Could My Central Sleep Apnea (CSA) be Normal?
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- čas přidán 30. 11. 2022
- Central sleep apnea (CSA) can be another major breathing disorder that occurs when sleeping, second in frequency to obstructive sleep apnea (OSA). Some forms of this condition can be serious, but are all forms of central sleep apnea pathological? Andy Berkowski, MD of ReLACS Health describes circumstances under which central sleep apnea can be seen on a sleep study (polysomnogram/PSG) but should not be worrisome. However, determining which forms of central sleep apnea should be treated often depend on identification of the underlying cause
For further discussion of a variety of sleep topics, follow his blog at:
www.relacshealth.com/blog/
These videos are for general information only. For those living in or near MI, OH, or FL, you can hire @andyberkowskimd as your personal sleep physician regarding whether your central sleep apnea really needs treatment or any other sleep symptom that keep you up at night. Go to www.relacshealth.com/ to schedule your consultation.
My brother is a 21-year old male. He started waking up gasping for air during sleep about 1.5 years ago. He feels extremely exhausted during daytime. So he got several tests done:
1. PNS Scan: There’s not really anything abnormal in the scan. He doesn’t snore either and is normal weight.
2. Polysomnography: He got this test done at the sleep lab several times. He claims that he couldn’t fall asleep during those tests due to trying to sleep in a new environment. So, he got home tests done and was diagnosed with mild sleep apnea about AHI 10. But he later got another sleep study at the lab. There I see he slept for 315 minutes and was awake for 15 minutes in that time. His AHI is 1.1, and all the sleep apnea episodes were CSA.
3. Other tests: He got his heart test ECG + Echocardiogram + ETT normal. His brain MRI report also says normal. He got his blood tests done as well. Everything is normal except little high cholesterol. When he first got this symptom, he didn’t use any medication that now. Now he takes cholesterol med and Clonazepam before sleep.
4. He developed involuntary limb and leg movements during sleep. It’s pretty frequent in him.
No doctor has been able to suggest an effective treatment. He tried different antidepressants because of doctors’ prescription. Nothing helped. He is struggling a lot in his university due to this. We really have no clue what should improve his condition. I truly hope you see this comment and share some helpful tips.
Even when im awake i stop breathing when not paying attention...
Me too. It's confusing
Same here.
I was recently diagnosed with severe complex sleep apnea and I’m at a loss. When I was first diagnosed with sleep apnea earlier this year, I was sent a Resmed Airsense 11. The Airsense 11 works great in treating the OSA, but I also get a high number of CA, sometimes into the 90’s!! I have no known medical condition that’s causing the CA. After much struggle with insurance, I did get an ASV, but I haven’t been able to use it because the machine is set wrong and it’s causing terrible heart palpitations and chest pain. It seems that my medical provider is at a loss for helping me with my complex apnea, so I’m going to be looking for another provider.
Thank you so much for the information sir, very well put video
Most welcome
Thank you so much!
You're welcome!
Very interesting and informative. My CA is still an unknown cause and being untreated currently. I'm the type that does need this treated, as I did have an ASV, but emphysema based COPD has made the ASV therapy incorrect.
Interestingly, those with significant COPD who have high baseline CO2 levels can develop central sleep apnea as a result of treatment of obstructive sleep apnea with types of bilevel PAP devices set too aggressively (e.g. VAPS, BiPAP®, VPAP®, AirCurve®, etc.). If the device causes them to over-ventilate (over-breathe), it can lower CO2 levels too much and lead to central apneas. This is one of the more common causes of treatment-induced central sleep apnea. It's a little too technical for this video but respiratory therapists and sleep, pulmonary, and ICU docs can understand this concept.
Conversely, one of the ways in which adaptive servoventilation (ASV) works is slightly under-breathing the individual to help increase CO2 levels a little which helps to prevent slowing down or pausing in breathing (yes, too far into the weeds with these details...)
Very interesting to watch - thank you. I recently had a sleep study which showed 15 apneas - of which 4 were central, with 30 hypapneas and 10 RERA's.....and have been concerned about the 4 central ones. It also showed 'sleep fragmented by multiple periods of wakefulness.' Although I'm only classified as having mild sleep apnea, I wake up unrefreshed and feel fatigued, with headache and general lethargy. I'm often aware - even when resting in a chair or on my side in bed - of being on the edge of sleep, then making a 'noise' in throat(?) and awakening. This sometimes happens many times a night....and seems to be getting more common. I have to wait some time before my next appointment to talk about it here on the NHS in UK - so any extra information would be gratefully received.
