Could My Central Sleep Apnea (CSA) be Normal?

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:

[NoshinYesmin]

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.

[RobdeKlerk-qglc]

Even when im awake i stop breathing when not paying attention...

[jenesoleil]

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.

[robertp.wainman]

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 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.

[nathanhale]

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.

[DeltaWhiskeyBravo]

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.

[vicaccino]

Thank you so much for the information sir, very well put video

[Vike]

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 )

[STURN]

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.

[kristensarajlic]

I noticed you said NOT buprenorphine… my providers seem to have the idea that my primary central sleep apnea (176 out of 179 events were central on the first study, 162 out of 162 on the second) is because of my chronic suboxone use. Even though I’m on a very low dose, 2mg/day. Could you possibly provide any sources showing that buprenorphine does not cause central sleep apnea, or point me in the direction in which to look? Thank you for sharing this information. 😊

[Guap]

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

[rickwhite-rsuv]

Is there a risk in using an ASV machine to manage complex sleep apnea, even if the central apnea might not be pathological? I seem to fall into that category, as I definitely have obstructive apnea with some central apnea, but there is no medical reason why I should have central apnea. The ASV machine definitely helps me get better sleep, but is using the ASV in this case a bad idea?

[perlaursen]

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😎🇩🇰

[THATHATSALLFOLKS]

Do any of you get a repeating dream every time you wake up

[ShwetaChoudhary-hesr]

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

[JennyPham-cj]

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.

[michelleslifeonrepeat]

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

[leslietherae]

Just saw whatvyou said about elevation and i justvwentbfrom the valley to up in the mountains to live too

[patrickhutley]

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.

[alexpopowski]

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.