Central Sleep Apnea
Unlike obstructive sleep apnea, central sleep apnea starts in the brain. Here's what causes it, how it's diagnosed, and what treatment looks like.
What is central sleep apnea?
Central sleep apnea (CSA) is a sleep-related breathing disorder where the brain does not consistently send the right signals to control breathing during sleep. This leads to repeated pauses in breathing followed by periods of normal or deeper breathing. Unlike obstructive sleep apnea, CSA is not caused by a blocked airway — the problem originates in the brain's signaling.
Common symptoms
- Waking up suddenly with shortness of breath
- Frequent awakenings or restless sleep
- Insomnia
- Daytime fatigue or sleepiness
- Difficulty concentrating
- Mood changes
- Morning headaches
Snoring is less common in CSA compared to obstructive sleep apnea.
Why it happens
Cardiovascular conditions
Heart failure and atrial fibrillation are among the most common underlying causes of CSA.
Neurological factors
Stroke, brainstem disorders, and neuromuscular conditions can disrupt the brain's breathing signals.
High altitude
Exposure to high altitude can destabilize breathing patterns during sleep, even in otherwise healthy people.
Medications
Opioids and sedatives are known to suppress respiratory drive and are a common trigger for CSA.
In some cases, no clear cause is identified. CSA can also occur alongside obstructive sleep apnea.
How it affects the body
Breathing during sleep is normally automatic and stable. In CSA, this control becomes unstable — breathing may slow too much or temporarily stop, reducing oxygen levels and fragmenting sleep. This cycle can repeat throughout the night, placing cumulative strain on the body and cardiovascular system.
Who is at higher risk
- Adults over 65
- People with heart conditions, especially heart failure or atrial fibrillation
- Individuals using opioid medications
- People with neurological or neuromuscular conditions
How it is diagnosed
The most reliable test is an overnight sleep study (polysomnography). This measures breathing patterns, oxygen levels, and sleep stages throughout the night. CSA is confirmed when repeated breathing pauses occur without any physical effort to breathe — distinguishing it from obstructive sleep apnea, where the airway is physically blocked.
Treatment options
PAP Therapy
CPAP or BiPAP devices regulate breathing and keep the airway stable. These are typically the first-line treatment.
Adaptive Servo-Ventilation
A more advanced device that adjusts pressure support in real time based on breathing patterns. Not recommended for certain patients with heart failure.
Oxygen Therapy
Supplemental oxygen during sleep can reduce breathing interruptions in some patients.
Phrenic Nerve Stimulation
An implanted device that stimulates the diaphragm to restore a more natural breathing rhythm.
Medication Adjustments
Reducing or modifying medications that suppress breathing — such as opioids — when clinically appropriate.
Treatment is individualized based on the underlying cause and the patient's overall health.
Why it matters
Untreated CSA can lead to poor sleep quality, chronic fatigue, reduced concentration and memory, and increased risk of heart rhythm problems. In patients with existing heart failure, untreated CSA is associated with significantly higher health risks.
When to seek evaluation
Consider a sleep assessment if you are experiencing:
- Ongoing sleep disruption or unexplained fatigue
- Nighttime breathing irregularities or sudden awakenings
- Decline in focus, mood, or daytime performance
CSA is manageable, but it requires proper diagnosis and targeted treatment. Addressing both the breathing pattern and any underlying condition is essential for improving sleep and overall health.