If you regularly wake up without feeling properly rested, then you may be experiencing a medical sleep disorder such as central sleep apnea. There are two different types of sleep apnea, but they are often lumped together as a singular condition when discussed in everyday conversation. The main symptoms of sleep apnea are drowsiness and napping during the day, poor quality sleep, and sleep interruptions. Quality sleep is essential for overall health, well-being, and quality of life, so it’s important for people who think they may have a sleep disorder to get a proper diagnosis. Central sleep apnea (CSA) can be an issue on its own, but it is also sometimes combined with obstructive sleep apnea (OSA) and defined as “mixed” or “complex” sleep apnea. Dr. Majid Jamali, D.M.D offers consultations and treatment for both types of sleep apnea in New York, NY, helping patients regain control and restful sleep.
What is Central Sleep Apnea?
Central sleep apnea occurs when the patient momentarily stops breathing while asleep. For most patients with CSA, this occurs many times during the night, leading to disrupted sleep. Central sleep apnea occurs when the brain and breathing muscles temporarily cease communication. The brain stem fails to tell the breathing system to function, causing a temporary pause in breathing. These pauses are known as “apneic events”, and they generally occur many times an hour during the night. CSA may also cause shallow breathing and shortness of breath when waking up in the middle of the night.
How is Central Sleep Apnea Different from Obstructive Sleep Apnea?
Central sleep apnea isn’t nearly as common as obstructive sleep apnea, which is a condition affecting 18 million adults in the United States. Obstructive sleep apnea occurs when there is an obstruction or blockage in the airway, typically due to the tongue relaxing at the back of the throat and blocking the airway. The brain then sends a signal to wake up so that breathing can be resumed, which interrupts the sleep cycle. The person may stop breathing for 10-60 seconds, interrupting sleep with pauses which can occur as often as one hundred times per night. This type of sleep apnea is often treated using a breathing machine that employs continuous positive airway pressure (CPAP), allowing patients to breathe in comfort. However, these machines can be intrusive, and some patients elect to have surgical intervention instead.
In contrast to OSA, CSA is caused by the body’s failure to inhale and breathe normally altogether, rather than by a blockage in the airway. Instead of the brain telling the body to breathe and encountering an issue, the brain fails to connect with the breathing muscles and the patient begins to lose oxygen. This triggers Cheyne-Stokes breathing as the body begins to notice high levels of carbon dioxide and begins shallow breathing to reduce CO2 and introduce oxygen. The breathing gets deeper until carbon dioxide levels begin to fall again.
Over time, low oxygen levels caused by sleep apnea can put a strain on the circulatory system and cause severe health problems, including heart disease and other heart problems, high blood pressure, and stroke. The lack of sleep caused by sleep apnea can also increase the patient’s risk of accidents due to drowsiness and a lack of focus. Both types of sleep apnea can cause massive sleep disruption and affect overall health, but the root cause of each condition is very different. This is why a sleep study is an important tool that must be used before a diagnosis and treatment plan can be made.
The Symptoms of Central Sleep Apnea
When patients experience sleep apnea at home, it’s not easy to tell whether the problem is caused by obstructive or central sleep apnea. Patients with sleep apnea wake up frequently in the middle of the night, sometimes having trouble catching their breath. Overall quality of sleep will be very poor, and most patients are very drowsy and lethargic during the day, often napping or having trouble concentrating. Some patients battle with chest pain at night and insomnia due to the airway obstruction and subsequent sleep interruptions. Waking up with headaches is also common.
For patients with neurological problems, additional symptoms may be present, including problems swallowing, changes in voice or speech patterns, or overall weakness.
Causes of Central Sleep Apnea
So what causes the brain to stop sending proper signals to the body that it’s time to take a breath? There are several reasons that central sleep apnea occurs, and the specific cause will indicate first steps for treatment. CSA can be caused by:
- Heart attack
- Heart failure
- Kidney failure
- Neurological conditions like Parkinson’s disease
- Spinal treatments like radiation or surgery
- Spinal arthritis
- Brain inflammation
- Excessive opioid use (causing irregular breathing)
- Sleeping at high altitude
Because the causes of central sleep apnea are so varied, it is important to determine what is influencing the CSA to help inform treatment. While some cases of CSA do resolve spontaneously, others will need different levels of intervention for successful treatment.
The Risk Factors for Central Sleep Apnea
Though it is possible for nearly anyone to develop central sleep apnea, there are some specific risk factors associated with the condition.
Men are more likely than women to have central sleep apnea, and it’s most common in older patients. Typically, people over 65 are more susceptible, simply because they are more prone to many of the medical treatments that can cause central sleep apnea. Heart problems like atrial fibrillation or congestive heart failure, or a stroke, brain tumor, or lesion can also be risk factors for CSA.
