Top 5 Central Sleep Apnea Treatment Options

Sleep Apnea Treatment Options Part 4 of 4
Sleep apnea, which is when breathing stops and starts while you sleep, is a big reason why people don’t get a good night of sleep. Fortunately, it can be treated.

Drugs

The most commonly used treatment for central apnea are drugs that stimulate breathing reflexes.

Some drugs are not very efficient; others work for a time, but people may become more sensitive to the drug over time.

Others have unwanted side effects. The current drugs for central apnea treatment should only be used as a temporary measure. We can only hope that experts will do more research in this area.

Acetazolamide has been the most popular drug. Acetazolamide makes blood more acidic which stimulates the breathing reflex. Studies have shown that Acetazolamide can reduce the frequency of apnea episodes and cause a slight decrease in daytime sleepiness.

Some studies have not been as positive, and reports indicate that the drug can cause obstructive sleep apnea. Although more research is required, Acetazolamide appears to be the most promising drug for central apnea treatment.

Clomipramine, an antidepressant, has also been shown to improve central apnea. Although it has only been administered to a small number of patients, it has positively affected sleep and respiration and has fewer apnea episodes. Some patients became tolerant to the drug within 6-12 months. After that, it was no longer effective. Clomipramine can also cause impotence, which is one of the side effects.

Doxapram, a respiratory stimulant that can treat central apnea, has also been tested experimentally. This drug is intended to stimulate patients’ breathing while still recovering from anesthesia.

It is not recommended for long-term usage. Some side effects include hyperactivity, irregular heartbeats, high blood pressure, nausea, diarrhea, and urinary retention. People with high blood pressure, heart disease, and irregular heartbeats should not use it. Many people with sleep apnea have serious complications. This drug’s effectiveness remains to be determined.

Theophylline and aminophylline are both bronchodilators used to treat asthma and emphysema. Also, theophylline and almitrine treat depression in the breathing reflexes due to certain drugs like morphine or codeine.

Medroxyprogesterone is a hormone similar to female progesterone and stimulates respiration. Tryptophan is an amino acid that is said to be an antidepressant. None of these drugs have had a dramatic effect on central apnea. Side effects can be severe for all but tryptophan.

Mixed results have also been reported for oxygen. You can use it in severe cases with CPAP or bi-level PAP (CPAP)

There are many medications available, and more are being developed every year. One hopes that there will soon be a drug that can provide central apnea treatment without side effects. This field requires more research.

Breathing devices

Newer Continuous Positive Airway Pressure (CPAP) Technology

Many CPAP variations have been developed thanks to technological advances. These can be used to help those suffering from central sleep apnea. AutoNation-servo devices are a new type of breathing device that can analyze a person’s breath and mimic it or improve when their breathing becomes irregular.

People suffering from central apnea, particularly those who have had poor results with CPAP, should consult their sleep center to inquire about the auto-servo-type CPAPs, which are currently available at Respironics, Inc. in Pittsburgh, PA and ResMed Corp. in San Diego, CA. You may use an auto-servo device in some cases instead of a heavier mechanical ventilator.

See the section earlier on treating obstructive sleep apnea for more information about CPAP or bilevel PAP. After a consultation with your sleep specialist, you should only make the decision about central apnea treatment.

Diaphragmatic Pacemaker

The diaphragmatic pacemaker functions in the same way as a heart pacemaker. The pacemaker stimulates rhythmic muscle contractions using tiny pulses of rhythmic electric current.

The first diaphragmatic pacemakers were developed for patients with poliomyelitis whose breathing reflexes had been damaged. The “iron lungs,” which were soon developed, meant that you no longer needed the device.

Since then, some work has been done using diaphragmatic pacemakers for spinal cord injuries whose breathing reflexes were disrupted and infants with bad breathing reflexes. Some diaphragmatic pacemakers were tested on adults with central sleep apnea.

This seems ideal in theory. The absence of the nerve signal to the diaphragm tells it to breathe during sleep. The pacemaker used in rest should be capable of providing this signal. This technology is not very advanced, and the diaphragmatic pulse maker has not yet been widely available.

This may be partly due to the lack of demand. With better recognition of central sleeping apnea, demand may rise. The delicate surgery required to implant the pacemaker is necessary to place two tiny electrodes near the phrenic nerves, which control the diaphragm.

You can either inject the local anesthetic in the neck or use general anesthesia in the chest cavity. It is common to stimulate both sides of the body’s nerves rather than one.

This would cause diaphragm stimulation to only one side. During surgery, a tiny receiver is also placed under the skin. A radiofrequency generator is used to stimulate the pacemaker.

It is placed on the skin above the receiver. There are some risks and problems with using a diaphragmatic pacemaker for sleep apnea. It can also cause obstruction apnea, which could lead to new situations.

