Sleep Apnoea
Sleep Disorders

Central Sleep Apnoea (CSA)

This is a fact sheet about Central Sleep Apnoea (CSA). CSA occurs when the brain fails to send the proper signals to the muscles that control breathing and a pause occurs between breaths.

Man sleeping in bed. Photo by Andrea Piacquadio
Homedown arrow iconSleep disordersdown arrow iconCentral Sleep Apnoea (CSA)
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December 24, 2024
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Summary

Things you should know:

  • In Central Sleep Apnoea (CSA) breathing stops and there is a pause before there is an effort to breathe again.
  • Loud snoring is not as common in CSA as in Obstructive Sleep Apnoea (OSA).
  • There are many possible reasons for CSA.
  • There are several possible treatment options for CSA, with CPAP being just one of them.

Central sleep apnoea occurs when the “central” drive to breathe from the brain is intermittent: switching on and off over a period of 5 or more minutes. It is however normal to have 1-2 minutes of this switching on and off breathing in otherwise healthy individuals. Commonly it is triggered by a change in the level of sleep: from deep to light sleep.

This apnoea is different to the more common Obstructive Sleep Apnoea (OSA),where the apnea is due to futile efforts to breathe against a blocked airway. For patients with CSA, the airway is not blocked, there is just a pause inbreathing efforts.

About 10% of people with breathing problems during sleep have CSA. This affects the quality of sleep and they feel sleepy during the day. The person might also complain of Insomnia or other sleep problems. Loud snoring is not as common in CSA as it is in OSA.

What causes CSA?

The brain may be slow to respond to changes in blood oxygen and carbon dioxide which results in  the slowing of breathing followed by a speeding up. Typically breathing speeds up with large deep breathes, then slows to slower shallow breathing, which some describe as waxing and waning breathing.  Commonly, CSA is due to underlying heart disease. Less common causes are medications (narcotics) stroke and kidney disease. In babies, it can occur with premature birth.

CSA can also be due to weakness of the muscles that make the lungs expand and contract, such as in neuromuscular disorders like polio. It can be also be caused by an abnormality in the shape of the chest wall (eg severe curvature of the spine) or the lungs being too stiff. This can lead to under breathing, called hypoventilation. CSA can disturb your sleep. It can also make your body retain carbon dioxide. This can lead to morning headaches or confusion.

Assessment of Central Sleep Apnoea

This requires a thorough evaluation of all the possible causes and also a Sleep Study. This is completed by a Sleep and Respiratory Physician.

What can be done about Central Sleep Apnoea?

  • Drugs (e.g. narcotics) which may cause CSA may need to be reduced or stopped if safe to do so. There are some other drugs which stimulate breathing. You might be able to try these.
  • Positive airway pressure therapies can help many forms of CSA. CPAP: Continuous Positive Airway Pressure may work. Adaptive servo ventilation is useful for some types of central apnoea – although always recommended to be trialed under the guidance of a sleep physician.  Sleep hypoventilation responds well to bilevel ventilatory assistance.
  • Oxygen therapy at night may be beneficial.
  • Where heart failure is a factor, treatment of this with medications is important.
  • Rarely a diaphragm pacemaker is used. This has been used experimentally in some patients with heart failure related CSA spinal cord injury patients or in congenital hypoventilation syndrome.

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