Central Sleep Apnea

Overview

Central sleep apnea is a sleep disorder in which your breathing repeatedly stops and starts because your brain fails to send the right signals to the muscles that control breathing. Unlike obstructive sleep apnea, the airway is not blocked. Instead, the problem lies in the control center in the brain.

Central sleep apnea is less common than obstructive sleep apnea (where the throat narrows or blocks the airway). It affects a small number of adults, though it is seen more often in people with certain heart or nervous system conditions.

It can affect anyone, but it is more common in older adults and in people with heart failure, a history of stroke, or a condition affecting the brainstem. It may also affect people using certain sedative medications or those recently at high altitudes.

Symptoms

Common symptoms

• Pauses in breathing noticed by a partner or family member
• Sudden awakenings with a feeling of gasping or shortness of breath
• Excessive daytime sleepiness or feeling unrefreshed after sleep
• Morning headache
• Difficulty staying asleep
• Trouble concentrating, mood changes, or irritability

Symptoms in children

• Breathing pauses during sleep, often noticed by a parent
• Unusually restless sleep or mouth breathing
• Daytime sleepiness, trouble focusing, or learning problems

Symptoms in older adults

• Increased confusion or memory problems
• Waking up frequently at night
• Morning fatigue or headache

Causes

Main causes

• Conditions that affect the brain's control of breathing, such as after a stroke, a brain infection, or injury to the brainstem
• Heart failure or end-stage kidney disease
• Use of certain strong pain medicines (called opioids)
• Sleeping at a very high altitude

Risk factors

• Being a man over 50 years old
• Having a history of heart attack or stroke
• Using strong pain medicines regularly

When to see a doctor

See a doctor urgently if:

• You or someone you live with notices repeated pauses in breathing while you sleep
• You have sudden, severe daytime sleepiness that makes it hard to stay awake at work or while driving

Book a routine appointment if:

• You have persistent loud snoring or waking up gasping
• You feel tired all the time despite getting what seems like enough sleep

Diagnosis

Your doctor will ask about your symptoms, sleep history, and any health conditions you have. They may ask your partner about what they observe during your sleep. If they suspect a sleep disorder, they will likely refer you for a sleep study.

Tests that may be done

• Polysomnography — a test done in a sleep lab that monitors your breathing, heart rate, oxygen levels, and brain waves overnight
• Home sleep apnea test — a simpler device that tracks breathing and oxygen during sleep at home
• Additional tests may include blood tests, an ECG to check heart rhythm, or imaging of the brain if needed

What to expect at your appointment

Most people are diagnosed in a sleep clinic. During the sleep study, sensors are placed on your body, and this sounds more complicated than it is. You can still sleep, and the results give your doctor clear information about how often your breathing pauses and why it happens.

Treatment

Treatment for central sleep apnea focuses on correcting the underlying cause and supporting normal breathing during sleep. That may involve treating heart or nervous system conditions, reducing medications that contribute, and using a device that keeps breathing steady while you sleep.

Self-care at home

• Follow treatment plans for any underlying condition, such as heart failure or kidney disease
• Avoid alcohol and sedative medicines because they can slow breathing further
• Maintain a consistent sleep routine and aim for adequate sleep

Medical treatments

Medical treatment is tailored to you. It may include the use of a breathing support device, such as a continuous positive airway pressure (CPAP) machine, or a more advanced machine that adapts to your own breathing rhythm. Sometimes doctors prescribe medicines that help stimulate breathing. These are used under specialist guidance. Your doctor will explain the options that fit your situation.

When is surgery considered?

Surgery is rarely needed for central sleep apnea. It may only be considered if a specific treatable problem, such as a brainstem abnormality, is causing the condition.

Living with this condition

Living with central sleep apnea means paying attention to how you feel during the day. Many people notice a big difference once treatment starts. Keep in touch with your healthcare team and tell them if your symptoms change or if you struggle with the treatment.

Lifestyle tips

• Use your breathing support device every time you sleep, not just at night
• Keep your bedroom quiet, dark, and cool
• Treat your current medical conditions exactly as prescribed

Diet and exercise

Eating a balanced diet and staying physically active support your overall health and can help you manage conditions that contribute to sleep apnea, such as heart failure. Ask your doctor what level of activity is safe for you, especially if you have a heart condition.

Mental health and emotional wellbeing

Living with a sleep disorder can be stressful and frustrating. You may feel irritable, anxious, or down. These feelings are valid, and they often improve with better sleep. If you notice lasting sadness, worry, or difficulty coping, talk to your doctor or a mental health professional. Many countries have support lines for people in distress.

Prevention

Central sleep apnea cannot always be prevented, especially when it is linked to a heart or brain condition. However, you can lower your risk by managing chronic conditions carefully, using strong pain medicines only as prescribed, and avoiding high altitudes if you are prone to breathing pauses.

Complications

If left untreated

• Worsening of heart problems, including heart failure or abnormal heart rhythms
• Poor sleep quality leading to daytime fatigue and a higher risk of falls, accidents, or driving errors
• Memory problems, difficulty concentrating, and reduced quality of life

Long-term outlook

The outlook is generally good when central sleep apnea is identified and treated. With the right approach, many people get better sleep, have more energy, and reduce their health risks. Work with your healthcare team — improvement often happens gradually, but it does happen.

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