Obstructive and Central Sleep Apnea: What’s the Difference?

Sleep apnea is a condition where there are irregularities in the muscles that control your breathing. The condition results in stopping breathing, also known as an apneic event.

Sleep apnea can, in some instances, have severe implications for your health. Aside from chronic sleep deprivation and excessive daytime sleepiness, sleep apnea is also linked to type 2 diabetes, heart problems, liver problems, weight gain, and more.

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Do you find yourself:

• Snoring at night?
• Waking up to a rough snort?
• Waking up in the morning feeling unrested after a full night’s sleep?

Then, you may have a form of sleep apnea. Several forms of sleep apnea include:

• Obstructive sleep apnea,
• Central sleep apnea
• Complex sleep apnea
• Pediatric sleep apnea
• SBD

There are also similar conditions like hypopnea, a sleep disorder where an individual’s breathing becomes momentarily shallow or limited.

Sleep apnea is a common disorder affecting approximately one in 15 people in the United States, or about 22 million Americans. 80% of people suffering from sleep apnea are undiagnosed.

It is essential to understand the differences between which type of sleep apnea you or a loved one may be suffering from to do something about it properly. Here we will discuss the two primary forms of sleep apnea: obstructive sleep apnea, the most common form, and central sleep apnea.

What Is Obstructive Sleep Apnea?

Obstructive sleep apnea, Verified Source Medline Plus Online resource offered by the National Library of Medicine and part of the National Institutes of Health. View source  or OSA, is the most common form of sleep apnea. Obstructive sleep apnea is where the muscles relax in the throat area, causing a degree of airway blockage.

The result is a need for your lungs and diaphragm to work harder to push past the blocked throat area to breathe. The air is forced through a small space causes snoring. In moments where breathing stops, this is called apnea or an apneic episode.

Causes and Risk Factors of Obstructive Sleep Apnea

Several causes and risk factors can lead to developing obstructive sleep apnea. While some aspects are hereditary, and there is little to change, others result from age or behavioral patterns that can be fixed or mitigated.

For example, hypertension Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source  is made worse by sleep apnea. Many heart failure patients had sleep apnea as a contributing factor, as is the case with most sleep-related breathing disorders.

Here are some of the primary causes of obstructive sleep apnea.

Behavioral and Age-Related Factors

• Obesity: The majority of people with sleep apnea are obese or overweight
• Being biologically male: Approximately twice as many men Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source  suffer from sleep apnea than women.
• Postmenopause in women: Among women in menopause, the rate of sleep apnea is almost equal Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source to men of the same age.

Hereditary Factors

• Family history of OSA or snoring: Snoring by one or both parents increases the likelihood of snoring children having sleep apnea.
• Jaw structure: When the jaw does not work correctly or is an abnormal size compared to the rest of the head, the mouth is more likely to work with muscles around the face and neck to support proper breathing.
• Acromegaly: Acromegaly is the airway obstruction from an enlarged tongue and thick larynx tissue caused by high thyroid hormone levels. These obstructions commonly lead to sleep apnea.
• Hypothyroidism: Hypothyroidism is the opposite of Acromegaly caused by low thyroid levels. While studies are currently inconsistent, Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source  Hypothyroidism is still considered a potential factor.
• Large neck circumference: A large neck can also mean a smaller airway preventing normal breathing.
• Large tonsils: Common in children with obstructive sleep apnea, enlarged tonsils can cause breathing obstruction, leading to surgical removal if necessary.

Diagnosing Obstructive Sleep Apnea

Diagnosing sleep apnea typically involves a comprehensive evaluation that includes a variety of tests and assessments. One of the primary methods used in diagnosing sleep apnea is a sleep study, also known as a polysomnography.

With treating sleep apnea, first, you have to take the crucial step of getting diagnosed by a sleep specialist, who can then prescribe the appropriate therapy. Additionally, prioritize long-term lifestyle changes that promote a healthy weight, as obesity is a common risk factor for both types of sleep apnea and many co-morbid conditions associated with this serious sleep disorder.

During a sleep study, a person spends a night in a sleep center or sometimes at home with specialized equipment to monitor various aspects of their sleep. The equipment used in a sleep study typically includes sensors that measure brain activity, eye movements, heart rate, blood oxygen levels, airflow, and muscle activity. An at-home sleep study will have simpler equipment, and an inconclusive one may prompt a later lab study.

The data collected during the sleep study helps healthcare professionals evaluate the presence and severity of sleep apnea. Specifically, these sleep apnea tests examine the frequency and duration of breathing interruptions or apneas, as well as associated drops in blood oxygen levels. The sleep study can also help identify other sleep disorders that may be present alongside sleep apnea.

