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How To Treat Central Sleep Apnea

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Central Sleep Apnea Causes And Associations

Severe Central Sleep Apnea Treatment *1 year later

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

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.

Central Sleep Apnea Causes And Types

There are several types of central sleep apnea, each with a different cause.

  • Cheyne-Stokes breathing. This is when your breathing speeds up, slows down, stops, and then starts again. Each of these cycles can last 30 seconds to 2 minutes. Cheyne-Stokes breathing is common in people whove had heart failure or a stroke. It happens in about half of central sleep apnea cases.
  • Narcotic-induced central sleep apnea.Opioid medications like morphine, oxycodone, and codeine can affect your breathing patterns.
  • High-altitude periodic breathing. Many people have trouble breathing when they go up to a high elevation, usually 2,500 meters or more.
  • Treatment-emergent apnea. About 5% to 15% of people who have positive airway pressure treatment for obstructive sleep apnea get CSA.
  • Medical condition-induced apnea. Health problems like heart failure, Parkinsons disease, stroke, and kidney failure can cause CSA.
  • Idiopathic central sleep apnea. This is when theres no clear cause.

A related condition named congenital central hypoventilation syndrome is linked to a certain gene. It affects about one in 200,000 children around the world.

Continued

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Treatment Of Central Sleep Apnea In Us Veterans

Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, MI

Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, MI

Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, MI

Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, MI

Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, MI

Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, MI

Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, MI

Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, MI

Central Sleep Apnea Treatments

Two Types of Sleep Apnea: Obstructive and Central
  • Treating the medical condition that is also causing central sleep apnea. Congestive heart failure or the aftermath of a stroke can interfere with night-time breathing and lead to CSA. The solution here is simple: Treat the heart failure or the stroke and the apnea will likely subside.
  • Cutting back or eliminating the use of opiods. Studies have proved that more powerful pain medications such as morphine, codeine and oxycodone can cause central sleep apnea. Reducing the dosage or not taking them altogether can help, but discussing this option with your doctor and with a sleep specialist is important. Pain medications do just thathelp with pain, and trying to fix the apnea might not be worth additional suffering when you are awake.
  • Continuous positive airway pressure . More commonly associated with obstructive sleep apnea , a CPAP device can also help CSA sufferers, particularly those who are recovering from heart failure. With this treatment, the patient wears a mask that continuously delivers a constant pressure of air to the lungs, thus countering any inclination the body might have to pause breathing.
  • Bilevel positive airway pressure . This is another treatment used for OSA sufferers that can be effective for central sleep apnea patients. Similar to a CPAP mask, a BPAP device adjusts the amount of air delivered to the lungs depending on whether the patient is inhaling or exhaling.
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    Other Types Of Sleep Apnea: Mixed And Complex Sleep Apnea

    Other classifications of sleep apnea can also be used. Mixed apnea refers to events that are both central and obstructive in nature. Typically, the apnea will begin as central and then an airway obstruction will follow.3 Complex apnea typically refers to central events that arise only after positive airway pressure therapy is applied.4

    How Is Central Sleep Apnoea Syndrome Diagnosed

    Breathing difficulties while sleeping can be caused by a variety of medical conditions, so a range of diagnostic tests may be needed to confirm or rule out CSA. Sleep studies are the main method of investigating CSA. A sleep study usually means an overnight stay in a sleep unit, where measurements of the childs breathing during sleep are recorded by technologists/physiologists experienced in working with children. The measurements are recorded using stick-on or wrap-around sensors and include respiratory rate, heart rate, oxygen saturation, chest wall movement, airflow, measurement of CO2, video and sound recording. The results are then interpreted by a paediatric sleep consultant, who can make a diagnosis of CSA.

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    Risk Factors And Related Conditions

    Central sleep apnea can affect patients of all ages. However, there are statistical factors that coincide with a potentially higher risk of patients developing the condition, including:

    • Being male, as they are more likely to develop the condition than females
    • Older age, especially adults over 65 years of age
    • Having a heart condition, such as an irregular heartbeat
    • Opioid use in any capacity
    • Suffering from a brainstem lesion, stroke, or brain tumor, any of which can potentially impair the ability to regulating breathing
    • Use of a continuous positive airway pressure machine, which is known as treatment-emergent central sleep apnea

    What Is Asv Treating Complex And Central Sleep Apnea

    Treating Sleep Apnea

    Sleep Medicine | Sleep Technologist Advice

      Adaptive Servo Ventilation is a non-invasive ventilatory treatment option created specifically for the treatment of adults who have obstructive sleep apnea and central and/or complex sleep apnea. It’s one of the newer positive airway pressure units on the market that continuously monitors and adjust to correct the patient’s breathing problem.

