Reasons for Central Sleep Apnea

Hi.
So my husband was recently diagnosed with central sleep apnea. Its several months before we can see a neurologist and his gp has no clue about csa. He is 43 with hypertension and tachycardia however since has gotten his machine the tachycardia has stopped. He is 5'8" and 230 pounds. He only takes lisinopril 10mg to control the HTN. His doctor does not want to run any test until he sees the neurologist because she feels that is his job not hers. He had an ECHO last month which was clear. The doctor who read his sleep study said to rule out medication (which he doesnt take anything other than the lisinopril, No drugs or Alcohol), Congestive heart failure and pulmonary hypertension (which the echo ruled out) and then to rule out Neurological disorders he does not have any that we are aware of. The neurologist we are being sent to is not familiar with csa and this is from his staff. I have been doing research and it seems to be very vague about neurological causes. Im reaching out to this group to find out what have been some of the reasons that people on here have for there central sleep apnea. I feel that if we go in to this dr with we need these test we will have a better chance of a diagnosis of a cause. Any articles as well would help. Thank you in advance. You can also email me at

He had surgery on a mass on his leg 3 months ago. After surgery I noticed a abrupt change in his snoring. It went from me hitting him with pillows to get him to role over cause he was noisy to a dramatic decrease in sound which is why i requested a sleep study. His tachycardia also started after surgery but the surgeon and gp both said it was due to a month long infection in his leg and then it took another month for his leg to heal. I dont know if this information makes sense even as a cardiac RN this seems odd to me.

When's the last time he had a GTT? I imagine it's been done, but...

Is he getting the centrals a few at a time just on dozing off and awakening or lots all night long? It's normal to have some at both ends of the night, esp. in the a.m., but big clusters otherwise is not and would need follow-up.

HI Im not sure what a GTT is?
His sleep study was pretty bad. He had an ahi of 114. he had 155 scored respiratory events in the first half of the test of 81 min of sleep, 47 obstruvtive events, 62 clear central apneas coming and trains and 45 hypopneas, mean durations 20 seconds, they began intervention. By the end of the night he was on 11 cm of pressure on an asv machine

he needs to lose some weight and not just for the apnea. the extra weight makes it harder for us to breathe. the more we weigh the more muscle and fat there is that need oxygen which, for us, is already in too short a supply.

I have placed him on a diet. We are just very much at a loss for the cause of his central sleep apnea. His main Dr said she didn't know anything about it and to go look it up online so we have been gleaning as much information as possible. He has no other medical conditions except for hypertension which was just recently discovered he didn't have it last yr, obesity and the central sleep apnea. His labs all came back normal, echo and ecg are normal, 24 hr urine normal.

Good. GTT = glucose tolerance test for diabetes - when you said his leg took a long time to heal, I wondered about that, but apparently it's not a factor.

CSA can be a difficult thing to get a grip on.

My doctor once told me, "sometimes we don't always know the why but if we can get your number of events under control we'll take it as a win.".

If you have the desire - do some research on low Vitamin D levels and sleep apnea.

Best of luck...

He had a hematoma which we kept going back in to see the Dr about but he felt the drainage was ok. it got infected and the incision opened up. We ended up going to another set of surgeons who opened it up and found that it was closed wrong and was not going to heal without another surgery but because it was open so long it took a long time for the muscle to close. He had a hemaglobin a 1c and fasting blood sugar and they were all normal.

Thank you Tom I will look that up. Thank you.

My understanding of central sleep apnea is that it is a condition in the central nervous system where normal breathing is regulated but in which the "command" to breathe is temporarily delayed so breathing stops, not because of an obstruction, but because of a lack of effort. Kudos to the sleep lab in switching him to an ASV mode during the test.

That type of machine is exactly what he needs right now.

In a normal breathing pattern, control is maintained by the level of Oxygen and / or Carbon Dioxide in the blood. During the waking times, the oxygen level is the controlling factor and the command to breathe is issued when the O2 level drops below some particular value that is for that patient. During sleeping times, control shifts from Oxygen to Carbon Dioxide so that breathing is commanded when the CO2 level exceeds the particular level for that patient. If the mechanism gets screwed up long delays can occur which are called central sleep apnea events. The longest one I have had that I recorded was two and a half minutes one night. That was before I switched to my current ASV machine which handles these events. On my machine now, I occasionally see breathing anomalies that have the machine breathing for me (ventilator mode) for as long as three hours at a time. And, of course, I sleep straight through.