Can Obstructive Sleep Apnea be Managed?

There are many ways of managing obstructive sleep apnea, whether it is hereditary or behavioral. First, losing weight can significantly reduce the chance of obstructive sleep apnea occurring. Studies show that reducing your weight by 10% can result in lowering your RDI (respiratory disturbance index) by 26%!

Additionally, lowering weight reduces blood pressure, improves pulmonary function, widens neck airway area, and more. Also, weight reduction increases the effectiveness of a CPAP therapy machine if used.

As breathing intermittently stops, falling blood oxygen levels prompt the release of the hormone epinephrine, triggering a “fight or flight” response that elevates the heart rate and may result in high blood pressure. The heart’s efficiency in pumping blood decreases overall, and the pressure changes in the chest directly impact the heart, contributing to the effects of high blood pressure on OSA.

Other simple behavioral modifications can help manage obstructive sleep apnea. Avoiding alcohol before bedtime reduces OSA symptoms. Alcohol decreases breathing and relaxes muscles in your throat, each factor making it harder to breathe while asleep.

Another simple method of sleeping better with obstructive sleep apnea is to sleep on your side. Sleeping on your back or stomach adds more pressure to your chest, making breathing more difficult.

However, suppose you have a more severe case of obstructive sleep apnea. In that case, you may need to seek medical solutions such as surgery, a CPAP machine, other oral appliance. Or even surgery. Here are four common medical device interventions and ten surgical resolutions.

Continuous Positive Airway Pressure

Continuous positive airway pressure, or CPAP, is a treatment where you wear a mask or nasal tubes, which then force compressed air into the lungs. The air pressure causes more regular breathing by keeping the airway from closing.

In adults, a CPAP device is the most common form of medical treatment for obstructive sleep apnea and is very successful for improving sleep. However, for some people, the device can be uncomfortable, leading to loss of sleep.

Oxygen

Oxygen treatment is not generally used for OSA. In fact, in some cases, oxygen may make apnea worse. However, some people using a CPAP will still have low blood oxygen levels. For people with this particular problem, you can add additional oxygen to improve effectiveness.

Bilevel positive airway pressure or BiPAP is similar to a CPAP but ‘bilevel’. Bilevel pressure means the BiPAP device monitors inhaling and exhaling pressure for a more complete remedy. The two pressure levels are called inhalation positive airway pressure (IPAP) and exhalation positive airway pressure (EPAP).

Adaptive-Servo Ventilation

Adaptive-servo ventilation, or ASV, is a newer, non-invasive option that adjusts pressure as needed while you sleep. The ASV tracks your breathing throughout the night and adjusts air pressure automatically as required.

Oral Appliances

Sometimes, you can use oral appliances to move the jaw and tongue forward, preventing obstruction. In most cases, oral appliances are custom devices made by a dentist experienced in treating obstructive sleep apnea. However, there are several drawbacks to an oral device, such as poor-fitting, excessive salivation, pain in the jaw the next day, and even possible damage to teeth.

Milder cases of sleep apnea may be able to get away with the simple application of mouth tape to stop snoring. However, it’s important to address potential causes of sleep apnea with your doctor and not just rely on at-home remedies like mouth tape.

Surgery for Sleep Apnea

For more severe cases of sleep apnea, there are also surgical options. Here are ten surgical solutions for obstructive sleep apnea.

Genioglossus Advancement

Genioglossus advancement Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source is when a doctor tightens up the tendons in the front of your tongue. The result is the tongue then will not roll back and interfere with breathing while sleeping.

Septoplasty

A bent nasal passage and/or bent walls of the nasal passage (turbinates) can reduce the amount of airflow through the nose. Corrective surgery to one or both of these areas can help open up the airways. Septoplasty Verified Source Medline Plus Online resource offered by the National Library of Medicine and part of the National Institutes of Health. View source  is a surgery done to fix problems in the nasal septum, the part inside your nose that divides it into two sections.

Hypoglossal Nerve Stimulation

Hypoglossal nerve stimulation Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source attaches an electrode to the nerve that controls the tongue. A hypoglossal nerve stimulator works similar to the way a pacemaker works for a heart. The HNS will stimulate your tongue to prevent it from falling back and blocking the airway when you stop breathing.

While this is a newer treatment option, the results are strong. However, this treatment works best with people who lose weight first or already have a lower body mass index (BMI).

