How Common Is Central Sleep Apnea

What Are The Types Of Sleep Apnea

There are three types of sleep apnea:

• Obstructive Sleep Apnea : OSA occurs when the airway at the back of the throat becomes physically blocked. That obstruction causes temporary lapses in breath.
• Central Sleep Apnea : CSA happens because there is a problem with the brains system for controlling muscles involved in respiration, leading to slower and shallower breathing.
• Mixed Sleep Apnea: When a person has both OSA and CSA at the same time, it is referred to as mixed sleep apnea or complex sleep apnea.

Because the underlying causes are distinct, there are important differences in the symptoms, causes, and treatments of OSA and CSA.

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What Causes Central Sleep Apnea In Children

Central sleep apnea can occur for a variety of reasons in children. It is important to note that a few central apnea events during sleep is considered normal. Central sleep apnea has been associated with rare genetic disorders in children, such as congenital central hypoventilation syndrome. It may also be present when children have health conditions that interfere with parts of the central nervous system that controls breathing.

Consequences Of Chf And Central Sleep Apnea

When your sleep is disrupted, your blood pressure rises. This is because when you stop breathing, your body gets lower oxygen levels which arouse your receptors that alert your brain. Your brain then responds by sending signals through your nervous system basically telling your blood vessels to increase the oxygen flow to your brain and heart by tightening up.

These lower levels of oxygen during the night can also affect various mechanisms during the day, even when you are breathing properly and are awake.

Central apneas while you sleep can negatively impact you if you already have congestive heart failure. The hypoxia can promote ischemia, worsen your blood pressure and even make your heart failure condition worse by causing arrhythmia . Because you are getting poor quality of sleep, you are likely sleepy or tired. In addition, when you have CHF, hypoxia can contribute to an overflow of free fatty acids, according to a study, that can cause vascular dysfunction, insulin resistance, heart muscle dysfunction and hyperlipidemia.

The good news, however, is that when you get your CHF and central sleep apnea treated, it significantly improves your heart failure condition. Its essential that you strengthen your lungs and heart with routine physical activity. However, congestive heart failure can limit the types and amount of activities you do.

Further Reading

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What Is Central Sleep Apnea A Look At The Central Sleep Apnea Definition

What is central sleep apnea? Much of the conversation around sleep apnea, including most of what we discuss here at the blog, focuses on obstructive sleep apnea , which is a common type of sleep apnea.

But just as important, if less frequent among patients, is central sleep apnea . Today, well begin a new series of blog posts that explores the central sleep apnea definition, then moves on to causes, symptoms and potential treatment options.

Sleep Apnea Cardiovascular Risk And Metabolism

Several studies have shown an association between sleep apnea and problems like type 2 diabetes , strokes , heart attacks and even a shortened lifespan, says Jun. Why this connection? For one thing, obesity is common in sleep apnea patients, and obesity greatly increases risks of diabetes, stroke and heart attack, he says. In most cases, obesity is the main culprit behind both conditions, Jun explains.

Still, its important to note that not everyone with sleep apnea is obese. Furthermore, evidence suggests an independent link between sleep apnea and diabetes. Our lab and others have shown that sleep apnea is associated with higher risks of diabetes, independent of obesity, and that sleep apnea can increase blood sugar levels, says Jun.

For people who are overweight or obese, weight loss is key for treating or avoiding sleep apnea. People who accumulate fat in the neck, tongue and upper belly are especially vulnerable to getting sleep apnea. This weight reduces the diameter of the throat and pushes against the lungs, contributing to airway collapse during sleep.

Women in particular should be careful as they age. While premenopausal women tend to put on weight in the hips and in the lower body instead of the belly, this shifts with time. Weight begins to accumulate in traditionally male areas like the tummy, and this leads to a greater chance of sleep apnea.

