Central Sleep Apnea
Reviewed by our editorial team
Last updated: 2026-04-01
Central Sleep Apnea (CSA) is a sleep-related breathing disorder in which your breathing repeatedly stops and starts during sleep. Unlike the more common Obstructive Sleep Apnea (OSA), which is caused by a physical blockage of the airway, CSA occurs because your brain doesn't send proper signals to the muscles that control your breathing.
Essentially, for brief periods, your brain 'forgets' to tell your body to take a breath. This leads to drops in blood oxygen levels and frequent awakenings as the brain realizes the lack of oxygen and triggers a 'startle' response to resume breathing. CSA is often associated with underlying medical conditions, such as heart failure or stroke.
Causes and Classifications
CSA can be categorized into several types. 'Primary' or idiopathic CSA has no known cause. 'Secondary' CSA is often caused by medical conditions like congestive heart failure, which can lead to a specific breathing pattern called Cheyne-Stokes respiration.
Other causes include damage to the brainstem (which controls breathing) from a stroke or tumor, and the use of certain medications, particularly opioid painkillers, which can suppress the respiratory drive in the brain.
Symptoms: Subtle but Serious
The symptoms of CSA often overlap with OSA, including daytime sleepiness and morning headaches. However, people with CSA are less likely to be loud snorers. Instead, they may report waking up suddenly with a sense of shortness of breath or gasping that feels more 'neurological' than 'choking.'
One of the most common signs is fragmented sleep and insomnia. Because the brain is frequently waking the body up to resume breathing, the sleeper never reaches deep, restorative stages, leading to chronic exhaustion and mood disturbances.
Cheyne-Stokes Respiration
Cheyne-Stokes respiration is a specific type of CSA common in patients with heart or neurological disease. It involves a periodic cycle of breathing that gradually gets deeper and faster, then shallower, followed by a complete pause (apnea).
This cycle can take 30 to 100 seconds to complete and repeats throughout the night. It is a sign that the brain's feedback loop for monitoring carbon dioxide levels is delayed or dysfunctional, causing the system to constantly 'over-correct' its breathing signals.
Treatment Approaches
The first priority is treating any underlying medical conditions, such as optimizing heart failure management. If the apnea is caused by opioids, reducing or changing the medication is necessary. For the apnea itself, specialized machines are used.
While a standard CPAP may help some, many CSA patients require Adaptive Servo-Ventilation (ASV) or Bilevel Positive Airway Pressure (BiPAP) with a backup rate. These machines monitor the sleeper's breathing in real-time and deliver a breath only when the brain fails to initiate one, ensuring a steady respiratory rate.
When to Speak With a Doctor
If you have a history of heart disease or stroke and experience new sleep disturbances or gasping at night, seek an evaluation by a sleep specialist.
Frequently Asked Questions
References
- [1]American Academy of Sleep Medicine. Central Sleep Apnea.
- [2]Mayo Clinic. Central Sleep Apnea: Symptoms and Causes.
- [3]Circulation. Heart Failure and Sleep-Related Breathing Disorders.
The information on this page is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.