      In one way, ASV is similar to CPAP therapy that is used in the treatment of obstructive sleep apnea, but there are significant differences.

      ASV’s pressure target is adjusted according to input from the patient. What that means is that the target is not a fixed value, but rather adapts to the patient’s breathing patterns. Because the device continuously adjusts itself to meet the patient’s needs, the discomfort often reported by PAP patients is avoided altogether since the machine’s pressure changes are subtle in a way that makes the patient feel comfortable.

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      Treating Sleep Apnea With Cpap Or Surgical Treatment

      Some individuals might get the therapy they require using CPAP. CPAP is a kind of therapy that does not entail surgical procedure. Rather, it functions by giving the individual with adequate oxygen throughout the day to keep them taking a breath well in the evening.

      If CPAP does not work, there are medical options offered. How To Deal With Central Sleep Apnea

      The surgical treatment for sleep apnea counts on removing the adenoids as well as tonsils to open up the air passage. Despite being a reliable therapy choice for this disorder, it does feature some risks.

      Central Sleep Apnea Treatment Options Symptoms And Causes

      Having been trapped in the fog of low focus and daytime drowsiness in the past, I understand how frustrating it is to be afflicted by constant poor sleep. Good sleep is essential to living a well-rested, and happy life. Poor sleep, on the other hand, ruins personal productivity, upsets health and ultimately affects our happiness.

      The good news is that there are usually solutions to our poor sleep especially when the lack of sleep is due to sleep apnea.

      Central Sleep Apnea is Characterized by excessive daytime sleepiness, un-refreshing sleep, and lack of focus.

      In past posts, weve focused on obstructive sleep apnea causes, symptoms, and treatments. Today well be talking about a different but similar type of sleep disorder central sleep apnea.

      In the next few quick moments, you will learn the following information:

      Central sleep apneas operating mechanism

      What causes central sleep apnea

      The seven main symptoms and risk factors of central sleep apnea

      The seven main central sleep apnea treatment options

      As you can see, weve got a lot to cover, so lets get started!

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      How Is Central Sleep Apnea Treated

      Treatment for central sleep apnea must be conducted under the care of your physician. There are several options for managing the effects of central sleep apnea that physicians will often suggest. These include:

      • A continuous positive airway pressure machine that provides enough pressure to keep the upper airway open via a mask
      • Diaphragm pacing, a minimally invasive process that stimulates the phrenic nerve so that the patient can breathe more naturally

      What Is The Treatment For Central Sleep Apnea

      Basics of Central Sleep Apnea

      The key to treating central sleep apnea is addressing any underlying health issues that are causing the condition. The type of treatment for central sleep apnea depends on the category and subtype of central sleep apnea. For example, steps may be taken to mitigate congestive heart failure. Those on opioids or other respiratory-depression medications may gradually reduce and taper off the medications. If at high altitude, the individual can trek back to sea level. In many cases, focusing on the coexisting problem can relieve or eliminate abnormal breathing during sleep.

      For many patients with central sleep apnea, the use of CPAP or BiPAP machines can decrease cessations in respiration. Supplemental oxygen may be used in a similar way.

      In 2017, the Food and Drug Administration approved an implantable device that stimulates breathing-related muscles as a treatment for CSA. This treatment has shown promise in improving breathing and sleep quality in some research studies.

      Depending on a persons situation, a combination of treatments may be used in order to best address their symptoms. A healthcare provider with a specialty in sleep medicine would be best to review the benefits and side effects of various treatment options for central sleep apnea.

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      What Happens When You Have Central Apnea

      A person with central apnea has issues with the respiratory center from the brain. This center controls the chest muscles to make breathing movements.

      When the respiratory center stops working during sleep, then your breathing stops, too. The brain does not respond to the changes of the respiratory gas levels from the blood .

      In central apnea, you stop breathing in sleep for a period of time , but there is no effort to breathe at all, like in obstructive sleep apnea. Therefore snoring is not present in central apnea.

      Typically, you will wake up several times at night, often with the sensation of gasping or choking during sleep. If these waking up episodes are frequent enough to cause disruption of your sleep, then you may feel very tired during daytime.

      The snoring is less common in central apnea, but it may be a symptom of mixed sleep apnea.

      Children with Central Sleep Apnea

      In children, central apnea syndrome is usually accompanied by a change in their facial color, such as bluish or purplish skin, and they may also have a change in their muscle tone like a limp body.

