Central Sleep Apnea: A concise overview

Sleep apnea is often associated with loud snoring and blocked airways, but not all types of sleep apnea are the same. While obstructive sleep apnea (OSA) is the most common, there’s another, lesser-known form: central sleep apnea (CSA). This type isn’t caused by a physical blockage—it starts in the brain.

If that sounds surprising, you’re not alone. Many patients are shocked to learn that their sleep troubles are neurological in nature. In this guide, we’ll walk through what central sleep apnea is, how it differs from obstructive sleep apnea, what causes it, and most importantly, what you can do about it.

What Is Central Sleep Apnea?

Central sleep apnea happens when your brain fails to send the proper signals to the muscles that control your breathing. Unlike OSA, where the airway is physically blocked, CSA involves a communication breakdown in the respiratory control centers of the brain. As a result, your breathing temporarily stops—even though the airway remains open.

"With obstructive sleep apnea, the problem is physical. With central sleep apnea, it’s more about timing and signal errors," explains Dr. Jack Maxwell, Sleep Specialist at Wellfirst Sleep. "The body simply forgets to breathe."

Symptoms of Central Sleep Apnea

Many symptoms overlap with other forms of sleep apnea, which can make CSA tricky to spot without a sleep study. Common signs include:

• Pauses in breathing during sleep (often noticed by a partner)

• Frequent nighttime awakenings

• Difficulty staying asleep (insomnia)

• Shortness of breath that wakes you up

• Morning headaches

• Daytime fatigue and sleepiness

• Mood swings or trouble focusing

"I woke up feeling like I hadn’t slept at all," says Jennifer, a Wellfirst Sleep patient. "It wasn’t until my sleep test that I realized my breathing kept stopping—without any snoring."

What Causes Central Sleep Apnea?

There are a few different types of CSA, each with its own potential causes:

1. Primary (Idiopathic) CSA

This is when CSA happens without a known cause. It’s rare and usually diagnosed after other causes have been ruled out.

2. Cheyne-Stokes Breathing

Cheyne-Stokes breathing is a specific type of abnormal breathing pattern that is often associated with heart failure, stroke, or certain neurological conditions. It is characterized by a rhythmic cycle of breathing where a person’s breathing gradually becomes deeper and faster, then slows down and stops temporarily (apnea) before starting again in a similar pattern.

3. High-Altitude Periodic Breathing

HAPB occurs at high altitudes where lower oxygen levels disrupt normal breathing, causing cycles of shallow breaths and pauses, much like the pauses seen in central sleep apnea. While HAPB is usually temporary and resolves with acclimatization or descent, both conditions share a common disruption in the brain's control of respiration.

4. CSA Linked to Medical Conditions

Certain conditions, especially heart disorders, kidney failure, or neurological diseases like Parkinson’s, can trigger CSA.

5. CSA Due to Medications

Certain medications—especially opioids—can directly impact how your brain regulates breathing. Opioids, which are often prescribed for pain relief, affect the central nervous system and can suppress the natural respiratory drive. This means the brain may “forget” to signal your body to breathe during sleep, leading to episodes of central sleep apnea.

This type of CSA is particularly concerning because it may go unnoticed in patients who are already dealing with chronic pain or other serious health issues. The higher the dosage and the longer the use of opioids, the greater the risk of disrupted breathing during sleep.

“It wasn’t just the painkillers affecting my day—it was what they were doing to my sleep,” says Monica, who developed CSA while taking prescribed opioids after surgery. “Once I learned what was happening, I was able to talk to my doctor about adjusting my meds and getting treatment.”

If you're on opioid medications and experiencing fatigue, poor sleep, or waking up feeling breathless, it’s worth considering a sleep evaluation. CSA related to medications is treatable, especially when caught early.

Diagnosing Central Sleep Apnea

Because CSA doesn’t usually involve snoring or noticeable obstruction, many people don’t suspect a sleep disorder at all. The best way to find out? A professional sleep study.

At Wellfirst Sleep, we offer both in-lab and home-based sleep studies, depending on your needs. During the test, we measure breathing patterns, oxygen levels, brain waves, and heart rate to detect abnormal respiratory events.

"The home sleep test was so convenient," says Maria, a Wellfirst patient. "I just wore the equipment overnight at home and got my results the next week."

Our online sleep risk assessment tool is a great place to start if you're unsure whether you need testing.

How Is Central Sleep Apnea Treated?

Treatment for CSA depends on the underlying cause. Here are some common strategies:

1. Treating Underlying Medical Conditions

If CSA is linked to heart failure, kidney disease, or neurological issues, managing those conditions can reduce or eliminate symptoms.

2. CPAP and Adaptive Servo-Ventilation (ASV)

• CPAP (Continuous Positive Airway Pressure) is sometimes effective but may not work as well for CSA as it does for OSA.

• ASV (Adaptive Servo-Ventilation) is often more effective. It adjusts airflow in real time to normalize breathing patterns.

  
  

3. Oxygen Therapy

In some cases, supplemental oxygen during sleep helps stabilize breathing. This added oxygen can help maintain healthy blood oxygen levels throughout the night. It’s often used in combination with other treatments to improve overall outcomes.

4. Medication Adjustments

For patients whose CSA is caused by opioids or other central nervous system depressants, adjusting or discontinuing the medication can help. It’s important to work closely with a healthcare provider to safely manage these changes and explore alternative treatments for pain or other underlying conditions.

Why Central Sleep Apnea Matters

It’s easy to dismiss poor sleep as stress or aging, but CSA can have serious consequences if left untreated. The condition has been linked to:

• Irregular heart rhythms

• High blood pressure

• Stroke

• Heart failure

• Cognitive impairment

And perhaps most importantly, it can greatly reduce your quality of life.

Take the First Step with Wellfirst Sleep

If any of these symptoms or stories sound familiar, don’t wait to get help. At Wellfirst Sleep, we specialize in diagnosing and treating all types of sleep apnea—including the often-overlooked central sleep apnea. We make the process easy, with our online risk assessment tool, sleep testing, and a dedicated team to support you every step of the way.

"I put it off for years, thinking it wasn’t a big deal," says David, a patient at Wellfirst Sleep. "Now, I can’t believe the difference it’s made."

Let Wellfirst Sleep help you understand what’s really going on.

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