At a Glance
Central sleep apnea is a sleep-related breathing disorder that occurs when the brain temporarily fails to send the signals needed to control breathing during sleep. Unlike obstructive sleep apnea, it isn't caused by a blocked airway but instead is often linked to conditions like heart failure or stroke or certain medications. Treatment depends on the cause and may include positive airway pressure (PAP) therapy, supplemental oxygen, medication, or other therapies.
Most people think of sleep apnea as a blocked airway, but some breathing pauses begin in the brain instead. In central sleep apnea, the brain temporarily fails to send the signals needed to control breathing during sleep. Although it's less common than obstructive sleep apnea, central sleep apnea can disrupt sleep and lower oxygen levels if left untreated.
Below, we'll explain the causes, symptoms, diagnosis, and treatment options for central sleep apnea.
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What Is Central Sleep Apnea?
Central sleep apnea (CSA) is a type of sleep apnea, a group of sleep disorders in which breathing becomes abnormal or stops during sleep. The primary symptom of CSA is repeated pauses in breathing called apneas. Apneas are described as “central” when issues the brain doesn't send proper signals to the muscles that control your breathing.
Interestingly, even healthy people have occasional central apneas, with brief pauses in breathing most often occuring during the transition from being awake to being in a stage of light sleep. These pauses in breathing may be diagnosed as a sleep disorder when people have an average of five or more central apneas during each hour of sleep.
Obstructive Sleep Apnea vs. Central Sleep Apnea
Both obstructive sleep apnea (OSA) and central sleep apnea are sleep disorders characterized by pauses in breathing during sleep. In obstructive sleep apnea, the breathing pauses are due to a blockage of air to the lungs. In central sleep apnea, the breathing pauses are due to a lack of respiratory effort.
CSA is less common than OSA in adults. CSA affects less than 1% of adults, while OSA affects 10% to 30% of adults. OSA and CSA are both seen in about 1% to around 5% of children.
Central Sleep Apnea Symptoms
The primary symptom of central sleep apnea is abnormal breathing during sleep. Many people are unaware of their nighttime breathing patterns, so these episodes of abnormal breathing may go unnoticed or are only noticed by a partner or caregiver.
Many people with central sleep apnea report restless or poor-quality sleep. People may also find themselves waking up at night with shortness of breath or nighttime chest pain. Daytime symptoms of central sleep apnea may include:
- Tiredness
- Fatigue
- Lack of energy
- Memory problems
- Attention or concentration issues
- Headaches after waking up
Central sleep apnea often occurs in people who also have another underlying health condition that affects the nervous system. Symptoms associated with several underlying causes of central sleep apnea include:
- Trouble breathing during the day
- Difficulty swallowing
- Changes to the voice
- Numbness or weakness
Central Sleep Apnea Causes
Breathing pauses associated with central sleep apnea happen when the brain stops signaling the body to breathe. Issues with brain signaling are thought to occur in the brain stem, a part of the brain that regulates breathing, partly in response to changes in the level of carbon dioxide in the blood. In people with CSA, the brain stem becomes less responsive to changes in carbon dioxide and may not appropriately trigger breathing.
There are several types of central sleep apnea, categorized by their underlying cause. Primary CSA is idiopathic, which means that its cause is unknown. Other types of CSA are secondary, meaning they are caused by an underlying health condition or other factor.
Primary Central Sleep Apnea
Primary central sleep apnea is a rare condition in adults, only diagnosed when there is no known underlying cause of breathing issues during sleep.
Primary CSA occurs more commonly in infants than it does in adults. Primary CSA of prematurity is a diagnosis given to preterm newborns with CSA, occuring in around 25% of infants born before 37 weeks of age. Primary CSA of infancy occurs in about 0.5% of full-term infants.
Secondary Central Sleep Apnea
Central sleep apnea is most often secondary to another health condition or medication.