People who sleep at high altitude may develop central sleep apnea, particularly if they’re not used to the high altitude. This should resolve once the patient returns to a lower altitude.
Opioid users, especially those who use a large amount of these drugs, are often susceptible to CSA.
Diagnosing Sleep Apnea
If you think you might have sleep apnea, your first step should be an appointment with your doctor, which may be followed by a sleep study.
During the sleep study, you will sleep in a sleep center where physicians will monitor your sleep over night. The test used to determine whether you are suffering from central sleep apnea is known as a polysomnography. During the polysomnography, electrodes will be attached to your head and body, which allows the physicians conducting the study to monitor your breathing and vital signs during sleep. Sleep center staff will count the number of episodes you have during the night and grade the severity of your apnea based on this information. Your doctors will review the results of the study and come to a specific diagnosis based on the data. Since there are several different types of sleep disorders, it’s important to pinpoint whether or not you have sleep apnea, and central sleep apnea in particular.
Central sleep apnea can also sometimes be detected through MRI (magnetic resonance imaging), and your doctor may suggest this as a diagnosis tool. The MRI can reveal abnormalities in the brain stem or spine that could be the underlying cause of central sleep apnea.
If you do have central sleep apnea, then your doctors may be able to treat the problem by addressing the underlying issue, but not always. Some patients experience relief after ceasing the use of opioid medications, and some medications may be prescribed to help encourage normal breathing (typically acetazolamide or methylxanthine theophylline). Other medications or treatments might be necessary for addressing heart or neurological problems that could be causing the sleep apnea. During this process, a breathing machine may be necessary to manage symptoms until the underlying cause is fully addressed. If treating the cause of sleep apnea is ineffective, however, you may need to seek help from a sleep apnea expert like Dr. Jamali.
Sleep Apnea Consultation
If you’ve been diagnosed with central sleep apnea and you’re interested in learning more about treatments, then you’ll need to request a consultation with Dr. Jamali at his offices in New York City. Because central sleep apnea can affect patients on its own or in conjunction with obstructive sleep apnea, Dr. Jamali needs to speak with each patient and go over the sleep study and other diagnostic results, as well as evaluate any treatments that may have been used already. Many patients come to Dr. Jamali because they have not seen good results from past treatments or have been inconvenienced by solutions like a CPAP machine.
During the consultation, Dr. Jamali will go over your medical history and diagnostic results, and he will consider the different options available to you. You may receive an x-ray or a nasopharyngeal exam in order to ensure there is no obstruction that needs to be corrected. He will evaluate your candidacy for different treatment options and give you a recommendation about how best to proceed with treatment. This is your opportunity to learn more about the different treatment types, ask questions, and get to know Dr. Jamali and his staff. It’s a good idea to come into the meeting with any questions you may have already prepared.
Treatment Options for Central Sleep Apnea
CSA is sometimes more difficult to treat than OSA, simply because the cause is a lack of communication between the brain and the body. You can’t just treat the obstruction because there is no obstruction to treat!
Initially, patients will be evaluated for the underlying cause of their central sleep apnea, and any conditions found to be triggering the problem will be addressed. Beyond this, your doctor may prescribe medications or recommend a breathing device for you. Unlike a CPAP machine, which provides positive airway pressure, patients with CSA may need an adaptive servo-ventilation (ASV) machine, or a bilevel positive airway pressure (BPAP) machine to assist in breathing. An ASV machine actually breathes for you, sensing when you haven’t taken a breath in a certain number of seconds. BPAP machines work similarly but don’t adapt to your breathing patterns—they operate on a fixed rhythm.
Your doctor may also have you use supplemental oxygen when treating your CSA.
Which Treatment is Right for You?
Because there are so many causes for central sleep apnea and because every patient is different, there is no way to tell which treatment will benefit you without speaking to a doctor who has the in-depth knowledge of the condition to help you find relief. Sometimes, it’s necessary to go through different treatment options to find out which one works for you. Insurance may not cover more invasive treatments before cheaper options have been exhausted, so it’s important to follow your doctor’s guidelines. As an oral and maxillofacial surgeon, Dr. Jamali can sometimes help patients get relief when other treatments have failed.
Jaw Surgery For Sleep Apnea
Though not typically used for treating central sleep apnea, jaw surgery can be a good option for some patients, especially those with OSA or mixed sleep apnea. Dr. Jamali offers several different surgeries for sleep apnea, and the best option for each patient varies depending on their specific situation. Some possible surgical procedures may include:
- Tonsillectomy—surgical removal of the adenoids and/or tonsils, since enlarged tonsils can cause airway obstructions.