Thanks for sharing. Central apneas can occur in anyone for natural reasons. Complex situations often require a sleep expert to distinguish from natural versus pathological.
@@andyberkowskimd Many thanks for your reply.
@@andyberkowskimdI’m assuming chronic stress can trigger light sleep and so onset CA happens frequently. Even normal people gets onset sleep apnea.
Some people naturally have a pause in breathing (AKA central apnea) many times when they fall asleep. This reflects the delay in the body switching from wake breathing to completely autonomous sleep breathing. If one is enduring acute or chronic stress, this can lead to sleep fragmentation (lighter, broken up sleep). Sleep fragmentation->more awakenings->more times falling asleep->more naturally occurring sleep apnea. This is also one of the causes of "treatment emergent central sleep apnea" seen in those who first start using a CPAP machine for obstructive sleep apnea. They do not tolerate the device well on the first night or few and have highly fragmented sleep and a bunch of central apneas on a sleep study. These central apneas should be left alone as they resolve after several days to weeks when a person acclimates to the CPAP and sleep becomes more consolidated. These two cases are examples of central sleep apnea that are naturally occurring and should not be "treated." A skilled clinician is often needed to identify the underlying cause of central apnea in order to determine how to address it. Not all central sleep apnea is bad or requires treatment.
I went from 15.8 AHI (mostly obstructive) pre-CPAP (APAP) to 2.7 AHI average after a month on CPAP and most of them are CSA. I know TECSA is quite common and can sometimes take months to clear and I suppose I should be happy that I'm now considered "normal" but I was just dx with Babesia. I read Babesia causes us to have problems with regulating oxygen-saturation flow properly due autonomic nervous system (ANS) issues and that Babesia attacks the sleep center of the brain. Wondering if that is what is keeping me from getting below 1 ? (Although I did get a 1.2 and a 1.6 in the past 3 weeks so maybe I just need to be patient while my brain figures it out ) Also highly likely that I have Lyme (tested postive for that too but less determinate than the Babesia was (which I have a ton of the symptoms of) How can I have a coinfection and not have the primary and Lyme doesn't help with sleep either (especially long term )
I have attention deficit disorder and it seems related to what I believe is central sleep apnea. When I get relaxed I just forget to breathe. I think I've been like this my whole life. Even as a toddler. I can't sleep on my back or sides because of obstructive sleep apnea so I have to sleep on my stomach slightly leaning to one side of the other. I always wake up tired and feeling worse than when I went to bed as well as nearly always waking up with a headache and feeling lethargic all day. Then when I lay down to try to sleep I can't and feel wide awake. It's impossible to imagine how frustrating it is unless you've experienced it and no one I've ever met has.
Central sleep apnea mainly refers to breathing during sleep and not when awake. The body has many more inputs to determine when to breathe while awake (e.g. choice to breathe, feeling short of breath, etc.) whereas when asleep, the brain relies on chemical measurements to trigger breathing like CO2 and O2.
Hi, try high doeses of Thiamin HCL 1000-3000mg and maybe in addition to that some choline. B1 + Choline are essential for making Acetylcholine that substance is essential for regulating the breathing in the autonomic nervous system.
If that doesnt work It could be that you deficient in other B vitamines or also in Vitamin E
I've noticed this myself too, both day and while asleep at night
I have this to all my family father's side have ADHD fybromyalgia sleep apnea
@@Truerealism747 is it obstructive sleep apnea where you snore until something obstructs your breathing or is it like you just forget to breathe when you get relaxed enough to sleep? Or both? I know they lump add in with Adhd but I'm anything but hyperactive.
doctor ...when i start to sleep .. Between awake to sleep ...i feels like forget to breathe but it doesn't happen all night and also doesn't happen everyday...what it could be
Just saw whatvyou said about elevation and i justvwentbfrom the valley to up in the mountains to live too
Great observation. If someone goes from sea level to a high elevation very quickly, the body cannot adjust to the relatively low oxygen levels and may develop central sleep apnea at least temporarily. Central sleep apnea and altitude sickness are significantly related in these processes.