One of the most prevalent forms of central sleep apnea is called CSA with Cheyne-Stokes breathing. Cheyne-Stokes breathing describes a cyclical pattern in which breathing speeds up then slows and briefly stops. CSA with Cheyne-Stokes breathing is often caused by heart failure or stroke.
Secondary central sleep apnea can also be due to a medical disorder without causing Cheyne-stokes breathing. Most people with this type of CSA have breathing issues caused by damage or an abnormality in the brainstem.
In addition to being caused by a medical disorder, CSA may be caused by a medication or substance. Both prescription and illegal opioids, along with other medications that diminish breathing, may trigger CSA.
Finally, CSA can also be secondary to changes in elevation. Air pressure is lower at high altitudes, which reduces the availability of oxygen and can trigger CSA. CSA due to high altitude may begin as low as 5,000 feet above sea level. Around 25% of people develop CSA at 8,000 feet of altitude and nearly everyone develops symptoms above 13,000 feet.
Treatment-Emergent Central Sleep Apnea
Treatment-emergent central sleep apnea (also called complex sleep apnea) is a type of central sleep apnea that develops after a person begins positive airway pressure (PAP) therapy for obstructive sleep apnea. Instead of completely eliminating breathing pauses, PAP therapy may initially trigger central apneas in some people as the body adjusts to the new breathing pattern.
This occurs in approximately 5% to 15% of people starting PAP therapy and often resolves on its own within several weeks to months as treatment continues.
Risk Factors for Central Sleep Apnea
A variety of factors can increase a person's risk of developing central sleep apnea. For example, CSA occurs more often in people over 65 years old and in men and people assigned male at birth. Certain medical conditions that affect breathing also increase the risk of developing central sleep apnea, including:
- Birth defects
- Heart failure
- Abnormal heart rhythms
- Kidney failure
- Hypothyroidism
- Stroke
- Brain infection
- Brain tumor
- Certain genetic conditions
Medications and other substances that can increase the risk of central sleep apnea or exacerbate the condition include:
- Prescription opioids
- Heroin and other illegal opioids
- Alcohol
- Benzodiazepines
- Antidepressants
- Seizure medications
- Muscle relaxants
- Blood thinning medications
If you are concerned about a prescribed medication increasing your risk for CSA, be sure to speak with a doctor before making any changes to your dosage.
How Central Sleep Apnea Is Diagnosed
To diagnose central sleep apnea, a doctor often begins by collecting a person’s medical history, conducting a physical exam, and ordering tests to find the cause of abnormal breathing. Because central sleep apnea is frequently linked to underlying medical conditions or certain medications, the evaluation may also include tests to help identify the cause of the abnormal breathing.
To confirm a diagnosis, the doctor may also recommend an overnight sleep study, also called polysomnography. During the study, sensors monitor breathing, oxygen levels, heart rate, brain activity, eye movements, muscle activity, and body position while you sleep. This information allows the sleep specialist to determine how often breathing pauses occur and whether they are caused by blocked airways (obstructive sleep apnea) or a lack of breathing effort (central sleep apnea).
In some cases, your healthcare provider may order additional tests, such as blood work, heart imaging, or neurological evaluations, if they suspect an underlying condition is contributing to central sleep apnea. Identifying the underlying cause is an important step in developing the most effective treatment plan.
Central Sleep Apnea Treatment
Treatment for central sleep apnea depends on the cause of the condition. In people with mild symptoms who have few to no health complications, treatment is often directed at the underlying cause of abnormal breathing. This may mean treating medical conditions like heart failure or lowering or stopping medications or substances that reduce breathing.
In people with severe disruptions in breathing or significant health consequences, treatment for CSA may address the underlying cause while also offering treatments to support normal breathing. Treatment options include positive airway pressure, supplemental oxygen, medications, and nerve stimulation.
- Positive airway pressure (PAP) therapy: PAP therapy includes several different types, including CPAP, ASV, and BiPAP. These are all methods of delivering pressurized air to keep the airway open during sleep.