Radiofrequency Volume Tissue Reduction

If a breathing device, such as a CPAP or BPAP (Bilevel Positive Airway Pressure) device, a doctor can recommend radiofrequency volume tissue reduction or RFVTR. RFVTR is the process of using radiofrequency waves to shrink or even wholly remove tissue at the back of your throat, which in turn creates a wider airway.

While this treatment is primarily to stop snoring, it is also an effective sleep apnea treatment.

Midline Glossectomy

The tongue is a contributor to sleep apnea for about 60 percent of patients. Midline glossectomy Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source can be done through various techniques, including lingual tonsillectomy and submucosal lingualplasty. Midline glossectomy involves removing portions of the middle and back of the tongue to make the airways larger. Studies show a 60% success rate on these procedures.

Lingual Tonsillectomy

Lingual tonsillectomy is the removal of the majority of the lingual tonsil, or sometimes all of the tonsils and tonsillar tissue near the back of your tongue to enlarge the airway behind the tongue. This procedure is Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source common treatment for children with pediatric sleep apnea.

Uvulopalatopharyngoplasty

Rumor has it, if you can pronounce this correctly and repeat it three times, you will become the ruler of a kingdom (Kidding, of course)!

Uvulopalatopharyngoplasty (UPPP) is a surgery Verified Source Medline Plus Online resource offered by the National Library of Medicine and part of the National Institutes of Health. View source to open the upper airways by taking out the uvula, the soft flap of tissue that hangs down at the back of the throat.

Maxillomandibular Advancement

Also known as MMA, or jaw repositioning, Maxillomandibular advancement surgery can be an excellent solution to OSA. The bones in the upper and lower jaw reposition to relieve obstruction on the airway by creating more space behind the tongue. In addition, the MMA procedure Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source suspends the pharyngeal airway muscles to an anterior position, which increases soft tissue tension.

Hyoid Suspension

Hyoid suspension is also known as hyoid myotomy and suspension or hyoid advancement. Hybrid suspension stabilizes the airway near the tongue, preventing obstructive airway collapse in this area.

The procedure is similar to a genioglossus advancement. This procedure benefits people who have a blockage near the bottom of the tongue. However, this procedure is complex and tends to have limited results. For this reason, most experts in sleep disorders will not recommend it.

Anterior Inferior Mandibular Osteotomy

This procedure splits the chin in two, allowing the tongue to move forward. While this procedure is relatively simple and non-invasive, it also tends to be less effective. Surgeries like this are often performed in conjunction with more effective procedures at the same time.

What Is Central Sleep Apnea?

Central sleep apnea Verified Source Medline Plus Online resource offered by the National Library of Medicine and part of the National Institutes of Health. View source or CSA is a disorder where your breathing stops and starts due to your cessation of the respiratory drive rather than an obstruction.

Central sleep apnea results from the brain not correctly sending signals to breathing muscles that regulate respiration. Severe central sleep apnea can result in dangerous other problems such as stroke or heart failure.

Mostly linked to Central sleep apnea, snoring is not as commonly associated with Obstructive Sleep Apnea. Central Sleep Apnea has various types, and one of them is the Cheyne-Stokes breathing pattern, which can be caused by conditions like heart failure or stroke. This type is identified by irregularities in breathing patterns, involving both an increase and decrease in breaths.

Central sleep apnea happens when the brain fails to send the right signals to the muscles controlling breathing. Unlike obstructive sleep apnea, where breathing stops due to relaxed throat muscles blocking the airway, central sleep apnea is less common. 

Usually, the muscles of the throat intermittently relax during sleep, causing a blockage by constricting the airway. This repetitive muscular collapse occurs throughout the night and frequently leads to people being awakened from their sleep cycle, though not always entirely.

This is caused by a mechanical blockage in the airway, central sleep apnea occurs due to a lack of proper messages from the central nervous system to the muscles controlling breathing. 

When sleeping, central sleep apnea prevents proper breathing, but it differs from obstructive sleep apnea because it doesn’t involve upper airway obstruction. Other conditions like heart failure and stroke can lead to central sleep apnea.

Central sleep apnea can also be a result of severe illness, especially conditions involving the brainstem. In infants, central sleep apnea can be fatal, causing pauses in breathing for several seconds.

