What Is Central Sleep Apnea? Causes, Symptoms & Treatment

Central sleep apnea (CSA) is a less common but distinct form of sleep apnea — one where the problem isn't a blocked airway, but a breakdown in communication between your brain and the muscles that control breathing. Sleep apnea overall affects an estimated one billion adults worldwide, and CSA accounts for only a small share of those cases — roughly 5-10%. That relative rarity is part of why it's so often misunderstood, even though it can be just as serious as the more familiar obstructive type.

This guide covers what CSA is, how it actually happens, its causes and types, symptoms, diagnosis, and treatment. For a broader introduction to sleep apnea in general, see our guide on what sleep apnea is, or our dedicated guide to obstructive sleep apnea, the more common type.

What Is Central Sleep Apnea?

In central sleep apnea, the airway itself stays open — there's no physical blockage. Instead, the problem originates in the brain: the signal telling your breathing muscles to move either doesn't get sent, or doesn't get through properly. As a result, the effort to breathe stops entirely for a period, rather than being blocked despite trying, which is the key difference from obstructive sleep apnea (OSA).

People with CSA typically wake feeling as though they can't catch their breath, and struggle with the same exhausting cycle of fragmented sleep as OSA — but notably, loud snoring is far less common, since there's no airway obstruction generating the sound.

How Breathing Normally Works — and What Goes Wrong in CSA

Breathing is normally involuntary — your brainstem constantly monitors carbon dioxide levels in your blood and adjusts your breathing rate accordingly, without you ever having to think about it. Once carbon dioxide builds up past a certain point (called the apneic threshold), the brain signals your breathing muscles to contract and take in air. A separate, voluntary system lets you consciously control your breathing while awake — which is part of why breathing problems like CSA become more apparent during sleep, when that voluntary backup isn't in play.

In CSA, something interferes with this automatic system — either the brain's sensitivity to carbon dioxide is altered, or the signal isn't getting through properly to the breathing muscles. The result is the same either way: breathing becomes shallow or stops altogether until the brain's arousal response kicks in, jolting you into a gasp for air.

Types of Central Sleep Apnea

CSA isn't a single, uniform condition — it's classified based on its underlying pattern and cause:

• Cheyne-Stokes breathing: a distinctive cycle of rapid, shallow breaths building to deeper breaths, followed by a pause — each cycle lasting roughly 40-90 seconds. Strongly associated with heart failure and stroke.
• High-altitude periodic breathing: can affect even healthy people at altitudes above around 6,000 feet, caused by lower oxygen levels affecting the breathing control system. Usually resolves once back at a lower altitude.
• Narcotic-induced CSA: caused by opioid medications suppressing the brain's breathing drive.
• Treatment-emergent (complex) CSA: sometimes appears in people being treated for OSA with CPAP therapy — the reason isn't fully understood, but it's thought to relate to how positive airway pressure affects the brain's oxygen and carbon dioxide sensing. It's more common in people with underlying heart conditions, and often resolves over time.
• Idiopathic (primary) CSA: CSA with no identifiable underlying cause — comparatively rare, and believed to stem from a functional issue within the brain itself.

What Causes Central Sleep Apnea?

Most cases of CSA are described as "secondary" — meaning there's an identifiable underlying cause — while primary (idiopathic) CSA has no clear trigger. Common underlying causes and associations include:

• Heart failure — one of the most common underlying causes, often producing the Cheyne-Stokes breathing pattern
• Stroke — can damage the brain regions that regulate breathing; roughly half of stroke survivors develop some form of sleep apnea
• Opioid medications — suppress the brain's respiratory drive and its sensitivity to carbon dioxide
• Neuromuscular diseases — affect how well muscles receive and respond to the brain's signals
• Central nervous system conditions and brain tumours — can interfere with the brain's ability to sense chemical changes in the blood or transmit breathing signals, depending on where they occur
• High altitude — lower oxygen levels can trigger a temporary form of CSA, even in otherwise healthy people

Symptoms of Central Sleep Apnea

CSA symptoms overlap with OSA in some ways, but a few differences are worth noting:

• Slow or shallow breathing during sleep
• Waking up gasping or choking for air
• Difficulty staying asleep, or fragmented sleep
• Restlessness at night
• Excessive daytime sleepiness
• Morning headaches
• Mood or cognitive changes
• Snoring — present in some cases, but typically much less pronounced than with OSA

Because snoring is far less prominent in CSA, it's more likely to go unnoticed by a bed partner compared to OSA — one reason it often takes longer to get diagnosed.

How Central Sleep Apnea Is Diagnosed

Diagnosis requires an overnight sleep study (polysomnogram), which monitors breathing, body movement, brain activity, and vital signs. A CSA diagnosis generally requires at least five apnea or hypopnea events per hour, each lasting more than ten seconds, alongside at least one recognised symptom. Your doctor will also look for specific patterns — such as Cheyne-Stokes breathing — to determine which type of CSA you have, and may recommend further cardiac or neurological evaluation if an underlying cause is suspected.

If you suspect a breathing issue during sleep, a home sleep test like the WatchPAT One can be a useful first step, though CSA sometimes requires the more detailed monitoring of an in-lab study to confirm and classify.

Treatment Options for Central Sleep Apnea

Treatment depends heavily on the underlying cause — some forms, like narcotic- or altitude-induced CSA, can resolve once the trigger is removed, while others require ongoing management. Common approaches include:

• Treating the underlying condition — for example, optimising heart failure treatment often improves or resolves associated CSA
• Adaptive Servo-Ventilation (ASV) — a device that continuously monitors your breathing pattern and adjusts pressure support breath-by-breath, often used specifically for CSA
• BiPAP therapy — delivers two pressure levels, which can ease the effort of breathing in people with underlying respiratory conditions; see our BiPAP machines and CPAP, APAP & BiPAP comparison guide
• Standard CPAP — sometimes tried first, particularly in milder cases
• Supplemental oxygen — used in some cases alongside other treatment
• Reviewing medications — if opioids are a contributing factor, under medical supervision

Health Risks of Untreated Central Sleep Apnea

Left untreated, CSA is associated with a higher risk of several long-term health issues, including metabolic syndrome, type 2 diabetes, cardiovascular disease, stroke, and depression or anxiety. Encouragingly, research suggests many of these effects can improve once treatment begins.

Reducing Your Risk

Since CSA is so often linked to an underlying condition, prevention largely means managing overall health and known risk factors:

• Maintain a healthy weight
• Stay physically active and eat well
• Avoid smoking
• Limit alcohol and sedative use
• Use narcotic medications only as directed by your doctor
• Seek treatment promptly for underlying heart or neurological conditions
• Sleep on your side, or with your upper body slightly elevated, if recommended by your doctor

Getting Evaluated in the UAE

If you're experiencing unexplained breathing interruptions during sleep — especially without the loud snoring typically associated with OSA — it's worth discussing this with your doctor, particularly if you have a history of heart or neurological conditions. Our team at CPAP Medical Trading in Business Bay, Dubai can help you access home sleep testing and the right equipment once you have a diagnosis and prescription. You're welcome to upload your prescription when ordering, or book a free consultation if you'd like guidance on next steps. You can also reach us through our contact page or WhatsApp.

— The CPAP Med Trade Team