central sleep apnea - possible causes?

absurdlyTired · Post by **absurdlyTired** » Fri Jan 18, 2013 6:57 am

I am still being put through all kinds of tests to determine why I have central sleep apnea (discovered and diagnosed Nov, 2012). So far I have had a brain MRI and physical. Last night, I went to see an ear nose & throat (ENT) specialist because my primary care physician had recommended it. I have a deviated septum, but I am pretty sure this type of thing doesn't play into central sleep apnea. Anyway, I went to the appointment and came out of there with her scheduling me for a "barium swallow" and "ph probe" to see if I have some kind of reflux - even though I never have heartburn or any other symptoms.

Now, I really want to find out what's going on with my health, but this seems ridiculous. I don't have the time or money to waste on chasing a dead end. Is there any connection between central and these non-symptomatic reflux things?

Other than this, does anyone have any idea or direction I can go for finding out what the cause is? Is this just a matter of my brain being broken? I'm 41 years old, 6-1, 185lbs, relatively active (I have 3 kids), and have never smoked. I'm not looking for a deadly diagnosis, but part of me was disappointed when the MRI came back negative. I desire an explanation of some kind.

kteague · Post by **kteague** » Fri Jan 18, 2013 12:20 pm

Your concern about possibly unnecessary testing is understandable. Nothing wrong with expecting your doctor to be able to justify ordering a test by making a clear case for a possibly connection. If they can't make that case, nothing wrong with saying you just aren't on board with testing that you don't understand the relationship to your particular diagnosis. Maybe they can give you a clear understandable explanation. If not, there's your answer.

I apologize for going so basic on this, so please don't take offense, but I remember reading a woman's story of being diagnosed with central sleep apnea and her doctor never figured out a medication she was on was the culprit. She got that suggestion from a forum. Are you on any meds that could be the culprit?

Good luck with your pursuit of answers.

absurdlyTired · Post by **absurdlyTired** » Fri Jan 18, 2013 12:42 pm

Thanks kteague.
The only medication I'm on is Flonase (nasal spray) for my allergies.

DoriC · Post by **DoriC** » Fri Jan 18, 2013 3:48 pm

Can you tell us how you have your humidifier set up? Since you have nasal allergies sometimes too much or too little humidity can cause breathing problems. I feel your frustration.

chunkyfrog · Post by **chunkyfrog** » Fri Jan 18, 2013 3:54 pm

Sometimes a couple nightcaps will do it (especially if they are in large glasses)

patrissimo · Post by **patrissimo** » Fri Jan 18, 2013 4:11 pm

Do you have central apnea when you aren't on CPAP?

I haven't seen much collected wisdom for non-CPAP caused central apneas, but there is lots for CPAP-caused central apneas (BiPap, ASV, etc...)

absurdlyTired · Post by **absurdlyTired** » Fri Jan 18, 2013 4:43 pm

DoriC - I have the humidifier attachment with my ResMed S9 VPAP Adapt. I tried 4.0, but bumped it up to 5.0 because I was experiencing dryness.

patrissimo - Yes, I have central sleep apneas without it. Since early November (when I first became aware I had a sleep disorder), most nights when I tried to fall asleep, I go through many attempts. As soon as I start to drift off, I startle after a minute or so, realizing that I am not breathing (my heart races, etc). The sleep study reported central onset and many throughout the night. I'm not sure if my feeling of gulping that happens is because I stop breathing and my device decides it's time to shove air down my throat, or something else. To be honest, I am not capable of really deciding much lately. My brain is mush and it keeps getting mushier.

patrissimo · Post by **patrissimo** » Fri Jan 18, 2013 7:42 pm

Well, that makes it hard, then (assuming it isn't something simple like congestive heart failure or shooting heroin). You mention a PCP and ENT, are you seeing a sleep doctor? I'd say at a minimum you need a sleep specialist, and you might need to go to a larger, research-oriented center like Stanford that can diagnose something obscure like non-CPAP caused central apnea.

While I expect this board can give you a lot of help on acclimatizing to, setting up, and tweaking your ASV device, you're probably going to need an expert sleep doctor to unravel idiopathic central sleep apnea. If you like reading academic research yourself, try these papers:

http://scholar.google.com/scholar?hl=en ... 5&as_sdtp=

TheUglyTruth · Post by **TheUglyTruth** » Fri Jan 18, 2013 8:39 pm

Causes
By Mayo Clinic staff

Central sleep apnea occurs when your brain fails to transmit signals to your breathing muscles. Central sleep apnea can be caused by a number of conditions that affect the ability of your brainstem — which links your brain to your spinal cord and controls many functions such as heart rate and breathing — to control your breathing. The cause varies with the type of central sleep apnea you have. Types include:

Idiopathic central sleep apnea. The cause of this uncommon type of central sleep apnea isn't known. It results in repeated pauses in breathing effort and airflow.

Cheyne-Stokes breathing. This type of central sleep apnea is most commonly associated with congestive heart failure or stroke and is characterized by a periodic, rhythmic, gradual increase and then decrease in breathing effort and airflow. During the weakest breathing effort, a total lack of airflow (central sleep apnea) can occur.

