Central Sleep Apnea: Symptoms, Diagnosis and Treatment

Central sleep apnea (CSA) involves pauses or reductions in breathing effort during sleep. It differs from obstructive sleep apnea (OSA), where the upper airway becomes blocked. Symptoms can overlap, so a list of signs or the sound of snoring cannot reliably identify which condition is present.

Symptoms that deserve assessment

Possible symptoms include observed breathing pauses, waking short of breath, difficulty staying asleep, daytime sleepiness and trouble concentrating. Snoring can occur but may be less noticeable than in OSA. These symptoms have other possible causes and are not a five-point diagnostic test.

Why the cause matters

CSA can occur in association with heart failure, stroke, opioid medicines or sleeping at high altitude. Sometimes no cause is identified. Some people treated for OSA develop central events during treatment, known as treatment-emergent CSA. This does not mean everyone using CPAP will develop CSA or should stop using it.

Describe medication changes, travel and existing medical conditions to your sleep team. Do not reduce an opioid or change prescribed therapy without discussing it with the prescriber.

How is central sleep apnea diagnosed?

An overnight sleep study can record breathing patterns, oxygen levels and other physiological signals. Polysomnography helps distinguish central from obstructive events and identify other explanations for disturbed sleep. Assessment by other specialists may be needed.

Ask which events were recorded and how they relate to your symptoms. Consumer snoring recordings do not replace this assessment.

Specialist treatment and follow-up

The American Academy of Sleep Medicine’s 2025 guideline gives conditional recommendations for several options in selected forms of CSA: CPAP, bilevel pressure with a backup rate, adaptive servo-ventilation (ASV), low-flow oxygen, acetazolamide and transvenous phrenic nerve stimulation. They are not interchangeable home remedies.

The guideline emphasises the underlying cause, quality of life and individual clinical judgement. ASV in people with heart failure and reduced ejection fraction requires experienced centres, close monitoring and follow-up. “Use ASV if CPAP fails” is therefore not sufficient general advice.

Discuss expected benefits, risks and the review plan before treatment changes. If central events appear during CPAP use, contact the sleep team for interpretation rather than changing settings yourself.

Can an anti-snoring solution treat CSA?

Asonor is not a treatment for central sleep apnea. Reducing throat-related snoring does not correct a problem with breathing control or prove that central events have resolved. Follow the care plan for the diagnosed condition.

Sources

• Mayo Clinic: Symptoms and causes
• Mayo Clinic: Diagnosis and treatment
• AASM: 2025 central sleep apnea treatment guideline

Editorial update: September 2026. General information for adults; specialist assessment determines appropriate treatment.