7 Key Signs and Symptoms of Central Sleep Apnea You Should Know

Introduction to Central Sleep Apnea

Central sleep apnea (CSA) is a serious sleep disorder characterized by repeated pauses in breathing during sleep. Unlike obstructive sleep apnea, which occurs when the airway becomes physically blocked, central apnea happens when the brain fails to send proper signals to the muscles that control breathing. This neurological communication breakdown can lead to episodes where breathing stops and starts repeatedly throughout the night, disrupting sleep quality and potentially causing significant health complications.

Understanding the symptoms of central sleep apnea is crucial for early detection and proper management. Many people with this condition may not be aware they have it, as some symptoms occur during sleep. However, recognizing the warning signs can help individuals seek timely medical attention and improve their overall health and quality of life.

1. Repeated Breathing Pauses During Sleep

The hallmark symptom of central sleep apnea is repeated episodes of stopped or shallow breathing during sleep. Unlike obstructive sleep apnea where breathing efforts continue despite airway blockage, central apnea involves a complete absence of breathing effort. During these episodes, the chest and abdomen do not move because the brain temporarily fails to signal the respiratory muscles to work.

These breathing pauses typically last for 10 seconds or longer and can occur multiple times per hour throughout the night. A bed partner may notice these episodes and observe that the person simply stops breathing without any snoring or gasping sounds. The frequency and duration of these pauses can vary from mild cases with 5-15 events per hour to severe cases with more than 30 events per hour. Each pause reduces oxygen levels in the blood, which can trigger brief awakenings that fragment sleep, though the person may not remember waking up.

2. Difficulty Staying Asleep (Insomnia)

People with central sleep apnea frequently experience chronic insomnia, particularly difficulty maintaining sleep throughout the night. This symptom differs from the excessive sleepiness more commonly associated with obstructive sleep apnea. Individuals may find themselves waking up frequently during the night, sometimes gasping for air or feeling a sensation of breathlessness.

These awakenings occur because the brain briefly rouses the person when oxygen levels drop too low or carbon dioxide levels rise too high. The person may wake feeling anxious, with a racing heart, or experiencing air hunger. Some people describe waking up with a choking sensation or feeling like they need to catch their breath. This pattern of disrupted sleep prevents the deep, restorative sleep stages necessary for physical and mental recovery, leading to poor sleep quality even if the person spends adequate time in bed. The chronic sleep fragmentation can become a significant source of frustration and may lead to anxiety about going to sleep.

3. Excessive Daytime Sleepiness and Fatigue

Chronic fatigue and excessive daytime sleepiness are prominent symptoms of central sleep apnea, resulting from the poor sleep quality caused by repeated nighttime breathing interruptions. Individuals may feel tired and drowsy throughout the day regardless of how many hours they spend in bed at night. This persistent exhaustion can significantly impact daily functioning and quality of life.

People with this symptom often struggle to stay awake during routine activities such as reading, watching television, sitting in meetings, or even during conversations. Some may experience sudden sleep attacks where they unintentionally fall asleep during the day. The fatigue is typically described as overwhelming and unrefreshing, not relieved by naps or extended sleep periods. This constant tiredness can affect concentration, memory, work performance, and the ability to perform tasks that require sustained attention. In severe cases, the excessive daytime sleepiness can become dangerous, particularly when driving or operating machinery, increasing the risk of accidents.

4. Morning Headaches

Waking up with headaches is a common symptom experienced by people with central sleep apnea. These morning headaches typically present as a dull, pressing pain that affects both sides of the head and usually resolves within a few hours after waking. The headaches are believed to result from elevated carbon dioxide levels and decreased oxygen levels in the blood during nighttime breathing pauses.

The headaches may also be caused by changes in blood flow to the brain and increased intracranial pressure that occurs when breathing stops repeatedly during sleep. People often describe these headaches as different from their typical headaches or migraines. The pain is usually present upon awakening and may be accompanied by a feeling of grogginess or mental fog. The frequency and intensity of morning headaches often correlate with the severity of the sleep apnea. While these headaches typically improve as the day progresses and normal oxygen levels are restored, their regular occurrence is a significant indicator that sleep quality is being compromised and medical evaluation is needed.

5. Difficulty Concentrating and Memory Problems

Cognitive impairment is a significant symptom of central sleep apnea, manifesting as difficulty concentrating, memory problems, and reduced mental clarity. The repeated drops in oxygen levels during sleep and the resulting sleep fragmentation can affect brain function, leading to noticeable changes in cognitive performance during waking hours.

