Home » Sleep Disorders » Central Sleep Apnea
January 2021 |  Reviewed by:  Imran Shaikh, MD and Seema Khosla, MD

What is central sleep apnea?

Central sleep apnea (CSA) is a breathing disorder that causes your body to decrease or stop the effort of breathing during sleep. It is usually caused by an issue in the brain or heart. Certain medications (like pain medications) can cause this breathing pattern too. It is different from obstructive sleep apnea (OSA) because the problem is not caused by a blockage of the airway. Central sleep apnea is less common than obstructive sleep apnea.

The brain and heart normally interact to direct, monitor, and change the amount of air that we breathe. The problem in CSA is that the brain does not send appropriate signals to breathe. CSA syndromes in adults are divided into these five categories:

Primary CSA

This breathing pattern consists of repeated periods of time where there is no effort to breathe. As a result, there is little to no airflow. The cause is unknown.

Cheyne-Stokes breathing pattern

This breathing pattern is rhythmic with a steady increase (crescendo) of breathing effort and airflow followed by a decrease (decrescendo) and then sometimes an absence of effort and airflow. This is associated with heart failure, stroke, and possibly kidney disease.

Medical condition not Cheyne-Stokes

This is when central apnea occurs due to medical conditions without the typical pattern of Cheyne-Stokes breathing. It is caused by heart and kidney problems. It may also result from a problem in the base of the brain where breathing is controlled.

High-altitude periodic breathing

This is seen when sleeping at altitudes higher than about 15,000 feet. The breathing pattern is similar to Cheyne-Stokes breathing pattern. The difference is that there is no history of heart failure, stroke, or kidney failure. It often improves as the altitude decreases. The cycle time (the time from one breath to another) also tends to be shorter.

Due to drug or substance

This breathing pattern can vary – from a regular increasing and decreasing respiratory effort to something that is quite irregular. Sometimes there are elements of obstruction such as the breathing that is seen in OSA. Medications most associated with this central sleep apnea pattern are in the opioid category – such as prescription pain medications or illicit substances such as heroin.

What are symptoms of central sleep apnea?

Many people with CSA have the following problems:

  • Disrupted sleep with frequent awakenings
  • Difficulty falling asleep
  • Daytime sleepiness

Other problems often seen include the following:

  • Snoring
  • Pauses in breathing
  • Waking up short of breath

A bed partner often can tell how often you snore and if you stop breathing.

Many people with CSA are sleepy during the day. They find that they are still tired even after a nap. When you stop breathing, your body wakes up. It happens quickly so you aren’t aware of it. This disrupts your sleep. You can stop breathing hundreds of times in one night. This can make you feel very tired the next day.

The medical conditions that cause CSA can also worsen  the problems with sleeping and daytime sleepiness.