      Polysomnographic Recognition Of A Heightened Respiratory Chemoreflex

      A related dimension is the criteria used for estimating success of therapies. For example, if 4% oxygen desaturation is used to score hypopneas , significant degrees of baseline and residual disease can be missed. Moreover, adaptive servo-ventilators distort the conventional polysomnogram signals and unless the pressure output of the devices are used to score events, inappropriate success may be declared. When periodic breathing is not adequately controlled, the primary marker on the polysomnogram is pressure cycling associated with arousals. Scoring respiratory events during adaptive servo-ventilation needs to use the pressure output signal from the ventilator, which is roughly equal and opposite to the patients abnormality. When pressure cycling persists, sleep fragmentation is usually severe even if respiration is improved by conventional criteria.

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      Can A Cpap Machine Treat Central Apneas

      I was diagnosed with moderate to severe apnea 8 years ago. Twice I tried to adjust to the CPAP machine, twice I gave up after a few weeks. Then last year I decided to try it again this time the machine was much quieter and I had a more comfortable mask, and after a few weeks of struggling I was waking up in the morning more rested and alert than I had for many years. Eureka!But after a few months of this, my AHI shot up from 4 to anything between 6 and 12, and my sleep quality really deteriorated. This has been going on for about 3 months. Turns out the CPAP is doing wonders with the obstructive apneas they are close to zero but I now have central apneas.Today I went back to the sleep doctor to ask about other treatments. Without explaining why, he said that he treats central apneas that come after CPAP treatment the same way as obstructive apneas, took me in to the technician and told her to work with me, to raise the pressure. And to come back to him if it doesn’t help.Has anyone had experience with, or know anything about, cases where the CPAP machine resolved central apneas?

      The Seven Main Central Sleep Apnea Symptoms

      Managing Central Sleep Apnea With Advancements In Treatment of Obstructive Sleep Apnea

      How do I know if I should get checked?

      If you believe you might have central sleep apnea, check out the following list of symptoms. If you answer yes to two or more of these, contact your physician to schedule a sleep study.

      1. Irregular breathing or breathing pauses while sleeping

      2. Sudden awakening during the night accompanied by shortness in breathing

      3. Excessive daytime sleepiness

      5. Morning headaches or chest pain

      6. Difficulty concentrating

      7. Irritability

      Some of these symptoms are indistinguishable from those caused by obstructive sleep apnea. A sleep study can reveal the presence of either category of sleep apnea.

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      Idiopathic Central Sleep Apnea

      Unfortunately, theres no known cause for this particular type of central sleep apnea.

      One should never ignore central sleep apnea. This is a serious respiratory disorder that could lead to many other complications and a significant drop in the quality of life. Severe fatigue and daytime drowsiness are commonly associated with central sleep apnea and can cause a lot of problems for the affected individual. Whats worse, the lack of necessary oxygen during sleep could end up affecting your heart health, which is even more dangerous when an underlying heart condition is present.

      How Is Central Sleep Apnea Diagnosed

      A definitive diagnosis of CSA is made using an in-lab polysomnography, which is a detailed sleep study that measures breathing, respiratory effort, electrocardiogram, heart rate, oxygen, eye movement activity, muscle activity, and electrical activity of the brain during an overnight stay in a sleep clinic.

      Because central sleep apnea can be tied to several health problems, a healthcare provider may also recommend other tests, such as a brain scan or an echocardiogram of the heart to determine the underlying cause.

      Anyone who has noticed potential symptoms of central sleep apnea should speak with a doctor who can review their situation and determine if any diagnostic testing is appropriate.

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      Most Effective Central Sleep Apnea Treatments

      Unlike sleep disorders that are easier to diagnose and understand, central sleep apnea can be baffling.

      CSA patients might not snore, may be at their ideal weight, and may have not had a history of sleep disorders yet still find themselves with the condition characterized by pauses in breathing many times during the night.

      Central sleep apnea is a neurological conditionin other words, the brain is not sending the correct signals to the respiratory system to keep breathing while the patient sleeps. Sometimes another medical condition causes CSA sometimes, pain medication can lead to it and sometimes, the apnea occurs for no known reason.

      Whatever the cause, treatments are available for central sleep apnea. Here five of the most effective ways to help the CSA patient:

      Alter Your Sleep Position

      Are You Suffering from Any of These Kinds of Sleep Apnea?

      Though a small change, altering your sleep position can reduce sleep apnea symptoms and improve your nights rest. A 2006 study found that more than half of obstructive sleep apnea cases are dependent on position.

      have shown sleeping on your back called the supine position can worsen symptoms. For some adults, sleeping on the side can help breathing return to normal.

      However, a found that children with sleep apnea sleep better on their backs.

      Discuss body positioning and your sleep apnea symptoms with your doctor to evaluate your options for treatment.

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