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What Are The Signs Of Sleep Apnea

There are two kinds of sleep apnea: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea happens when air cant flow into or out of the nose or mouth, although youre trying to breathe. Central sleep apnea happens when the brain fails to send the right signals to your muscles to make you start breathing.

Sleep apnea may be noticed more by the bed partner than by the sleeper, says Jun. Your bed partner might notice that your breathing pauses, or they may complain of your loud snoring.

That said, snoring itselfthough annoyingisnt the same as sleep apnea. Snoring is just the vibration sound created by airway resistance. You can snore loudly and not have sleep apnea, and you may even have sleep apnea without much snoring.

People with sleep apnea might also suffer from unexplained fatigue and mood swings, because their breathing interruptions continually wake them and prevent them from settling into a deep, nourishing sleep.

The consequences can be significant, Jun says. We’re talking about car accidents in the daytime, lost productivity at work, mood swings, waking up feeling groggy and falling asleep in class.

Other sufferers might wake up with a dry mouth, since sleep apnea tends to make you breathe with an open mouth, drying out your saliva. Some awaken with a headache, which may be caused by low oxygen or high carbon dioxide levels during sleep.

How is Weight Control Linked to Sleep Apnea?

Continuous Positive Airway Pressure Machines

In many cases of sleep apnea, doctors will suggest using a continuous positive airway pressure machine as a first line of treatment.

CPAP machines move air through a mask and into the persons airways. This can help reduce the likelihood of sleep apnea, as the force of the air helps keep the airways open and air moving through them.

That said, CPAP machines may not be effective in people with central sleep apnea. A study in the Journal of the American College of Cardiology notes that CPAP is only effective in about 50% of people with central sleep apnea.

If CPAP does not improve symptoms, it is important to seek an alternative treatment option.

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How Is Central Sleep Apnoea Syndrome Treated

• MaturityApnoea of prematurity/infancy may improve as the child gets older and the respiratory centre matures. It is likely the sleep consultants will check this by organising follow-up sleep studies.
• Supplemental oxygenBreathing extra oxygen during sleep may help reduce the number of apnoeic pauses and lessen the effects of CSA by improving the oxygen levels in the blood.
• Bilevel Positive Airway Pressure BPAP is a form of breathing assistance using a ventilator device that delivers extra air pressure into the airway via a mask placed on the face. The level of air pressure provided varies on breathing in or breathing out. BPAP can also be set to deliver a breath if there has not been a breath within a certain number of seconds.
• MedicationsIt is possible that medication may be available to help stimulate breathing in patients with CSA.
• SurgicalIf the brainstem is affected by either an abnormality or a compression from the skull, such as in Chiari malformation, surgical options may be available.

Further Exploring The Central Sleep Apnea Definition

Central sleep apnea is widely believed among medical professionals to be much less common than obstructive sleep apnea. Estimates vary as to the frequency of central sleep apnea, states the website of the American Sleep Apnea Association. Some say it accounts for 20 percent of all cases of sleep apnea.

Because of the crossover between central and obstructive sleep apnea in the form of mixed or complex sleep apnea, where patients exhibit symptom of both types those exact numbers can be hard to pinpoint.

So, considering that central sleep apnea and obstructive sleep apnea are often found together, and since the symptoms are often described as the same daytime drowsiness, lack of energy how can you tell which type you may have?

The best answer, as always, is to talk to your doctor or sleep therapist. But in the meantime, well continue to explore the central sleep apnea definition, as well as causes, types, symptoms and treatment options.

This blog post contains general information about medical conditions and potential treatments. It is not medical advice. If you have any medical questions, please consult your doctor.