Causes and Risk Factors of Central Sleep Apnea

Central sleep apnea can be caused by several conditions, in particular damage to the brainstem. Several types of central sleep apnea can develop including:

• Treatment-emergent central sleep apnea: This form of sleep apnea used to be called complex sleep apnea syndrome. Treatment-emergent central sleep apnea is often the result of using CPAP therapy for treatment. This form is a combination of both obstructive and central sleep apneas.
• Medical condition-induced central sleep apnea: Several medical conditions such as stroke and kidney disease can cause non-Cheyne-Strokes apnea.
• Cheyne-Stokes breathing: The Cheyne-Stokes pattern involves a period of fast breathing followed by slow and heavy breathing and sometimes stopping breathing entirely. Instead of apnea, some people have periods of prolonged shallow breathing, known as hypopneas.
• Drug-induced apnea: Taking certain medications such as opioids and sleep medication — including morphine (MS Contin, Kadian, others), oxycodone (Roxicodone, Oxycontin, others), or codeine — can cause your breathing to become irregular, to increase and decrease in a regular pattern, or to stop entirely temporarily.
• High-altitude periodic breathing: A breathing pattern resembling Cheyne Stokes breathing can occur at very high altitudes. This pattern Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source involves alternating periods of rapid and slow breathing (or episodes of hyperventilation and apnea) to cope with reduced oxygen levels. At higher altitudes, the air pressure decreases, leading to a reduction in the partial pressure of oxygen. This change in oxygen levels can affect the respiratory system and contribute to the development or exacerbation of sleep apnea. Individuals are especially at risk of high altitude sleep apnea if they rapidly ascend without acclimatization.
• Idiopathic central sleep apnea: A final diagnosis that is usually given for all other conditions where the cause is unknown. ICSA Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source has no standardized treatment, though CPAP and pharmaceutical treatments may be tried.

Risk Factors for Central Sleep Apnea

Risk factors are mainly similar to those of obstructive sleep apnea, including:

• Age: Central sleep apnea becomes more common in adults as they age, especially those over age 60. However, this may be because older adults also tend to have other factors that cause central sleep apnea in higher amounts.
• Sex: Biological males are more likely to develop central sleep apnea than females. However, this is more complex with transgender sleep apnea. Testosterone increases sleep apnea risk. Persons assigned male at birth and persons who transition into males face increased risk due to increased testosterone. In addition, transitioning to a female can reduce sleep apnea risk due to increased estrogen. Many factors such as hormone levels and surgical status determine the exact risk of central sleep apnea in a transgender person.
• Heart disorders: People suffering from atrial fibrillation or congestive heart failure are at greater risk of central sleep apnea.
• Stroke, tumor, or other brain abnormality: Brain abnormalities can cause breathing impairments, including sleep apnea.
• CPAP complications: Some people using a CPAP can develop treatment-emergent central sleep apnea.
• High altitude: Sleeping at an altitude higher than your body is at can cause sleep apnea while at a higher altitude. However, this issue resolves itself typically after returning to your regular altitude.

Treatments for Central Sleep Apnea

Managing other medical issues such as heart and weight problems or even the removal of a tumor when needed can help improve central sleep apnea.

A CPAP or BiPAP machine can also help with both central and obstructive sleep apnea. However, it is essential to use the device properly as improper use can make your condition worse. If a CPAP or BPAP device is insufficient, an ASV (Adaptive servo-ventilator) may be needed.

​​Cheyne-Stokes breathing is characterized by a cyclical pattern of gradual increase and decrease in breathing, often associated with certain medical conditions, including heart failure and stroke.

People with heart problems face a higher risk of central sleep apnea, especially if they have an irregular heartbeat, known as atrial fibrillation. Additionally, an increased risk is associated with heart muscles that don’t pump enough blood for the body’s needs, a condition known as congestive heart failure.

Also, people with OSA may wake up dozens to hundreds of times per night. However, not everyone who snores has OSA, so it’s crucial to notice other signs such as fatigue and morning headaches. Central sleep apnea (CSA), though less common, is as dangerous as OSA. If you have CSA, your brain isn’t sending out the “Wake Up!” signal.

During episodes of central apnea, reduced airflow and breathing irregularities may contribute to dry mouth, as the normal production of saliva decreases when breathing becomes less consistent during sleep.

Finally, there are medications. Some sleep medicine may cause sleep apnea, while other drugs such as acetazolamide stimulate breathing in people with central sleep apnea. Medication is often for people who can not use positive airway pressure.

Diagnosing the Difference Between Obstructive and Central Apnea

Obstructive sleep apnea is the most common sleep disorder. With OSA, there is an obstruction in the airway when your muscles relax during sleep. The blockage often culminates in snoring.

Central sleep apnea is far less common but equally as dangerous. People who have central sleep apnea almost always have symptoms that begin in the brain. The brain fails to send breathing signals to the chest muscles and fails to send a message to wake up the sleeper to stop it.

Two key differences are OSA begins in the throat or mouth and causes repeated waking up. CSA starts in the brain and causes NOT waking up.