Medical condition-induced central sleep apnea. In addition to congestive heart failure and stroke, several medical conditions may give rise to central sleep apnea. Any damage to the brainstem — which controls breathing — may impair the normal breathing process.

Drug-induced apnea. Taking certain medications such as opioids — for example, morphine, oxycodone or codeine — may cause your breathing to become irregular, to increase and decrease in a regular pattern, or to stop completely.

High-altitude periodic breathing. A Cheyne-Stokes breathing pattern may occur if you're acutely exposed to a high-enough altitude, such as an altitude greater than 15,000 feet (about 4,500 meters). The change in oxygen at this altitude is the reason for the alternating rapid breathing (hyperventilation) and underbreathing.

Complex sleep apnea. Some people with obstructive sleep apnea develop central sleep apnea while on treatment with continuous positive airway pressure (CPAP). This is known as complex sleep apnea because it is a combination of obstructive and central sleep apneas.

BlackSpinner · Post by **BlackSpinner** » Fri Jan 18, 2013 8:39 pm

absurdlyTired wrote:I am still being put through all kinds of tests to determine why I have central sleep apnea (discovered and diagnosed Nov, 2012). So far I have had a brain MRI and physical. Last night, I went to see an ear nose & throat (ENT) specialist because my primary care physician had recommended it. I have a deviated septum, but I am pretty sure this type of thing doesn't play into central sleep apnea. Anyway, I went to the appointment and came out of there with her scheduling me for a "barium swallow" and "ph probe" to see if I have some kind of reflux - even though I never have heartburn or any other symptoms.

.

There is silent acid reflux associated with sleep apnea. You wouldn't notice it because it happens when you are asleep. You might notice some mucus in your throat in the morning, a cough maybe but the real damage is happening in your esophagus, quietly, slowly and insidiously. Often, once you get treated, it goes away but it would be good to check for damage if you want to.

archangle · Post by **archangle** » Mon Jan 28, 2013 7:26 am

Work with your doctors, but my impression is that other than drugs, heart problems, or perhaps obesity, looking for a root cause doesn't have any real benefit to the patient.

There's probably something wrong in your brain or nervous system, but searching for it rarely finds anything and even if you do find something about the cause, there's no treatment for the root condition.

jnk · Post by **jnk** » Mon Jan 28, 2013 7:41 am

Doc P. has an intersting take on it:

Although we have a way of treating central sleep apnea, the results are not as satisfying compared with treating obstructive sleep apnea. Ultimately sleep doctors don’t have very good answers to why this happens, or how to treat it effectively. Think of it as a permanent neurologic condition, where rather than having weakness of your lower legs, you have weakness of the nerves that control your breathing patterns. Treating the obstructive component probably won’t cure the central sleep apneas, but at least it could prevent it from getting worse.--http://doctorstevenpark.com/centralsleepapnea

blueh2o · Post by **blueh2o** » Mon Jan 28, 2013 12:37 pm

I was initially diagnosed with complex sleep apnea. I understand that this is different than pure central apnea. However, I'll offer an explanation for the central part of complex sleep apnea. As Dr. Guilleminault with Stanford explained to me, the central part of complex sleep apnea is due to the fluctuating levels of Co2 in your bloodstream. When we fall asleep our bodies require a higher level of Co2 than when awake. As a person who has obstructive apnea (in my case mostly hypopneas) falls asleep the airway becomes more constricted requiring a higher level of breathing effort. This higher level of breathing effort results in a lower level of Co2 (higher level of O2) in your bloodstream. To counter this low level of Co2, the brain tells your body to stop breathing thus increasing the levels of Co2 in an effort to obtain a sleeping state (I still haven't reconciled how this "helps" you sleep as it always woke me up). Regardless, according to Guilleminault, the proper treatment for complex apnea is not ASV but rather APAP. The theory being that APAP will resolve the obstructive component of the complex apnea which eventually results in resolving the central component. In my case, this proved true. However, I still struggle with sleep just no longer with cental apneas.
Back to your case. I assume based on your posts that you have no obstructive components to your central apneas? Have you had more than one sleep test that confirms that to be the case? If so, the pure central sleep apnea extends way beyond any of more already minimal knowledge.

MagsterMile · Post by **MagsterMile** » Mon Jan 28, 2013 12:45 pm

I have a lot of Centrals too. They did a MRI and nothing was determined from it. I was asked if I had a stroke or heartattack. I don't believe I've had either. I don't do drugs so that wouldn't be the cause. The Dr is unable to determine why I have the Centrals and I've learned that being on therapy is a life long thing. That makes me sad but grateful that it is treatable. There is no cure at least for now.

TheUglyTruth · Post by **TheUglyTruth** » Mon Jan 28, 2013 4:37 pm

BlackSpinner wrote: There is silent acid reflux associated with sleep apnea.

Only with obstructive apnea, not with central.

Obstructive apnea is probably causative. You struggle to breathe using muscles in the trunk and the muscle contractions sometimes expel some stomach contents into the esophagus or higher.

With central there is no struggle.

central sleep apnea - possible causes?

central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Re: central sleep apnea - possible causes?

Mask	Humidifier

Additional Comments: Surgeries: MMA, tonsils/adenoids, septoplasty/turbinate