Central Sleep Apnea: What It Is and What to Do
Central sleep apnea (CSA) happens when your brain doesn’t send regular signals to the muscles that control breathing while you sleep. That means pauses in breathing are not due to a blocked airway (that’s obstructive sleep apnea) but due to a communication problem. The pauses can reduce oxygen levels and fragment sleep, leaving you tired, foggy, and less able to function during the day.
How to spot it
Common signs include loud or irregular breathing, repeated short pauses in breathing, waking gasps, morning headaches, daytime sleepiness, and trouble concentrating. If you use opioids, have heart failure, had a stroke, or travel to high altitude often, your risk is higher. A partner’s observation—like noticing long pauses or shallow, irregular breaths—is often what prompts a doctor visit.
Diagnosis starts with a sleep study. A full in-lab polysomnography records breathing, oxygen levels, brain waves, and heart rhythm. Some cases can be screened with home tests, but a lab study gives a clearer picture and distinguishes central from obstructive events. Bring a list of medications and describe any heart or neurological issues—those matter for planning treatment.
Treatment that actually helps
Treatment focuses on the cause and on stabilizing breathing during sleep. CPAP (continuous positive airway pressure) is often tried first because it’s widely available and can help mixed cases. If CPAP doesn’t work or central events persist, your sleep doctor may suggest adaptive servo-ventilation (ASV). ASV adapts to your breathing pattern and can reduce central pauses—though it’s not right for everyone. If you have heart failure with reduced ejection fraction, recent studies showed potential risks with ASV, so discuss the risks and benefits carefully with a specialist.
Other options include supplemental oxygen at night (useful in some heart-failure-related CSA), certain medications such as acetazolamide or theophylline in select cases, and treating underlying issues like heart failure, stroke, or stopping opioids when safe. Lifestyle moves help too: avoid alcohol and sedatives before bed, manage fluid retention if you have heart issues, and keep a regular sleep schedule.
Follow-up matters. After starting treatment, you should have a repeat sleep test or device data review to confirm improvement. If daytime sleepiness or breathing pauses continue, ask your clinician about second opinions or specialist referral. Early and targeted treatment reduces symptoms and lowers health risks tied to untreated CSA.
If you're seeing long pauses in breathing, sudden daytime sleepiness, or you fall into a higher-risk group, make an appointment with a sleep clinic. Bring observations, medication lists, and a short medical history—those details speed up the right diagnosis and treatment plan.