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Central Sleep Apnea Causes And Associations

Central sleep apnea is caused by a failure of a persons brain to consistently send signals to activate the breathing muscles while asleep. Central sleep apnea has a number of known associations, including2

• Cardiac disorders, including congestive heart failure and atrial fibrillation
• High altitude
• Treatment emergent central sleep apnea
• Idiopathic central sleep apnea
• Other medical conditions

CARDIAC DISORDERS

Studies have shown that up to 40% of people with congestive heart failure and 30% of people with atrial fibrillation may have central sleep apnea.10,11 In fact, heart failure is the most common cause of CSA in the general population.2

HIGH ALTITUDE

Periodic breathing appears when people are exposed to high altitudes. This may be due to how your body responds to changes in the atmosphere.2

OPIOIDS

Certain medications, including opioids, can disrupt the breathing pattern and lead to central sleep apnea.2

TREATMENT EMERGENT CENTRAL SLEEP APNEA

Treatment emergent central sleep apnea refers to central events that occur when a person is using Positive Airway Pressure therapy such as CPAP or BiPAP. Reasons for treatment emergent CSA may occur due to an increased number of arousals during titration, mask leak, or overtitration. This may improve with ongoing PAP use.2

IDIOPATHIC CENTRAL SLEEP APNEA

Mistaking Sleep Apnea For Menopause

As a woman’s risk of sleep apnea increases around menopause, so does the likelihood she’ll mistake sleep apnea symptoms for menopausal ones. Women and their HCPs may assume signs like frequent waking are related to menopause without considering other causes.

“There’s sound research that the symptoms of sleep apnea are frequently misinterpreted or underappreciated, not just by patients but also providers,” said Dr. Kristen Zarfos, a breast surgeon, women’s health advocate and WHAC member.

“When a woman is awakened at night drenched in sweat and she happens to be the age that menopause could be occurring for her, it seems the symptoms are either discounted, or they’re just assumed to be menopause,” Zarfos said.

Patel agrees. “Women may often go undiagnosed or be misdiagnosed, especially if they don’t present with classic sleep apnea symptoms,” she said.

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Information About One Of The Most Common Sleep Disorders

Sleep apnea, a potentially serious sleep disorder in which breathing stops and starts repeatedly while sleeping, is experienced by roughly 25% of men and 10% of women. Sleep apnea can affect people of all ages but is more likely to occur in those over the age of 50. Left untreated or undiagnosed, sleep apnea can lead to serious health problems, such as heart trouble, chronic fatigue, and cognitive impairment. In addition to immediate health concerns, long term sleep apnea can also cause chronic daytime sleepiness and impact a persons ability to function normally while awake.

What Are The Symptoms Of Central Sleep Apnea

Most people with central sleep apnea present with disturbed sleep, such as excessive daytime sleepiness, fragmented sleep, waking up feeling unrefreshed, or having morning headaches. As you can imagine, these symptoms are quite non-specific, and one should seek a healthcare professional for further evaluation if these symptoms are present.

In some cases, central sleep apnea can present because a bed partner notices quiet pauses in breathing. In contrast to OSA, snoring is not a common symptom for central sleep apnea.

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The Link Between Congestive Heart Failure And Central Sleep Apnea

When a disorder such as CSA leads to congestive heart failure, the disorder is secondary to your heart not being able to pump your blood adequately. When your blood isnt being adequately pumped, the consequence is that your blood returns to your heart causing an increase in pressure in your veins and lungs of your body. This increased pressure causes some of the bloods fluid to seep into your lung or surrounding tissues which makes it harder for you to breathe.

Up to 70 percent of congestive heart failure patients end up developing a breathing disorder related to sleep. These breathing stoppages they experience in the nighttime exposes their heart to lower blood-oxygen levels which results in their heart to not properly function and can increase their risk of premature death.

Of the congestive heart failure patients who end up developing sleep breathing disruptions later on, only a small percentage of these patients experience the breathing stoppages from airway obstructions seen in obstructive sleep apnea. Most of these CHF patients develop CSA instead.

When Should We See A Doctor

It is a good idea to consult a doctor anytime abnormal sleep symptoms are present. Also, children who are not sleeping well may have trouble focusing, display irritability, or have poor impulse control. If a child is struggling with behavior concerns, it could be helpful to ask the doctor whether a sleep disorder such as sleep apnea may be a contributing factor.