I'm glad i see this video
I don't know if i have this kind of sleep disorder. Last night my breath was cut while I'm sleeping, then i sleep again i awake with dry mouth sometimes my sleep is 4 to 5 hrs only and it's hard to back to sleep. Sorry my English is bad.
Sorry to hear about your symptoms. Central sleep apnea as a disruptive condition is fairly uncommon. Sleep apnea including obstructive rarely cause individuals to sleep less or have trouble falling back to sleep. These conditions may cause more awakenings but not longer awakenings.
thanks for sharing. My son recently diagnosed with Central Sleep Apnea and I'm curious to figure out why he has it. He'a not snoring but wet head while sleeping, sneeze and runny nose during the day even not in allergy season.
Thanks for sharing. This video did not address causes and types of CSA in infants and young children but it is often much different than in adults.
Hi Doc, hope you're well. I'm trying to fix my sleep in general, as I've had insomnia since 17. I'm 32 currently. I've recently gotten to the point of being able to induce sleepiness consistently (something I have rarely felt), however, I have an issue that predates my trying to fix my insomnia. When I'm drifting off, I choke. I've imagined choking on my lip piercing a lot, so I took it out. I've had a pretty horrific episode of imagining I was choking on an apple (despite not eating apple that night); also choking on my own spit. It's scary... I'm rarely well rested and it's hard to feel positive right now as I'm stressed and tired all the time. I run 8-10 kilometers every other day, I am a healthy weight. and my blood work is great. I do have ulcerative colitis and pretty bad sinus issues though, so I probably breathe through my mouth at night. I feel my concentration and memory has suffered as of late; losing my mind it feels like.
Most of the time these episodes have happened while I was drifting off but I'm half sure I've been pulled out of sleep by a few, although it could be sleep disturbance as you'd mentioned. I went to the doctor and he took my heart readings, said I was fine and told me it was most likely sleep paralysis but his language was indicative that he was referencing obstructive sleep apnea and he'd not even considered central sleep apnea. He recommend I get cognitive behavioral therapy but I feel like I also need to be tested for CSA. I am hoping it's just some weird quirk my brain has developed due to imagining I was choking on my piercing one time and linking it to the lack of oxygen during the awake-sleep transition you've described. I did have a huge amphetamine drug overdose in which I seemed to have some kind of mini stroke (undiagnosed), 10 years back and I felt brain damaged for a long time afterwards - worth mentioning.
I'll admit the choking episodes have been on and off and I am under a great deal of life stress currently. I suppose it could also be true that even if I feel I haven't had an episode of stopping breathing that night, it could still be happening consistently whilst asleep but it hasn't manifested as I've described in the above paragraph. Probably need to go to a sleep clinic? What are your thoughts?
Thanks. Your video made it feel less scary.
Thanks for sharing. You answered your own question. For specific medical advice, one must see a sleep physician and have a full assessment. The point of this video is that central apneas can be normal in some people, though pathological in those who have an underlying condition that can cause them. Heart failure and higher doses of opioid medications are two common causes. I talk about heart failure here:
czcams.com/video/f-ORLany1tQ/video.html
One week in the future, I will do a video on how opioids can lead to central sleep apnea. However, even when there is a known cause, central sleep apnea does not always need to be treated. Sometimes it's the effect of something else and not the cause of anything. It is not straightforward.
Yes, I developed central sleep apnea after quitting alcohol. I wonder if it'll go away
Dear doc. I wonder if you could make a video about an interesting subject: I suddenly got CSA levels of ~37, and a corresponding drop in nightly oxygen levels to below 85%, caused by an old type 2 lead Right Ventricular only pacemaker. My Doctors called it the Pacemaker Syndrome. After upgrading to a CRT-pacemaker the CSA problem vanished. A simple solution to my CSA, that I couldnt reach with CPAP or medications. Per in Denmark😎🇩🇰
In the video, I stress the importance of finding a cause for the CSA. Heart problems are a main cause with CSA being a secondary effect. In some people they can be a normal part of sleep. It takes a deep understanding of what causes CSA in an individual to figure out the cause and whether/how it should be treated.
