You probably know that sleep apnea is a disorder that interrupts sleep with repeated stops and starts in breathing. You may think it’s something that only snorers or overweight people have to worry about. If so, think again. There is a type of sleep apnea that happens silently without any snoring or other noises. It could be happening to you even if you think you sleep well—and a bed partner might not even notice.
This type of sleep apnea, called central sleep apnea (CSA), is getting more attention among doctors as they learn about how much sneakier and more dangerous it is than the commonly known obstructive sleep apnea (OSA). To really take charge of the situation, sleep specialists have recently banded together to create a web portal called Sleep Apnea Doctors for consumers and physicians alike, where folks can become informed about all types of sleep apnea, find specialists in their area who treat it and even get online consultations and guidance about insurance coverage.
But if CSA can’t be seen or heard, how do you know whether you have it so you can seek medical help?
Bottom Line spoke about this with sleep disorder specialist and author of Sleep Soundly Every Night, Feel Fantastic Every Day, Robert S. Rosenberg, DO, who runs a sleep lab in Prescott Valley, Arizona.
SUFFOCATING IN SILENCE
Although OSA generally occurs in overweight people who usually snore because of it, CSA can develop whether you are slender or chubby, Dr. Rosenberg explained. Unlike the mini-suffocations of OSA that are characterized by grunts, gasps and snores, those of CSA are, as mentioned, virtually silent. Because signs and symptoms of CSA are easily missed, serious and even permanent health problems are more likely to occur than they are for people with OSA. These health problems can include diabetes, atrial fibrillation (irregular heartbeat), high blood pressure, sexual dysfunction and emotional disorders. CSA can even lead to a decrease in the brain’s gray matter, resulting in poorer planning skills, working memory, attention span, problem solving and verbal reasoning.
Over time, the hippocampus, the part of the brain that controls memory, can become irreversibly damaged, and this may be why some people with sleep apnea are misdiagnosed with early Alzheimer’s disease.
WHAT CAUSES IT?
Whereas OSA is triggered by something blocking the airway, such as fat deposits or simply anatomy, CSA can happen when the central nervous system, which contains the brain’s respiratory control center, fails to send a signal to the respiratory system to breathe. These breathing lapses are usually 15 seconds long but may last nearly a minute. This glitch happens because the brain temporarily stops sending signals to the muscles that control breathing. Although sometimes the reason for this can’t be pinpointed, CSA doesn’t necessarily affect people willy-nilly, Dr. Rosenberg said. There are specific risk factors, including diseases that weaken the heart or affect the brain stem, such as Parkinson’s disease, kidney failure and severe arthritis that includes degenerative changes to the upper spine and base of the skull. Opiate pain medications, such as morphine, methadone, oxycodone and hydrocodone, also can cause CSA, and it can sometimes temporarily develop in people who travel to high altitudes, causing fitful sleep, fatigue and headaches for a few days until the body adjusts to the reduced oxygen.
HOW TO KNOW IF YOU HAVE CENTRAL SLEEP APNEA
Although CSA can be hard to detect, certain symptoms can offer clues that it may be happening. Red flags include…
• Abrupt awakenings accompanied by shortness of breath, including shortness of breath that’s relieved by sitting up
• Difficulty staying asleep (insomnia, that is) or excessive daytime sleepiness (hypersomnia)
• “Brain fog,” characterized by difficulty concentrating and poor memory
• Morning headaches
• Daytime tiredness, lack of energy, moodiness and/or irritability—symptoms that can build into anxiety, depression or another mood disorder
Also, although CSA is a lot more of a challenge for a bed partner to detect than OSA, it can be done. A partner who listens carefully may hear a few rapid breaths followed by no breath at all for 15 seconds or longer—that’s a telltale sign. A person with CSA may also lightly snore.
GETTING A DIAGNOSIS
If CSA, or any sleep disorder, is suspected, its presence must be confirmed by a sleep study. This may require an overnight stay at a sleep center, which may be in a hospital or freestanding clinic. Your respiration, brain waves and maybe even muscle movements will be recorded while you sleep, and you may be videotaped as well. Make sure that the sleep center you visit is accredited by the American Academy of Sleep Medicine (AASM), Dr. Rosenberg cautioned. These facilities are staffed only by AASM board-certified sleep doctors. You can find an accredited sleep lab or a sleep apnea doctor in your area, as well as get more information on sleep disorders, at the AASM website.
Fortunately, CSA is treatable, but the treatment is individualized and depends on the particular cause. Sometimes the remedy is as simple as getting supplemental oxygen at night, which consists of sleeping with a mask over your nose or your nose and mouth that is connected to a canister of oxygen. In other cases, working with a cardiologist to improve heart function is the key, or else it might be getting off opiate pain medications.
Although continuous positive airway pressure (CPAP) machines, which mechanically push air through the windpipe, are often prescribed for people with OSA, another device is better and recommended for people with CSA. It is called an adaptive servo-ventilator (ASV). This device, which, like OSA machines, requires wearing a mask, analyzes normal breathing patterns and stores the data in a computer. If you stop breathing, the device automatically delivers pressurized air, sometimes with extra oxygen, until normal breathing resumes. ASV is approved by most insurers and Medicare, and that’s great news. So if you at all suspect that you or a bed partner might be having interrupted breathing while asleep, don’t suffocate in silence. Use the resources now available to find the right doctor and get evaluated for a referral to a sleep disorder clinic so you can work toward a solution.