In your husband's case, when he gets his ASV machine ( I like the Respironics version ), the difference in his sleep patterns will be remarkable. He will breath regularly, no snoring ( after a correct mask fit ) and will become rested in the morning. It sometimes takes a while to get the rested part but it will come.

What is commonly seen, but doesn't apply in your case, is a sequence of central apneas that are associated with going to sleep or waking up. This happens, (and is normal) when the trigger levels between O2 and CO2 are different so when the switchover occurs there is a short delay as the new controlling level is reached. Breathing stops during this internal and resumes normally after the control is successfully moved from on to the other.

It will be helpful if you do the following things:
1) Register as a member of this forum.
2) Get a copy of the full sleep study report.
3) Get a copy of the scrip for his new CPAP machine.
4) Get a copy of the scrip for his new mask which should say "CPAP mask of patient's choice."
5) Continue to come to this forum and ask about anything that concerns you about sleep apnea, anything at all.

Congratulations on your noticing his different breathing pattern at night and having the had the energy to force the subject of the sleep study. Because you did that, you likely saved his life.

JDS74 we were very lucky the woman that did his sleep study has many yrs experience as soon as she saw that cpap and bipap were not helping she switched him to asv. My husband has noticed a dramatic change in his energy levels and being rested. With in the first two nights of using the asv he said he hasn't felt this good or awake in a while. The other night he tried a face mask versus his nasal mask and the next morning he was exhausted and said he must not have slept well. We downloaded sleepy head and found that he had 41 events and 93 large leaks so he went back to his nose mask. The next step is finding why he has central sleep apnea. We are waiting to se the neurologist but that won't be until January and his primary Dr does not want to run any test because she doesn't believe there is a difference (very frustrated w this Dr). His tachycardia which he has struggled with the last two months has almost completely disappeared in the last week in a half. I am working on getting mu husband to join the forum but it just might be me. I was able to get the sleep study and the prescription from the Dr.

You may never know what triggers centrals, but if things are set up as well as possible for your husband and he feels better, that may be what you have to do. There generally isn't an obvious cause that can be traced or fixed, the way you can operate and remove or sew something up - the brain is still pretty mysterious.

jeniburns1@gmail.com wrote:... The other night he tried a face mask versus his nasal mask and the next morning he was exhausted and said he must not have slept well. We downloaded sleepy head and found that he had 41 events and 93 large leaks so he went back to his nose mask. ....

With the face mask (AKA FFM) the issues of leakage are different than those with a nasal mask. If the nasal mask is working, I would recommend sticking with it.

However, there may be circumstances in which the nasal mask doesn't work properly - head cold, congestion, etc.
Then having a functioning FFM is a blessing.

So ... Get a soft cervical collar (I get mine from Amazon) and have it available. The collar supports the jaw which can drop somewhat after falling asleep and create leakage problems for a FFM. Then make sure that the FFM is properly adjusted by doing it while lying down and while the machine is running at maximum prescribed pressure. It is common to adjust the mask while sitting up and during the Ramp period and the pressure is much lower than later while asleep. Get those adjusted properly and then just put it away for a rainy day when it will be needed.

Nasal masks are much better from the standpoint of humidity control. The nasal passages are designed to supply moisture to the incoming air as a protection to the lungs. The mouth, on the other hand, doesn't supply nearly enough moisture so that the external humidification system needs to be cranked up higher to get the same effect.

jeniburns1@gmail.com wrote: His sleep study was pretty bad. He had an ahi of 114. he had 155 scored respiratory events in the first half of the test of 81 min of sleep, 47 obstruvtive events, 62 clear central apneas coming and trains and 45 hypopneas, mean durations 20 seconds, they began intervention. By the end of the night he was on 11 cm of pressure on an asv machine

Even without the centrals he has severe OSA (47 obstructive events and 45 hypopneas).

I am glad his ASV is working.

The causes for centrals often just not known. For some people just going under anaesthesia can cause brain damage - my father lost some short term memory ability every time he had heart surgery.