Individuals may experience trouble focusing on tasks, difficulty processing information, reduced attention span, and problems with both short-term and long-term memory. They may forget appointments, misplace items frequently, or have trouble remembering conversations or instructions. Decision-making abilities may be impaired, and complex problem-solving can become more challenging. Some people describe feeling mentally “foggy” or having slower thinking processes. These cognitive symptoms can affect work performance, academic achievement, and daily activities. The brain requires adequate oxygen and quality sleep to consolidate memories and maintain optimal function. When central sleep apnea disrupts these processes night after night, the cumulative effect on cognitive abilities can be substantial and may worsen over time if left untreated.

6. Mood Changes and Irritability

Central sleep apnea can significantly impact emotional well-being, leading to mood changes, increased irritability, and a higher risk of depression and anxiety. The chronic sleep deprivation and reduced oxygen levels associated with this condition affect the brain’s ability to regulate emotions effectively, making it harder to cope with daily stressors.

People with central apnea often report feeling more irritable, short-tempered, or emotionally reactive than usual. Small frustrations that would normally be manageable may provoke disproportionate emotional responses. Some individuals experience persistent feelings of sadness, hopelessness, or loss of interest in activities they once enjoyed, which are characteristic symptoms of depression. Anxiety symptoms are also common, including excessive worry, restlessness, or feelings of being overwhelmed. The emotional toll of living with chronic fatigue and sleep disruption can strain relationships with family members, friends, and colleagues. Partners may notice personality changes or increased conflict. These mood disturbances are not simply character flaws or separate mental health issues but are often direct consequences of the sleep disorder’s effects on brain chemistry and function.

7. Shortness of Breath That Improves When Sitting Up

Some people with central sleep apnea experience episodes of shortness of breath or breathlessness, particularly when lying flat or during the night. This symptom, sometimes called orthopnea, involves difficulty breathing that improves when the person sits up or elevates their head. It’s particularly common in cases where central sleep apnea is associated with heart conditions.

This breathing difficulty may wake the person from sleep, causing them to sit up abruptly to catch their breath. The sensation can be frightening and may be accompanied by anxiety or panic. Some individuals may need to sleep propped up with multiple pillows or in a reclining chair to minimize these episodes. The shortness of breath occurs because lying flat can affect heart function and fluid distribution in people with certain cardiac conditions, while the upright position improves breathing mechanics and cardiac efficiency. Additionally, during central apnea events, the lack of breathing effort combined with body position can worsen oxygen deprivation. People experiencing this symptom should seek medical attention promptly, as it may indicate the presence of heart failure or other serious cardiovascular conditions that require evaluation and management.

What Causes Central Sleep Apnea?

Central sleep apnea develops when the brain fails to transmit proper signals to breathing muscles, and several underlying conditions and factors can cause this neurological dysfunction:

• Heart Disorders: Congestive heart failure is one of the most common causes of central sleep apnea. When the heart cannot pump blood effectively, it can disrupt the respiratory control centers in the brain, leading to irregular breathing patterns known as Cheyne-Stokes respiration.
• Stroke or Brainstem Injury: Damage to the brainstem, which controls breathing, can result from stroke, trauma, or other neurological injuries. The brainstem contains respiratory control centers, and any damage to these areas can impair the brain’s ability to regulate breathing automatically during sleep.
• Medications: Certain medications, particularly opioid pain medications and some sedatives, can suppress the brain’s respiratory drive. These substances can interfere with the normal breathing reflexes, especially during sleep when conscious control of breathing is absent.
• High Altitude: Sleeping at elevations above 15,000 feet can trigger central sleep apnea in some individuals due to lower oxygen levels and changes in breathing patterns as the body attempts to adapt to the thinner air.
• Kidney Failure: Chronic kidney disease can lead to fluid retention and metabolic imbalances that affect the brain’s respiratory control mechanisms, potentially causing central apnea episodes.
• Premature Birth: Infants born prematurely may have underdeveloped respiratory control systems, leading to central sleep apnea that often resolves as the nervous system matures.
• Idiopathic Cases: In some instances, central sleep apnea occurs without any identifiable underlying cause. This is referred to as idiopathic or primary central sleep apnea and may be related to subtle abnormalities in the brain’s control of breathing that are not yet fully understood.