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How Is Central Sleep Apnea Different From Obstructive Sleep Apnea

In obstructive sleep apnea, a person makes a notable effort to breathe, but the airway in the back of the throat is blocked. The blockage in the back of the throat causes an obstruction to our windpipe, which leads to sleep fragmentation and a disturbed oxygen balance in the body.

In central sleep apnea, the problem isnt a blocked airway. Instead, pauses in breathing occur because the brain and the muscles that control breathing arent functioning properly. As a result, there is no normal respiratory effort, which is in clear contrast to OSA.

While OSA and CSA are separate conditions, they can arise at the same time in what is known as mixed sleep apnea. In addition, treatment of OSA with continuous positive airway pressure , can induce central sleep apnea, and this is called treatment-emergent central sleep apnea.

Diagnosing And Treating Sleep Apnea For Better Health

Its important to treat sleep apnea, because it can have long-term consequences for your health. While there have been some high-profile deaths linked to sleep apneasuch as with Judge Antonin Scalia Jun says that the true risk is from damage done over time.

Obstructive sleep apnea can range from mild to severe, based on a measurement system called the apnea-hypopnea index . The AHI measures the number of breathing pauses that you experience per hour that you sleep.

Obstructive sleep apnea is classified by severity:

• Severe obstructive sleep apnea means that your AHI is greater than 30
• Moderate obstructive sleep apnea means that your AHI is between 15 and 30
• Mild obstructive sleep apnea means that your AHI is between 5 and 15

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We provide high quality, individualized care for patients of all ages where you feel most comfortable your home or community. Our services and equipment are designed to help you regain and retain a level of independence.

Whether or not you need treatment for sleep apnea depends on its severity, whether or not you have symptoms such as sleepiness and other health conditions. For example, if you have risk factors for heart disease, your doctor might opt to treat you even for mild sleep apnea. On the other hand, if you have a severe case of sleep apnea, your doctor might insist on treatment even if youre not sleepy.

Not very relaxing, right? Luckily, its treatable.

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Don’t Dismiss Poor Sleep As A Normal Part Of Aging It Could Be Sleep Apnea A Disorder With Serious Health Consequences

Susan Christian had never been a good sleeper, so when her sleep got increasingly worse during her 40s, she chalked it up to aging. It wasn’t until she turned 50 and started waking up gasping desperately for air that Christian decided to get help and was eventually diagnosed with sleep apnea.

Although it’s true that many women have trouble sleeping soundly as they get older, especially during menopause, you shouldn’t assume disruptions like snoring and restless sleep are normal. They could be signs of sleep apnea, a potentially serious sleep disorder.

What Are The Health Risks Of Sleep Apnea

Sleep apnea can lead to sleep deprivation from constant nightly interruptions and shallower overall sleep. Lack of sleep is associated with far-reaching health consequences that affect a person physically, mentally, and emotionally, and as a result, it comes as no surprise that sleep apnea has been tied to diverse health problems.

Because of how it affects oxygen balance in the body, untreated sleep apnea raises dangers for various types of cardiovascular issues including high blood pressure, heart attack, heart disease, and stroke.

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A Restful Night Now Awaits

We hope that this advice will help you better understand the complexity of sleep apnea.

Sleep apnea is a condition that can be managed by having the right medical care and the right medical diagnosis to make sure you also have the right equipment. Whether you need a CPAP, APAP, BiPAP, or ASV machine, the first step if you have experienced any of the symptoms commonly associated with each type of sleep apnea is to contact your physician for a diagnosis and medical recommendations.

The symptoms discussed here may also be associated with other disorders, so a doctor would be able to advise whether you need a sleep study or if you should be concerned with something else.

If you need a sleep study, you may even be eligible to complete a home sleep study , which doesnt require you to leave the comfort of your home. Explore your options when it comes to a sleep study to find what would work best for you.