Central sleep apnea: what it is and how it differs from obstructive sleep apnea

Central sleep apnea is a type of sleep apnea in which the brain doesn't send the right signal to breathe, so breathing effort drops or stops during sleep. It isn't caused by a blocked airway, which is what happens in the far more common obstructive sleep apnea. It usually has a medical cause, such as heart failure, stroke or opioid medicines, and it's diagnosed and treated by a sleep doctor.

What is central sleep apnea?

Central sleep apnea is a breathing disorder that causes your body to reduce or stop the effort of breathing during sleep, according to the American Academy of Sleep Medicine (AASM). The brain and heart normally work together to set how much you breathe. In central sleep apnea, the brain doesn't send appropriate signals, so there are pauses with little or no airflow.

The AASM says it is usually caused by a problem in the brain or heart, and that certain medicines, such as pain medicines, can cause it too. It is less common than obstructive sleep apnea.

The pauses wake the body briefly, often without you knowing. The AASM notes this can happen hundreds of times a night, which is why many people with central sleep apnea feel very tired the next day.

How is central sleep apnea different from obstructive sleep apnea?

Central and obstructive sleep apnea differ in where the problem starts. In obstructive sleep apnea, breathing stops because the throat muscles relax and block the airway, even though you keep trying to breathe. In central sleep apnea, the airway stays open but the brain doesn't send the signal, so the effort itself stops.

That difference shapes almost everything else, from who gets it to how it's treated.

Some people have both kinds of events. Our guide to snoring vs sleep apnea explains the obstructive side in more detail.

What causes central sleep apnea?

Central sleep apnea has several distinct causes, and the AASM sorts adult cases into types based on them. Heart failure, stroke, kidney disease, opioid medicines and high altitude are the main ones. A smaller group develops it while being treated for obstructive sleep apnea, and in primary central sleep apnea the cause isn't known.

Heart failure and stroke

The AASM describes a pattern called Cheyne-Stokes breathing, where breathing effort and airflow rise steadily, fall, and sometimes stop altogether before the cycle repeats. It is linked with heart failure, stroke and possibly kidney disease. The AASM says it occurs mainly in men aged 60 or older, is seen in 25% to 40% of men with chronic congestive heart failure, and is found in 10% of men who have had a stroke.

Central apnea can also come from heart or kidney problems, or a problem in the base of the brain where breathing is controlled, without the Cheyne-Stokes pattern.

Opioids and other substances

The AASM says the medicines most associated with central sleep apnea are opioids, including prescription pain medicines and illicit drugs such as heroin. The risk seems to rise as the dose rises. Most studies have looked at use longer than three months, and it isn't clear whether short-term use carries the same risk.

High altitude

High-altitude periodic breathing looks similar to Cheyne-Stokes breathing but happens in people without heart failure, stroke or kidney failure. The AASM says some people sleeping above about 15,000 feet (about 5,000 meters) develop it, anyone sleeping above about 25,000 feet (about 7,600 meters) is affected, and it often improves as altitude decreases. Our guide to sleeping at altitude has more on this.

Treatment-emergent central sleep apnea

Some people with obstructive sleep apnea develop central apneas once they start CPAP. This is called treatment-emergent central sleep apnea. A 2020 review in the Chinese Medical Journal describes it as obstructive sleep apnea on the first sleep study, with obstructive events clearing on CPAP but central events appearing or persisting, making up more than half of all events.

How often it happens varies widely between studies. In a 2024 study in Sleep and Breathing of 116 people with obstructive sleep apnea, 20 (17.2%) developed central sleep apnea during a full-night CPAP titration. The 2020 review says it may settle on its own with continued CPAP in some people, while in others it persists and a different device may be needed.

What are the symptoms of central sleep apnea?

The most common symptoms of central sleep apnea are broken sleep with frequent waking, trouble falling or staying asleep, and daytime sleepiness. The AASM also lists pauses in breathing during sleep and waking up short of breath. A bed partner is often the first to notice the pauses.

Altru Health System's patient guide adds trouble focusing, mood changes and morning headaches. It also says snoring can happen in central sleep apnea, but may be less noticeable than in obstructive sleep apnea. So quiet nights don't rule it out. Our article on sleep apnea without snoring covers this in more detail, and our list of sleep apnea warning signs is a useful checklist.

