Five CSA categories: 

1. Primary Central Sleep Apnea: The breathing pattern with primary central sleep apnea consists of the repeated absence of airflow and breathing effort. There's no known cause.
2. Cheyne-Stokes Breathing Pattern: The Cheyne-Stokes breathing pattern consists of rhythmic waxing and waning of breathing effort (increasing and decreasing) and air flow. Common causes include stroke and heart failure.
3. Medical Condition Not Cheyne-Stokes: Medical conditions can also cause CSA that does not show the Cheyne-Stokes breathing pattern. Kidney and heart problems are common causes. Another cause may be an injury to the base of the brain where your patient's breathing is controlled.
4. High-Altitude Periodic Breathing: Sleeping above 15,000 feet altitudes may cause a periodic breathing pattern that is similar to the Cheyne-Stokes breathing pattern, but with a shorter cycle time, and without a history of any medical issues such as stroke, kidney failure, or heart failure.
5. Due to Drug or Substance: Drug use can cause CSA, particularly opioid pain medications. Your patient's breathing may be shallow or repeatedly stop completely when taking these medications. Some drugs may also cause irregular breathing, as well as combined CSA and OSA.

What Are the Symptoms of Central Sleep Apnea?

• Shortness of breath with abrupt awakenings
• Observed abnormal breathing or stopped breathing patterns while sleeping
• Insomnia (difficulty staying asleep)
• Shortness of breath that gets better while sitting up
• Difficulty concentrating
• Nighttime chest pain
• Morning headaches
• Hypersomnia (excessive daytime sleepiness)

Snoring may be present in patients who have a combination of CSA and OSA.

 

Treatment Options for Central Sleep Apnea

There are several treatment options for central sleep apnea. These are:

CPAP Therapy

It is a type of sleep apnea therapy that delivers air pressure to the patient’s airway using a nasal mask that your patient wears on their face while they sleep.

CPAP is set at a predetermined setting in a continuous stream of air that maintains an open airway while the patient sleeps.

CPAP therapy helps your patient tremendously by:

• Keeping their airway open while they sleep.
• Eliminating or at least reducing their snoring.
• Improving their sleep quality.
• Eliminating or reducing their daytime sleepiness.

As soon as your patients begin treatment, they should start feeling the effects. Many patients show maximum improvement within a couple of days or weeks after starting therapy.

Adaptive Servo-Ventilation (ASV)

ASV, may be indicated for a patient if CPAP isn't effective. ASV is a non-invasive treatment used to treat adults with OSA and CSA or complex sleep apnea. ASV is a newer type of PAP device that monitors your patient's breathing issues continuously and adjusts as needed to maintain breathing. ASV adjusts based on the patient's breathing efforts, meaning the pressure delivered isn't a value that's fixed, but instead adapts to the breathing patterns of your patient.

If the ASV device detects any breathing abnormalities, it will intervene with enough support to keep your patient's breathing at least 90 percent of their baseline breathing pattern. With this continuing adjustment, when your patient has stable breathing, the device offers the right pressure support to reduce work of breathing and thereby increase patient comfort.

BiLevel Therapy

BiLevel is similar to CPAP therapy.

A common complaint of the CPAP device is that the constant pressure is uncomfortable for them to breathe against when they exhale; which can be a challenge if they're using CPAP at higher pressures.

However, with using BiLevel  your patients can easily breathe, since the device decreases the pressure level during exhalation. This allows your patient to more comfortably on PAP therapy. BiLevel machines come with two pressure settings: a lower exhalation pressure and a higher pressure during inhalation. These are known as IPAP and EPAP or inspiratory and expiratory PAP settings.

Your patient's BiLevel device increases their pressure while they're inhaling to ensure their airway is kept from closing while they're sleeping. It also provides a lower exhalation pressure that continually maintains an open airway. Patients using BiPAP typically find it more comfortable than using a CPAP device with a single pressure.

Other treatments may include treating relevant medical problems, decreasing opioid medication, providing medicine that stimulates breathing, using supplemental oxygen and treating underlying conditions that cause CSA.

Conclusion:

• With CSA, your patient's breathing effort stops, or starts and stops, repeatedly while they sleep.
• Stroke and heart failure can trigger CSA.
• There are risk factors that increase your risk of CSA including age, sex, and certain health conditions.
• There are several treatment options for CSA including CPAP, BiLevel and ASV.