I’d love to hear your thoughts on this. A new watch Samsung6, and my husbands Samsung 4 keep recording very low oxygen in my sleep some days 70, some 80’s. It’s a drop will jump up to low 90s. Well I made appointment with my sleep doctor, and he can’t get me in for two or three months. So I purchased an Emory test on Amazon and it correlates with what my watch is reading. I purchased a new finger oxygen reader and it is accurate with my watch and the heart rates match. I finally get a home test. My watch that night was an amazingly high 84 or 87% for its lowest drop. Doctor calls and says everything looks fine. The lowest I went was 93%. How do we trust accuracy in all this? I cried.not every night is low 70s. Every night is different. And the other day it his 74and yesterday 70. I want to cry. I. So exhausted. Every fiber is tired. I get 9hours of sleep and have to nap daily, and itself wake up at about 1 hr 50 min daily. I’m hoping insurance goes further with a in lab test. Can you have randomly good nights? I’ve been dealing with this for possibly a year. I just got the watch 4 months ago.
An in lab test
Sorry to hear about your frustrations. Even medical grade home sleep apnea testing devices are prone to sensor "artifact" in which the numbers reported may not be accurate or real. I'm not sure we know exactly what to do every time a watch or gadget picks up something abnormal and how far we should go with medical testing. In a sleep clinic, the home sleep apnea test is not particularly accurate for central sleep apnea, so a study in the sleep lab (polysomnogram) is often needed if this is suspected.
This is the link to fybromyalgia
Great video 👍 as someone who suffers from Mixed Apneas and has ADHD, could the medication ie Ritalin cause more central events? Also i have found when i have a few drinks AHI goes down lower than usual.
Central events can be caused by medications but are usually from opioids at higher doses and rarely others, as opioids can impair the brainstem's breathing centers that determine when we breathe while we are sleeping. I'm not aware of stimulants having this effect like methylphenidate (Ritalin)
Same here. I have both obstructive and central sleep apnea and periodic breathing, and now have an ASV, which works very well. Now my AHI is usually less than 2.5, and I feel great.
I feel like I'm dying I need help I don't have an asv and I haven't slept in 3 days I just realized I have csa after years of OSA with large tonsils and overweight I've lost weight but, I've always had insomnia around the time I was diagnosed this last week I had a little onset of csa first by sensation of chocking then now my brain doesn't let me go to sleep for fear of not breathing, and maybe CO2 levels off, but I've always used a sleep drink called neurosleep and also this Walgreens drink wal z with an added antihistamine for pain, I hope that's not why I have brain problems cause I drink that stuff all night to stay asleep, drink one bottle of neurosleep then take sips when needed, also this pa put me on this blood pressure medicine called metoprolol and it was bad made my heart race and other things, I think it over worked my heart or something, I also have a bad bite due to missing teeth and had tmj symptoms head pain tension, cause I was biting to deep and pinching the nerve i guess but then the pain went away, but i might have neuromuscular problems adding to it which i read could do it this all happened in the last 2 weeks, and now im stuck with this feeling of i cant inhale, and i heard my cpap might be the cause and i need an asv, only thing i can do is take sleep drinks put cpap on and try to sleep until my brain wakes me up
Hey
Iam 34 and usually wake up More Than 10 timmes at night and my sleep very shallow/light and my concentration and memory very poor. I wasn’t like that before .
I dont know if that’s sleep apnea .
Does anyone else has same sleep issue ?
Shallow or light sleep is often known as sleep fragmentation. This video addresses this in more detail:
czcams.com/video/Jotr6AQFPkY/video.html
I don't even know what to do. I can't fall asleep anymore, and when I do, it's only for a couple hours at a time. I put on a pulse ox ring and it shows my oxygen dropping down to low 90s and mid-80s but when I try to fall asleep I feel myself feeling extremely short of breath with low oxygen levels and I wake up. I did a sleep study I'm waiting on the results I just don't know what to do, I'm fed up. I used to be able to fall asleep within seconds and stay asleep and now I just wake up immediately while I'm dozing off due to the low oxygen
I have the exact same thing. All this started for me after covid. It's been an awful 3 years. It's right when I'm transitioning from awake to sleep and then bam, it drops, and then repeats over and over again.
@mattbellon828 I'm sorry you're going through this. I'm seeing a pulmonologist on Monday. My test showed positive for sleep apnea which was pretty obvious and now I'm waiting on a cpap. I wish you the best, hang in there
@Guap303 thank you. Same with you. Hopefully you get some relief.
