Central sleep apnea is a condition that many people have never heard of, yet it affects thousands of Americans every year. I am Dr. Farshid Ariz, DMD, a periodontist at the TMJ & Sleep Centre of San Fernando Valley in Northridge, California. My team and I work closely with patients who struggle with various sleep-disordered breathing issues, and central sleep apnea is one of the most misunderstood. In this post, I want to share important facts about this condition, explain how it differs from other types of sleep apnea, and highlight the treatment options available to our patients in the San Fernando Valley and surrounding communities.
What Is Central Sleep Apnea?
Central sleep apnea, often abbreviated as CSA, is a sleep disorder where your brain temporarily stops sending signals to the muscles that control breathing. Unlike obstructive sleep apnea, which happens when throat tissues physically block your airway, central sleep apnea originates in the brain. Your airway is actually open, but your body simply does not make the effort to breathe for brief periods during sleep.
These pauses in breathing can last anywhere from a few seconds to over a minute. They can happen dozens of times each hour. Each pause reduces blood oxygen levels and disrupts your sleep cycle. Over time, untreated central sleep apnea can lead to serious cardiovascular problems, daytime fatigue, and a reduced quality of life.
How Common Is Central Sleep Apnea?
Central sleep apnea is less common than obstructive sleep apnea, but it is far from rare. According to the American Academy of Sleep Medicine, central sleep apnea accounts for approximately 5 to 10 percent of all diagnosed sleep apnea cases. A study published in the Journal of Clinical Sleep Medicine found that the prevalence of CSA increases significantly in patients with heart failure, affecting up to 30 to 40 percent of that population (National Institutes of Health, 2017). These numbers underscore why awareness and proper diagnosis matter so much, especially for patients in Northridge and nearby communities who may be at elevated risk.
Central Sleep Apnea vs. Obstructive Sleep Apnea
Many patients ask me about the difference between central and obstructive sleep apnea. It is an excellent question. Obstructive sleep apnea, or OSA, occurs when the muscles in the back of the throat relax too much and collapse the airway during sleep. Central sleep apnea, on the other hand, involves a communication problem between the brain and the breathing muscles. The airway remains physically open, but the brain fails to tell the body to breathe.
Some patients experience a combination of both types. This is called complex sleep apnea syndrome or treatment-emergent central sleep apnea. It sometimes appears when a patient who has been treated for obstructive sleep apnea with CPAP therapy begins to develop central apnea events. Understanding which type of apnea is present is essential for choosing the right treatment plan.
If you want to learn more about how sleep apnea relates to other conditions we treat, I encourage you to read our post on understanding sleep apnea symptoms, risks, and treatments.
What Causes Central Sleep Apnea?
Several factors can cause or contribute to central sleep apnea. The most common causes include:
- Heart failure: Congestive heart failure is one of the leading causes of CSA. The weakened heart affects blood flow and the brain’s ability to regulate breathing.
- Stroke: Damage to the brainstem, which controls breathing, can lead to central apnea events.
- Opioid medications: Long-term use of opioid pain medications can suppress the brain’s respiratory drive.
- High altitude: Sleeping at high elevations can trigger periodic breathing patterns similar to central sleep apnea.
- Neurological conditions: Diseases such as Parkinson’s disease and certain brainstem lesions can interfere with the brain’s breathing signals.
It is worth noting that some patients develop what is called idiopathic central sleep apnea, meaning no clear underlying cause can be identified. In these cases, the brain’s breathing control center simply does not function as smoothly during sleep as it does while awake.
Recognizing the Signs and Symptoms
Central sleep apnea symptoms can be subtle, and many patients do not realize they have the condition until a bed partner notices pauses in their breathing. Common signs include:
- Repeated awakenings during the night
- Shortness of breath that wakes you from sleep
- Excessive daytime sleepiness and fatigue
- Difficulty concentrating during the day
- Morning headaches
- Mood changes such as irritability or depression
Unlike obstructive sleep apnea, loud snoring is not always a hallmark of central sleep apnea. This is one reason why CSA can go undiagnosed for years. If you experience any of these symptoms, I recommend scheduling a sleep evaluation. Our team at the TMJ & Sleep Centre in Northridge can help guide you toward the right diagnostic pathway.
How Is Central Sleep Apnea Diagnosed?
The gold standard for diagnosing any form of sleep apnea is a sleep study, also known as a polysomnography. During this overnight test, sensors monitor your brain activity, heart rate, blood oxygen levels, breathing patterns, and body movements. The results clearly distinguish between obstructive events, where effort to breathe is present but blocked, and central events, where the effort to breathe is absent.