The most serious risk is that the phrenic nervous could be damaged during surgery or later. The person would be paralyzed and unable to breathe independently if they lost both of the phrenic nerves.

It is essential to perform the surgery with great care to avoid any nerve damage. It is a wise decision to consider this type of surgery. It would be best to look for a hospital with a history of using diaphragmatic pacemakers.

Also, seek out the most familiar surgeon with the procedure. A diaphragmatic pacemaker is currently not an option for many people suffering from central apnea. However, it might be possible for some patients. These devices could become more appealing as research continues and more experience is gained.

Mechanical Ventilators

People with central apnea can use various mechanical breathing systems to aid their sleep. You can use these devices to force air into the lungs using “positive pressure,” which mimics the rhythmic breathing pattern.

A positive-pressure ventilator is a device that continuously pushes air through a tube into the airway. You can supply air via a nasal mask, face mask, or tube.

It may also enter the body through a tracheostomy (an opening at the throat) or the nose or mouth. The use of a positive-pressure ventilator is more straightforward than that of a negative-pressure ventilator.

A negative-pressure ventilator functions differently. A negative-pressure ventilator works differently. The “iron lung” is probably the most well-known example. It was created in the 1930s to help polio victims “breathe” after losing their ability to breathe. The iron lung has been reduced to a smaller size and is now limited to the chest.

There have been problems with mechanical ventilators. It can be challenging to regulate the rhythm.

You should closely monitor blood oxygen and carbon dioxide levels to ensure those ventilator settings are safe and effective. A mechanical system that controls all breathing is uncomfortable for people who can breathe normally and are somewhat independent.

The latest generation of ventilators is small and portable. They minimize discomfort by allowing the individual to breathe naturally and stopping breathing.

These ventilators are small and portable and can be very effective for people with central apnea who cannot sleep or breathe simultaneously.

Summary

  • The most effective treatment is the conservative one and will work for you.
  • Treatments for mixed apnea or obstructive sleeping apnea
    • Weight loss
    • Breathing devices like CPAP
    • Oral appliances, such as jaw or tongue retainers
    • Medication
    • Sleep apnea surgery
  • Before you agree to have surgery:
    • Ask a sleep specialist for an estimate of the likelihood that surgery can eliminate your sleep apnea.
  • Treatments for central hypopnea
    • Medication
    • Ask for a second opinion by an ENT surgeon who has experience and skill in treating sleep apnea.

Sources:

  • Diaphragm Pacing: Background, Indications And Contraindications, Technical Considerations. (2018, January 22). Diaphragm Pacing: Background, Indications and Contraindications, Technical Considerations. https://emedicine.medscape.com/article/1970348-overview.
  • Offices And Distributors. (2020, November 9). Healthcare Professional. https://www.resmed.com/en-us/healthcare-professional/contact/offices-distributors/.
  • Choose Your Country/language | Philips Respironics. (n.d.). Philips. https://www.usa.philips.com/healthcare/resources/landing/experience-catalog/respironics.
  • Oxygen Therapy for Sleep Apnea. (2020, June 5). Verywell Health. https://www.verywellhealth.com/oxygen-therapy-in-sleep-apnea-3015220.
  • Effects Of Medroxyprogesterone Acetate In Obstructive Sleep Apnea – PubMed. (1986, December 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/2946559/.
  • The Effects Of Aminophylline On Sleep And Sleep-disordered Breathing In Patients With Obstructive Sleep Apnea Syndrome – PubMed. (1987, July 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/3300449/.
  • The Effect Of Theophylline On Sleep-disordered Breathing In Patients With Stable Chronic Congestive Heart Failure – PubMed. (2003, November 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/14642143/.
  • Effect Of Doxapram On Obstructive Sleep Apnea – PubMed. (1986, April 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/3708186/.
  • [The Effects Of Clomipramine On Diurnal Sleepiness And Respiratory Parameters In a a Case Of Prader-Willi Syndrome] – PubMed. (1998, December 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/9894231/.
  • Acetazolamide Attenuates the Ventilatory Response To Arousal In Patients With Obstructive Sleep Apnea. (2013, February 1). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543060/.
  • The Effect Of Acetazolamide On Sleep Apnea At High Altitude: a Systematic Review And Meta-analysis – PubMed. (2017, January 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/28043212/.
  • Which Medications Are Used In the Treatment Of Central Sleep Apnea (CSA) Syndromes?. (2022, January 25). Which medications are used in the treatment of central sleep apnea (CSA) syndromes?. https://www.medscape.com/answers/304967-114309/which-medications-are-used-in-the-treatment-of-central-sleep-apnea-csa-syndromes.
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