Talk to your doctor if you wake up short of breath, someone notices pauses in your breathing, or you're sleepy enough to nod off at work or while driving. These are worth checking whatever type of apnea turns out to be involved.

How is central sleep apnea diagnosed?

Central sleep apnea is diagnosed by a sleep doctor, usually with an overnight in-lab sleep study called polysomnography. The AASM says the doctor will review your history and symptoms, and may ask you to keep a two-week sleep diary noting bedtimes, wake-ups, naps and how rested you feel.

Polysomnography records brain waves, heartbeat, breathing and limb movement during sleep. It shows whether you have central sleep apnea and how severe it is. For high-altitude periodic breathing, the AASM says a detailed history alone may be enough.

Home tests have limits here. The AASM's 2017 diagnostic guideline recommends in-lab polysomnography rather than a home sleep apnea test for people with significant heart or lung disease, a history of stroke, or long-term opioid use, all of which raise the chance of central events. Our guide to what happens at a sleep study walks through the night step by step, and our home sleep apnea test article explains when a home test fits.

How is central sleep apnea treated?

Central sleep apnea treatment starts with the cause, then adds a breathing device, oxygen or medicine where needed. The AASM's 2025 guideline says doctors should put treating the contributing conditions and improving how patients feel ahead of simply eliminating breathing events. The certainty of evidence behind each recommendation is low or very low.

Treating the underlying cause

The AASM says heart failure or kidney failure needs its own treatment, and stroke may need rehabilitation and a careful look at the risk of another stroke. For apnea caused by a medicine or substance, a change of medication or stopping it may be needed. Never stop or change a prescribed medicine, including an opioid, without talking to the prescriber.

CPAP and bilevel PAP

The 2025 guideline suggests CPAP for primary central sleep apnea and for central sleep apnea due to heart failure, medicines or substances, treatment-emergent central sleep apnea, and other medical conditions. It also suggests bilevel positive airway pressure with a backup rate for several types, and suggests against bilevel PAP without a backup rate.

Adaptive servo-ventilation (ASV)

ASV is a positive airway pressure device that measures your breathing pattern and adjusts pressure to steady it, the AASM explains. The 2025 guideline suggests ASV for most types of central sleep apnea, with shared decision-making first.

There is one important caution. In the SERVE-HF trial, published in the New England Journal of Medicine in 2015, 1,325 people with heart failure, an ejection fraction of 45% or less and mainly central sleep apnea were randomly assigned to ASV plus usual care or usual care alone. ASV didn't change the main outcome, but all-cause and cardiovascular death were both higher in the ASV group. The 2025 guideline says ASV in heart failure with reduced ejection fraction should be limited to experienced centers with close monitoring.

Oxygen, medicine and nerve stimulation

The guideline suggests low-flow oxygen for central sleep apnea due to heart failure and due to high altitude, though it notes people with mild, short-lived symptoms at altitude may reasonably decline it. It also suggests the medicine acetazolamide for several types. For primary and heart-failure-related central sleep apnea, it suggests transvenous phrenic nerve stimulation, an implanted device that signals the diaphragm, but says other treatments may be more appropriate first because it is invasive and costly.

Our overview of sleep apnea treatment options covers the treatments for obstructive sleep apnea.

Do mouth tape or nasal strips help central sleep apnea?

Mouth tape and nasal strips don't help central sleep apnea, and they aren't designed to. Both work on how air moves through the mouth and nose. Central sleep apnea is a problem with the brain's signal to breathe, so keeping the lips together or opening the nostrils doesn't touch the cause.

Mouth tape doesn't treat any kind of sleep apnea. A 2025 systematic review in PLOS One found that 4 of the 10 studies it included discussed a serious risk of asphyxiation if the mouth is sealed while the nose is blocked. If you have central sleep apnea, or suspect any kind of sleep apnea, skip the tape and follow your sleep doctor's plan. We don't recommend mouth tape for children.

If a doctor has ruled out sleep apnea and you simply want to breathe through your nose more, our guide to mouth tape vs CPAP explains where tape does and doesn't fit.

This article is general information, not medical advice.

Read next

• What happens at a sleep study, step by step
• Sleep apnea treatments explained
• Snoring vs. sleep apnea: how to tell the difference

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.