- Uvulopalatopharyngoplasty (UPPP)—a surgical expansion of the airway by reshaping the uvula, soft palate, tongue, and other oral structures.
- Laser-assisted UPPP—a less invasive procedure performed under IV sedation.
- Laser-assisted uvulapalatoplasty (LAUP)—a laser-assisted procedure typically used to address excessive snoring.
- Maxillomandibular advancement surgery—jaw advancement and bite correction surgery. This procedure requires that braces be worn before and after surgery.
Recovery and Downtime
Because jaw surgery is usually quite invasive, patients will experience some discomfort in the week following surgery, including swelling, bruising, and congestion. Prescription painkillers will be given to control this discomfort and inflammation. Antibiotics will also be used to prevent infection. After a week, patients will return to Dr. Jamali’s office for a follow-up, and patients typically can return to office jobs at this time. However, strenuous activities will need to be postponed for at least 6 weeks to help prevent complications.
Patients will need to keep their mouths scrupulously clean with salt water rinses and an antiseptic rinse in conjunction with a soft baby toothbrush. Patients will initially be on a liquid diet, moving to pureed foods within a week or so, which they should remain on for the first month. Normal diet can gradually be resumed starting at 6 weeks.
Central Sleep Apnea FAQs
Q: How many people have central sleep apnea compared to obstructive sleep apnea?
Overall, an estimated 22 million Americans suffer from sleep apnea, but many of these cases are undiagnosed. About 18 million of these cases are obstructive sleep apnea, with far fewer patients suffering from central or mixed sleep apnea. The risk for OSA increases as people age or gain weight, and many people develop the condition late in life.
Q: Do I have to use my breathing device every night?
Many patients who have been diagnosed with sleep apnea choose not to use their breathing devices every night because they don’t like wearing the mask. Unfortunately, this can lead to serious health problems due to lack of oxygen—plus, they don’t get the benefits of a good night’s sleep. If you have been instructed to use a breathing device, you should use it every night.
Q: What are the risks of sleep apnea surgery?
As with any major surgery, there are always some risks involved with surgical treatment of sleep apnea. Bleeding, infection, poor healing, and anesthesia complications are all standard complications that can occur. Other risks that are specific to the procedure will be discussed before the day of the surgery so you can make an informed decision about your care. However, if you choose a highly skilled and experienced surgeon, the risks are greatly reduced.
Q: Why are there so many different kinds of breathing machines?
Because there are different types of breathing patterns and different types of sleep apnea, breathing devices are not one-size-fits-all. Your doctor will choose from a variety of machines to help address your specific problem. Some patients, for example, just need help keeping the airway clear, while others need the machine to do some or all of their breathing for them.
Q: How well will the treatment work?
It’s impossible to tell how well each treatment will work before you try it. It’s important to stay in close communication with your doctors so that you can keep them abreast of your progress and let them know how the treatment is working. If one treatment isn’t doing the trick, a new approach may prove necessary.
Q: Does central sleep apnea cause snoring?
While some patients with central sleep apnea do snore, it is not a major symptom of the condition. Patients with obstructive sleep apnea often do snore more as a result of their condition, but snoring much less common in CSA patients.
Q: How many apneas can occur per night?
The number of apneic episodes that can occur during the night varies greatly, but some patients can experience more than a hundred during a full night of sleep. This disrupts sleep, including the all-important REM stage of sleep.
Q: Will a sleep study show if I have mixed sleep apnea?
During a sleep study, physicians will track every aspect of your breathing and lung function, as well as your body’s oxygen levels, brain activity, and heart rate. This allows for a more precise diagnosis and can show physicians what type of sleep apnea you suffer from.
Q: Where can I get a sleep study?
There are sleep centers located all over the country, and your physician should refer you to a reputable center you can use.
Q: Are there any lifestyle changes that can help improve sleep apnea symptoms?
When it comes to improving central sleep apnea, it’s important to reduce or eliminate any use of opioids and monitor overall health carefully. In the case of mixed apnea or OSA, maintaining a healthy weight and avoiding cigarettes and alcohol can help reduce the problem, but these methods will only enhance existing treatments, not replace them. It’s important to get treatment from a qualified physician, whether that means using a breathing machine, taking medication, or even undergoing surgery.
Talk to an Expert
If you’ve been frustrated by your poor sleep quality or waking up with headaches and staying drowsy all day, then it may be time to talk to a sleep apnea expert like Dr. Jamali. If you’ve tried different treatment options and it hasn’t worked, don’t give up hope. Come visit Dr. Majid Jamali, D.M.D in New York, NY, for a consultation. Call (347) 417-5076 to schedule your appointment today!