What is the difference between obstructive sleep apnea and central sleep apnea?

Sleep apnea is a common disorder where breathing stops or becomes very shallow. These pauses can last for a few seconds or even minutes and may occur 30 times or more per hour. There are two main types of sleep apnea: obstructive and central, each with different causes and mechanisms.

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is the most common type and occurs when the airway collapses or becomes partially or completely blocked during sleep. This blockage is usually caused by excessive relaxation of the tongue muscles, the soft palate, or other parts of the throat, preventing airflow. When the brain notices a lack of oxygen and an increase in carbon dioxide, it sends a signal to take a breath, which briefly wakes the person up without them remembering it in the morning. This cycle repeats many times each night, leading to feelings of fatigue and exhaustion in the morning [1].

Common symptoms of obstructive sleep apnea include loud snoring, followed by a temporary pause in breathing, and then a snorting or choking sound when breathing resumes. A bed partner may notice these symptoms. Other symptoms include excessive daytime sleepiness, waking up with a dry throat or headache, frequent awakenings during the night, frequent nighttime urination, and difficulty concentrating or mood changes during the day [1].

Central Sleep Apnea (CSA)

Central sleep apnea is less common and occurs when the part of the brain that controls breathing fails to send the correct signals to the muscles responsible for breathing. This means the problem lies in the neurological control of the breathing process itself, rather than an obstruction of the airway [1].

Diagnosis and Treatment

To diagnose either type, doctors rely on medical and family history, a physical exam, and the results of a sleep study, which can be performed in a sleep lab or at home [1]. The severity of the condition (mild, moderate, or severe) is determined based on the average number of breathing pauses per hour during sleep [1].

Treating sleep apnea is vital because it not only affects sleep quality but also increases the risk of serious health problems such as heart attacks, strokes, and type 2 diabetes [1]. Treatment options include lifestyle changes such as weight loss, reducing alcohol consumption, quitting smoking, and using devices that assist with sleeping in certain positions. However, these changes may not be sufficient on their own [1].

Assisted Breathing Devices

The most common device for treating obstructive sleep apnea is the Continuous Positive Airway Pressure (CPAP) machine. This device uses air pressure to keep airways open during sleep and delivers air through a mask that covers the nose and mouth or the nose only [1]. The CPAP machine (Arabic) is considered the standard treatment for obstructive sleep apnea [1]. Some people who cannot tolerate the pressure of a CPAP machine may need a Bilevel Positive Airway Pressure (BiPAP) machine, which provides different pressure levels during inhalation and exhalation [1].

Other treatments are also available, such as oral appliances worn during sleep to keep the jaw in a forward position, tongue stabilization devices, neuromuscular tongue muscle stimulators, or implantable nerve stimulators. In some cases, surgery may be necessary to correct a narrow airway [1].

Tips and Preventive Measures

If you have symptoms suggesting sleep apnea, it is important to consult your doctor. Early diagnosis and appropriate treatment can improve your quality of life and reduce the health risks associated with this condition. CPAP devices should be cleaned regularly with water and mild soap, or according to the manufacturer's instructions, to avoid the buildup of germs [2]. There are no FDA-approved medications for treating sleep apnea itself, but doctors may prescribe medications to help with wakefulness if you continue to experience sleepiness despite using a CPAP machine [1].

Medical references

• Always Tired? You May Have Sleep Apnea
• Do You Need a Device That Claims to Clean a CPAP Machine?