- Supplemental oxygen: Supplemental oxygen delivers extra oxygen to help correct breathing disruptions and normalize oxygen levels in the blood. Supplemental oxygen may be used alone or at the same time as PAP therapy.
- Medication: In some cases, a doctor may recommend medications that stimulate breathing. Although medications may be helpful for people who don’t respond to other treatments, medications to stimulate breathing are also associated with significant side effects and must be closely monitored by a doctor.
- Phrenic nerve stimulation: Phrenic nerve stimulation is another treatment for people with CSA who don’t respond to other therapies. This treatment involves having a medical device implanted in the upper chest, which uses an electrical current to stimulate breathing during sleep. Phrenic nerve stimulation is typically only available in specialized facilities.
When to Talk to a Doctor
If you experience symptoms of sleep apnea, such as pauses in breathing during sleep, waking up gasping for air, excessive daytime sleepiness, or morning headaches, it's important to talk to your doctor.
You should also see a doctor if you have heart failure, have had a stroke, take opioid medications, or have another condition that increases your risk of central sleep apnea and you develop symptoms of disrupted breathing during sleep. Your healthcare provider can determine whether your symptoms are related to central sleep apnea, another sleep disorder, or a different health condition.
Frequently Asked Questions
Almost everyone snores every once in a while, and between 28% and 44% of adults snore on a regular basis. Snoring can be a sign of sleep apnea, but in most cases, snoring is not related to an underlying sleep disorder.
People with central sleep apnea rarely snore, and their snoring is typically less severe than in people who have obstructive sleep apnea.
Untreated CSA causes nighttime awakenings as well as repetitive drops in oxygen levels, unusual variations in chest pressure, and repeated activation of the sympathetic nervous system, a part of the nervous system that controls the body’s fight-or-flight response.
Together, changes in the body caused by CSA increase inflammation and contribute to long-term health concerns including cognitive changes, heart health issues, and insulin resistance.
Fortunately, treatment for central sleep apnea can help to reestablish normal breathing during sleep, improve sleep quality, and reduce the risk of health consequences.
Whether central sleep apnea can be cured depends on its underlying cause. In some cases, treating the condition that is contributing to central sleep apnea — such as heart failure, medication use, or high-altitude exposure — may reduce or eliminate breathing pauses during sleep.
For many people, however, central sleep apnea is a chronic condition that requires ongoing management with treatments such as positive airway pressure (PAP) therapy, supplemental oxygen, medication, or other therapies recommended by a healthcare provider.
Central sleep apnea isn't generally considered a hereditary condition. Most cases develop as a result of an underlying medical condition, certain medications, or changes in the way the brain regulates breathing during sleep. While some rare genetic disorders can increase the risk of central sleep apnea, inherited causes are uncommon.
No. Inspire and other hypoglossal nerve stimulation devices are approved to treat certain adults with obstructive sleep apnea, not central sleep apnea. These devices work by stimulating the muscles that help keep the upper airway open during sleep, but they don't address the disrupted brain signals that cause central sleep apnea.
Medical Disclaimer: This content is for informational purposes and does not constitute medical advice. Please consult a health care provider prior to starting a new treatment or making changes to your treatment plan.
Written by
Tochukwu Ikpeze, MD, Contributing WriterTochukwu grew up in New York and has a passion for creative and scientific writing. Tochukwu holds an undergraduate degree in Biology and Psychology, a Master’s degree in Biomedical Science, and a Medical Degree as well. In his free time, Tochukwu enjoys reading, learning, exploring various topics pertaining to the human condition and conveying that information to the public through writing.
Reviewed by
Howard J. Hoffman, DDS, Medical ReviewerDr. Howard J. Hoffman is a dentist specializing in dental sleep medicine and the treatment of obstructive sleep apnea and temporomandibular joint (TMJ) disorders. With more than four decades of experience in dentistry and over 25 years focused on sleep apnea treatment, he works with physicians and sleep specialists to help patients manage sleep-disordered breathing using oral appliance therapy.