If these symptoms sound familiar and you feel you are suffering from a form of sleep apnea, you will want to speak to a doctor or other qualified medical specialist. They can arrange participation in a sleep study to determine the issue and take proper corrective action.

To address central sleep apnea, treatments may include managing existing conditions, utilizing a breathing assistance device, or incorporating supplemental oxygen to enhance the breathing process. 

Monitoring oxygen saturation levels is crucial in assessing respiratory health, especially in conditions like sleep apnea, where disruptions in breathing can impact the amount of oxygen reaching the bloodstream.

There is one device known for being very comfortable and less bulky compared to other options. It is the Phrenic Nerve Stimulation, which is an implantable therapy for central sleep apnea sufferers, stands out as it is not a mask, making it ideal for those who cannot or choose not to wear one. Activating each night, this implantable device ensures signals are sent to the diaphragm via the phrenic nerve. This can be used long-term. 

To effectively treat sleep apnea, take the essential step of consulting a sleep specialist for a diagnosis, enabling the prescription of the appropriate therapy.

Frequently Asked Questions

What’s the difference between obstructive sleep apnea and central sleep apnea?

Obstructive sleep apnea is the most common type of sleep apnea. The soft palate in your throat relaxes when you fall asleep, collapsing into the back of your throat and obstructing your breathing. This causes you to start and stop breathing while sleeping. It’s common among overweight people, older individuals, asthma sufferers, and people with nasal congestion.

Central sleep apnea is less common compared to obstructive sleep apnea. This condition is a result of neurological issues, often caused by Parkinson’s, stroke, and heart failure. With central sleep apnea, the brain is unable to transmit signals properly to your muscles, causing your breathing to pause throughout the night.

Can you have both obstructive and central sleep apnea?

Yes, having both obstructive and central sleep apnea is called complex sleep apnea (CompSAS). This is a newly discovered form of sleep apnea and is still widely debated in regard to the exact issue at hand.

Still, CompSAS patients are initially diagnosed with standard obstructive sleep apnea and treated for it. Most often, they’ll be prescribed a CPAP machine to improve their breathing at night.

However, when the obstruction issues are resolved and a person is still experiencing breathing difficulties, it means there is more at play and that the brain may be involved. From there, patients need to be diagnosed and treated for central sleep apnea along with obstructive sleep apnea.

What are the 3 types of sleep apnea?

The 3 types of sleep apnea are obstructive sleep apnea, central sleep apnea, and complex sleep apnea. Obstructive sleep apnea (OSA) is the most common type of sleep apnea. It’s characterized by an obstruction in your airways interrupting your breathing and lowering your oxygen levels, thus affecting your sleep.

Central sleep apnea (CSA) is a less common type of sleep apnea. With central sleep apnea, the brain doesn’t send proper signals to the muscles that control breathing, causing a person to stop breathing for ten seconds or more at a time.

Complex sleep apnea (CompSAS) is a syndrome where a person has both central and obstructive sleep apnea. When OSA patients don’t find relief with CPAP therapy, it means their breathing issues aren’t only the result of obstruction, thus suggesting that they have CompSAS.

When does central sleep apnea typically occur?

Central sleep apnea events most often occur during non-REM (non rapid eye movement) as this is when your body is least able to prevent these episodes. While you can still experience central sleep apnea events during REM sleep, it’s less likely compared to non-REM.

Another common time to experience central sleep apnea episodes is during the transition between wakefulness and sleep. As a sleep apnea sufferer, you’re unlikely to experience episodes when fully awake.

How common is central sleep apnea?

Central sleep apnea is one of the least common types of sleep apnea. Roughly 0.9% of people Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source  over forty years old have central sleep apnea, and it affects men over 65 more than women. Your risk of developing central sleep apnea is higher if you have heart disease, suffered from heart failure or a stroke, or live in high altitude regions.

The Bottom Line

In conclusion, sleep apnea is a condition where your breathing becomes irregular while you sleep. It can have serious effects on your health, such as chronic tiredness and problems with your heart and weight. How can you tell if you have sleep apnea? If you snore loudly, wake up suddenly during the night, or feel tired even after a full night’s sleep, you may have sleep apnea.

There are different types of sleep apnea, with obstructive sleep apnea and central sleep apnea being the most common. Obstructive sleep apnea happens when the muscles in your throat relax and block your airway, while central sleep apnea is caused by problems with the brain signals that control breathing.

Managing sleep apnea is important, and there are different treatments available, including lifestyle changes, medical devices like CPAP machines, and sometimes even surgery. It’s important to talk to a doctor if you suspect you have sleep apnea so that you can find the best treatment for you.