Prevention Strategies

While not all cases of central sleep apnea can be prevented, especially those caused by underlying medical conditions, certain strategies may help reduce the risk or minimize the severity of symptoms:

• Manage Underlying Health Conditions: Proper management of heart disease, kidney disease, and other medical conditions associated with central sleep apnea is crucial. Regular medical check-ups, following treatment plans, and keeping conditions under control can help reduce the risk of developing central apnea.
• Avoid Opioid Medications When Possible: If you require pain management, discuss alternatives to opioid medications with your healthcare provider. If opioids are necessary, use the lowest effective dose and be monitored for respiratory complications. Never combine opioids with alcohol or sedatives without medical supervision.
• Sleep Position Adjustment: Sleeping with the head elevated or using an adjustable bed may help reduce episodes in some people, particularly those with heart-related central apnea. Discuss optimal sleeping positions with your doctor.
• Maintain a Healthy Weight: While obesity is more strongly associated with obstructive sleep apnea, maintaining a healthy weight supports overall cardiovascular health and may reduce strain on the heart, potentially decreasing the risk of heart failure-related central apnea.
• Avoid Excessive Alcohol and Sedatives: Alcohol and sedative medications can suppress breathing drive and worsen central sleep apnea. Limiting or avoiding these substances, especially before bedtime, may help prevent or reduce episodes.
• Gradual Altitude Acclimatization: If traveling to high altitudes, allow time for gradual acclimatization rather than rapid ascent. This gives your body time to adjust to lower oxygen levels and may prevent altitude-induced central sleep apnea.
• Regular Medical Monitoring: If you have risk factors for central sleep apnea, such as heart failure or a history of stroke, regular monitoring by healthcare providers can help detect the condition early and allow for timely intervention before complications develop.

Frequently Asked Questions

What is the difference between central sleep apnea and obstructive sleep apnea?

Central sleep apnea occurs when the brain fails to send signals to breathing muscles, resulting in no breathing effort during apnea episodes. Obstructive sleep apnea happens when the airway becomes physically blocked despite continued breathing effort. Central apnea is a neurological problem, while obstructive apnea is a mechanical airway issue. Some people can have both types, a condition called mixed or complex sleep apnea.

Can central sleep apnea be dangerous?

Yes, central sleep apnea can be serious and potentially life-threatening if left untreated. Repeated drops in oxygen levels can strain the cardiovascular system, increase the risk of heart rhythm abnormalities, worsen heart failure, raise blood pressure, and increase the risk of stroke. The associated daytime sleepiness also increases accident risk. Anyone suspecting they have central sleep apnea should seek medical evaluation promptly.

How is central sleep apnea diagnosed?

Central sleep apnea is typically diagnosed through a sleep study called polysomnography, which can be conducted in a sleep laboratory or sometimes at home with portable equipment. The study monitors breathing patterns, oxygen levels, heart rate, brain waves, and chest and abdominal movement during sleep. This test can distinguish central apnea from obstructive apnea by showing the absence of breathing effort during apnea episodes.

Who is at higher risk for developing central sleep apnea?

People at higher risk include those with congestive heart failure, individuals who have had a stroke or brainstem injury, those taking opioid pain medications, older adults (especially men), people with kidney failure, and those sleeping at high altitudes. Central sleep apnea is more common in men and becomes more prevalent with age.

Can central sleep apnea go away on its own?

In some cases, such as altitude-induced central sleep apnea, the condition may resolve when the triggering factor is removed. In infants with prematurity-related central apnea, the condition often improves as the nervous system matures. However, for most adults with central sleep apnea related to chronic conditions like heart failure, the condition typically requires ongoing management and does not resolve spontaneously without addressing the underlying cause.

Is snoring common with central sleep apnea?

Snoring is less common with central sleep apnea compared to obstructive sleep apnea. Because central apnea involves a lack of breathing effort rather than airway obstruction, there is typically no airflow through a narrowed airway to create snoring sounds. People with central sleep apnea may breathe quietly or simply stop breathing without the loud snoring characteristic of obstructive apnea. However, some individuals may have both conditions and therefore may snore.

Should I see a doctor if I suspect I have central sleep apnea?

Yes, absolutely. If you experience symptoms such as repeated nighttime awakenings with shortness of breath, chronic insomnia, excessive daytime sleepiness, morning headaches, or if a bed partner observes periods when you stop breathing during sleep, you should consult a healthcare provider. Early diagnosis and appropriate management are important to prevent complications and improve quality of life. Your doctor can evaluate your symptoms, assess risk factors, and recommend appropriate testing.

References:

• Mayo Clinic – Central Sleep Apnea
• National Heart, Lung, and Blood Institute – Sleep Apnea
• Sleep Foundation – Central Sleep Apnea
• Johns Hopkins Medicine – Central Sleep Apnea
• National Center for Biotechnology Information – Central Sleep Apnea