Your doctor may make an evaluation based on your signs and symptoms or may refer you to a sleep specialist in a sleep disorder center.
A sleep specialist can help you decide on your need for further evaluation. Such an evaluation often involves overnight monitoring of your breathing and other body functions during a sleep study called polysomnography.
During polysomnography, you're connected to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. You may have a full-night or split-night sleep study.
In a split-night sleep study, you're monitored during the first half of the night. If you're diagnosed with central sleep apnea, staff may wake you and give you positive airway pressure for the second half of the night.
Polysomnography can help your doctor diagnose central sleep apnea. It also can help your doctor rule out other sleep disorders, such as obstructive sleep apnea, repetitive movements during sleep (periodic limb movements) or sudden attacks of sleep (narcolepsy), which can cause excessive daytime sleepiness but require different treatment.
Doctors trained in nervous system diseases (neurologists), heart diseases (cardiologists) and others may be involved in evaluating your condition. Doctors may also order imaging of your head or heart to look for contributing conditions.
Treatments for central sleep apnea may include:
- Addressing associated medical problems. Possible causes of central sleep apnea include other disorders, and treating those conditions may help your central sleep apnea. For example, therapy for heart failure may improve central sleep apnea.
- Reduction of opioid medications. If opioid medications are causing your central sleep apnea, your doctor may gradually reduce your dose of those medications.
Continuous positive airway pressure (CPAP). This method, also used to treat obstructive sleep apnea, involves wearing a mask over your nose or your nose and mouth while you sleep. CPAP is usually the first treatment given for central sleep apnea.
The mask is attached to a small pump that supplies a continuous amount of pressurized air to hold open your upper airway. CPAP may prevent the airway closure that can trigger central sleep apnea.
As with obstructive sleep apnea, it's important that you use the device only as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your doctor. Several types of masks are available. Doctors can also adjust the air pressure.
Adaptive servo-ventilation (ASV). If CPAP hasn't effectively treated your condition, you may be given ASV. Like CPAP, ASV also delivers pressurized air.
Unlike CPAP, ASV adjusts the amount of pressure during inhalation on a breath-by-breath basis to smooth out the breathing pattern. The device may also automatically deliver a breath if you haven't taken a breath within a certain number of seconds.
ASV isn't recommended for people with symptomatic heart failure.
Bilevel positive airway pressure (BPAP). Like ASV, BPAP delivers pressure when you breathe in and a different amount of pressure when you breathe out. Unlike ASV, the amount of pressure during inspiration is fixed rather than variable. BPAP can also be configured to deliver a breath if you haven't taken a breath within a certain number of seconds.
BPAP could worsen central sleep apnea in people with heart failure. Be sure to talk to your doctor about the potential risks of BPAP if your doctor is considering this therapy and you have heart failure.
- Supplemental oxygen. Using supplemental oxygen while you sleep may help if you have central sleep apnea. Various devices are available to deliver oxygen to your lungs.
Medications. Certain medications, such as acetazolamide (Diamox) or theophylline (Theo-24, Theochron), have been used to stimulate breathing in people with central sleep apnea.
These medications may be prescribed to help your breathing as you sleep if you can't tolerate positive airway pressure. These medications may also be used to prevent central sleep apnea in high altitude.
Surgery or other procedures
A new therapy for people with symptomatic heart failure who have moderate to severe sleep apnea involves stimulation of the nerve that runs from the brain to the diaphragm (transvenous phrenic nerve stimulation). A nerve stimulator, which is implanted in your chest, acts like a pacemaker to help you breathe normally during sleep. The device monitors your breathing and stimulates the phrenic nerve to generate a breath if you've gone too long without breathing during sleep.
Preparing for your appointment
You're likely to start by seeing your primary care doctor. However, you may then be referred to a sleep specialist.
Because appointments can be brief and there's often a lot to talk about, it's a good idea to be well-prepared for your appointment. Here's some information to help you get ready for your appointment and what to expect from your doctor.
What you can do
- Bring results of prior sleep studies or other tests with you, or ask that they be given to your sleep specialist.
- Ask someone, such as a spouse or partner, who has seen you sleeping to come with you to your appointment. He or she will likely be able to provide your doctor with additional information.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Write down questions to ask your doctor.
Your time with your doctor may be limited, so preparing a list of questions will help you make the most of your time together. For central sleep apnea, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need? Do these tests require any special preparation?
- Is this condition temporary or long lasting?
- What treatments are available, and which do you recommend?
- How will treating or not treating my central sleep apnea affect my health now and in the future?
- I have other health conditions. How can I best manage these conditions together?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or do they come and go?
- Can you describe your typical sleep schedule?
- How long do you sleep, and do you sleep soundly? How many times do you wake during the night?
- Do you know if you snore?
- How do you feel when you wake up? Are you short of breath?
- Do you fall asleep easily during the day?
- Has anyone ever told you that you stop breathing while you're sleeping?
- Are you short of breath when you wake up at night?
- Do you have heart problems? Have you suffered a stroke?
- What medications are you taking?