associated with congestive heart failure or stroke, and it is characterized by a rhythmic, gradual increase and then decrease in breathing effort and airflow. During the weakest breathing effort, a total lack of airflow (central apneas) can occur.
  • Medical condition induced. In addition to congestive heart failure and stroke, several medical conditions may give rise to central apneas. Any damage to the part of the brain that controls breathing (the brainstem) or the nerves that supply breathing signals — such as from a tumor, trauma, infection (for example, polio) or degenerative brain disorder — may impair the normal breathing process. In addition, many disorders that affect muscles, such as amyotrophic lateral sclerosis, myotonic dystrophy or myasthenia gravis may lead to central apneas or poor breathing during sleep.
  • High-altitude periodic breathing. Periodic breathing occurs in most people if they're exposed to a high-enough altitude, such as greater than 15,000 feet. The change in barometric pressure at this altitude can cause loss of breath as well as rapid breathing (hyperventilation). The breathing pattern can be similar to Cheyne-Stokes respiration, but the time it takes to cycle through the pattern is shorter.
  • Drug or substance induced. Taking certain medications such as opioids — for example, morphine, oxycodone or codeine — may cause your breathing to become irregular, to increase and decrease in a regular pattern, or to stop completely.
Treatment

Treatments for central sleep apnea may include:
  • Treatment for associated medical problems. Possible causes of central sleep apnea include heart or neuromuscular disorders, and treating those conditions may help your sleep apnea. For example, appropriate therapy for heart failure may eliminate central sleep apnea.
  • Reduction of opioid medications. If opioid medications are causing your sleep apnea, your doctor may gradually reduce your dose of those medications.
  • Supplemental oxygen. Using supplemental oxygen while you sleep may help if you have central sleep apnea. Various forms of oxygen are available as well as different devices to deliver oxygen to your lungs. This treatment isn't recommended for those with heart failure.
  • Medications. Certain medications have been used to stimulate breathing in people with central sleep apnea. For example, some doctors prescribe acetazolamide to prevent central sleep apnea in high altitude.
  • Continuous positive airway pressure (CPAP). This method, also used to treat obstructive sleep apnea, involves wearing a mask over your nose while you sleep. The mask is attached to a small pump that supplies pressurized air which holds open your upper airway. CPAP may eliminate snoring and prevent central sleep apnea. As with obstructive sleep apnea, it's important that you use the device only as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your doctor so that adjustments can be made.
  • Bilevel positive airway pressure (bilevel PAP). Unlike CPAP, which supplies steady, constant pressure to your upper airway as you breathe in and out, bilevel PAP builds to a higher pressure when you inhale and decreases to a lower pressure when you exhale. The goal of this treatment is to boost the weak breathing pattern of central sleep apnea. Some bilevel PAP devices can be set to automatically deliver a breath if the device detects you haven't taken a breath after a certain number of seconds.
  • Adaptive servo-ventilation (ASV). This newer airflow device is designed to treat central sleep apnea and complex sleep apnea. The device monitors your normal breathing pattern and stores the information in a built-in computer. After you fall asleep, the machine uses pressure to regulate your breathing pattern and prevent pauses in your breathing.


Information obtained from National Institute of Health
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