I find it impossible to sleep when i hook a home test up to myself
Those who have trouble sleeping with a home sleep apnea test often have an in-center sleep study (PSG). It is a lot more wires, but once someone falls asleep, the sleep study data can show when one is sleeping, unlike the home test, and that can help to determine when to look at one's breathing. Central sleep apnea is really best diagnosed by PSG.
My mom have central sleep apnea , she would get up and can’t breath . Is there any vitamin to strengthen brain ? Since central apnea caused by defect in the brain .
The observation of central sleep apneas on a sleep study may be seen in anyone and not be a problem. However, they can be problematic in some with other conditions that cause central sleep apnea including heart failure, spinal cord injury in the neck, high doses of opioid medications, sudden move to high elevation, but it can be tricky sometimes to identify whether it requires treatment or not.
@@andyberkowskimd like my mom would get up middle of the night saying she can’t breath or move . Then we end up calling ambulance
Please answer my 3 question ..i am from india ...and very stressed for my father...what precaution we should take to ignore central apnea in future please reply we are middle class people can't have money
1. My father has a deviated nasal septum nd sleep apnea with ahi 46 , he is currently using cpap but some studies suggest that septoplasty can cause central apnea in future... but how?
2. My father getting aerophagia without Epr so ...he use Epr at 2 level ..my question is if he is having central apnea caused by Epr in future so what should i do???..currently he is using apap pressure minimum 8.8 to max 10.2 ...and Ahi is 2 sometimes 1.6
3) how can i lower my father Ahi under 1.0 ? Currently Ahi is between 1 - 2 and maximum 95 % pressure goes to 10.0 ...so what should i do...we dont have oscar support because we are middle class people and use resmed airstart 10
If you are middle claass how did u afford CPAP that is expensive
Those who struggle acclimating to CPAP may develop central sleep apnea, but it is a non-pathological form. If someone is uncomfortable, they may not sleep deeply or have fitful sleep. The brain will go in and out of sleep and every time the brain goes into sleep, a central apnea occurs in some people. Thus, this is one way that CPAP, particularly if someone is having difficulty can develop central sleep apnea. This is very complicated however and there can be multiple causes of central sleep apnea that could be unmasked by the CPAP, rather than caused by it.
I had an at home sleep study… the pause ox kept falling apart, so I stayed up with a little mirror, watching to make sure it was connected…I took it off after 4 hours and went to sleep. Then went back for the results and was instantly set up to get an apnea machine, i was told because my o2 dropped to 84%. This doctor would not except that his machine was not functioning correctly. When I asked if it was central or obstructed, he didn’t seem to know what I was talking about and also would not tell me if the low pause ox was once, twice, an hour or a second. The next thing he said was that I sleep to much during the day…… I never nap, because I would never fall asleep during the day, in fact I have problems staying asleep at night. I worked 12 hour midnights shifts before I retired because I would not fall asleep till 3-4 am, and did not sleep the first day of the 3 shifts, I would lay down and rest in front of the tv for a couple hours, take a shower and go in to work. I did not get his apnea machine! I don’t think he deals with other medical professionals very much… As a nurse I researched this to death before!
One downside to home sleep apnea testing is that it does not actually measure sleep, though this technological barrier should be eliminated within a few years as the progress is getting close. The device only reflects the breathing parameters occurring during the time of the recording, regardless of how much or little one slept. If it records 4 hours of someone who is awake the whole time, it will reflect the breathing pattern of someone who is awake (usually normal) and say nothing of breathing when the person is asleep. One must be asleep for most of the time that the device is recording for a home sleep apnea test to be accurate in its reflection of breathing during sleep. Because it is not monitored by a person, sometimes there can be errors like a false reading from a pulse ox that may show a falsely low oxygen level, simply because it was not attached to the finger correctly. Often when there are technological issues, the sleep center can easily repeat the home sleep apnea test for a more accurate measurement.
@@andyberkowskimd the sleep doctor I guess reported to my psychiatrist and called the pharmacy and took away my Xanax that I use for sleep… luckily I had just had it refilled so I have the ability to wean off… a faster wear than it should be…I feel like I was being manipulated. Thank goodness I got that degree in nursing, what do you do if you have no medical background?