Home sleep tests are widely used for obstructive sleep apnea screening, but they are generally less effective at identifying central apnea events. An in-laboratory sleep study with full monitoring is usually recommended when CSA is suspected.
Treatment Options for Central Sleep Apnea
Treatment for central sleep apnea depends on the underlying cause and the severity of the condition. Here are the most common approaches:
Addressing the Underlying Cause
When central sleep apnea is related to heart failure, opioid use, or another medical condition, treating that root cause can significantly reduce or eliminate apnea events. Optimizing heart failure medications, tapering opioids under medical supervision, or managing neurological conditions can all make a meaningful difference.
Positive Airway Pressure Therapy
CPAP therapy, which is the most common treatment for obstructive sleep apnea, can sometimes help with central sleep apnea as well. However, a more specialized device called an adaptive servo-ventilation machine, or ASV, is often more effective for CSA. ASV devices monitor your breathing pattern in real time and adjust air pressure breath by breath to maintain smooth, consistent breathing throughout the night.
Supplemental Oxygen
Some patients benefit from supplemental oxygen delivered through a nasal cannula during sleep. This approach helps maintain healthy blood oxygen levels and can reduce the frequency of central apnea episodes.
Medications
In certain cases, medications such as acetazolamide may be prescribed to stimulate breathing. This is more commonly used for high-altitude-related central sleep apnea or idiopathic CSA.
Phrenic Nerve Stimulation
For patients who do not respond well to other treatments, a newer option called phrenic nerve stimulation is available. A small device implanted in the chest sends electrical signals to the phrenic nerve, which controls the diaphragm. This keeps the breathing muscles active during sleep. The FDA approved this technology in 2017, and studies have shown it can reduce central apnea events by more than 50 percent in many patients.
For related information about how we approach sleep-disordered breathing in our practice, you may also enjoy our article on the connection between TMJ disorders and sleep apnea.
Why Early Detection Matters
Central sleep apnea places significant stress on the cardiovascular system. Each breathing pause causes blood oxygen to drop, which triggers a stress response in the body. Over time, this can contribute to high blood pressure, heart rhythm problems, and worsening heart failure. Early detection and treatment can protect your heart and dramatically improve your sleep quality and daytime energy levels.
Patients throughout Northridge, Encino, Granada Hills, and the wider San Fernando Valley deserve access to knowledgeable care for sleep-related breathing disorders. At our practice, we take a comprehensive, multidisciplinary approach that considers the full picture of each patient’s health.
Frequently Asked Questions
What is the main difference between central sleep apnea and obstructive sleep apnea?
The main difference is where the problem originates. In obstructive sleep apnea, the airway is physically blocked by relaxed throat tissues. In central sleep apnea, the airway stays open but the brain temporarily fails to send breathing signals to the respiratory muscles. Both conditions disrupt sleep and lower blood oxygen levels, but they require different treatment approaches.
Can central sleep apnea go away on its own?
In some cases, central sleep apnea can improve or resolve when the underlying cause is treated. For example, if CSA is caused by opioid medications, tapering off those medications under a doctor’s supervision may eliminate the apnea events. However, many cases require ongoing treatment, so it is important to work with a qualified healthcare provider.
Is central sleep apnea dangerous if left untreated?
Yes, untreated central sleep apnea can be dangerous. The repeated drops in blood oxygen place strain on the heart and cardiovascular system. Over time, this can lead to high blood pressure, heart arrhythmias, worsening heart failure, and an increased risk of stroke. Early diagnosis and appropriate treatment can significantly reduce these risks.
Does CPAP work for central sleep apnea?
Standard CPAP therapy can help some patients with central sleep apnea, but it is not always effective for this condition. Many patients benefit more from adaptive servo-ventilation, or ASV, which adjusts air pressure in real time based on your breathing patterns. Your sleep specialist can determine which device is best suited for your specific type of apnea.
How do I know if I have central sleep apnea instead of obstructive sleep apnea?
The only reliable way to distinguish between central and obstructive sleep apnea is through an in-laboratory sleep study called a polysomnography. This test monitors brain activity, breathing effort, airflow, and oxygen levels throughout the night. If you experience symptoms like repeated awakenings, shortness of breath during sleep, or excessive daytime fatigue, ask your doctor about scheduling a comprehensive sleep evaluation.
Written by: Dr. Farshid Ariz, DMD — Periodontist, TMJ & Sleep Centre of San Fernando Valley, Northridge, California