Unlike sleep disorders that are easier to diagnose and understand, central sleep apnea (CSA) can be baffling.

CSA patients might not snore, may be at their ideal weight, and may have not had a history of sleep disorders yet still find themselves with the condition characterized by pauses in breathing many times during the night.

Central sleep apnea is a neurological condition—in other words, the brain is not sending the correct signals to the respiratory system to keep breathing while the patient sleeps. Sometimes another medical condition causes CSA; sometimes, pain medication can lead to it; and sometimes, the apnea occurs for no known reason.

Whatever the cause, treatments are available for central sleep apnea. Here five of the most effective ways to help the CSA patient:

Central Sleep Apnea Treatments

1. Treating the medical condition that is also causing central sleep apnea. Congestive heart failure or the aftermath of a stroke can interfere with night-time breathing and lead to CSA. The solution here is simple: Treat the heart failure or the stroke and the apnea will likely subside.
2. Cutting back or eliminating the use of opiods. Studies have proved that more powerful pain medications such as morphine, codeine and oxycodone can cause central sleep apnea. Reducing the dosage or not taking them altogether can help, but discussing this option with your doctor and with a sleep specialist is important. Pain medications do just that—help with pain, and trying to fix the apnea might not be worth additional suffering when you are awake.
3. Continuous positive airway pressure (CPAP). More commonly associated with obstructive sleep apnea (OSA), a CPAP device can also help CSA sufferers, particularly those who are recovering from heart failure. With this treatment, the patient wears a mask that continuously delivers a constant pressure of air to the lungs, thus countering any inclination the body might have to pause breathing.
4. Bilevel positive airway pressure (BPAP). This is another treatment used for OSA sufferers that can be effective for central sleep apnea patients. Similar to a CPAP mask, a BPAP device adjusts the amount of air delivered to the lungs depending on whether the patient is inhaling or exhaling.
5. Adaptive servo-ventilation (ASV). Yet another device that uses a mask, ASV goes one step further by continuously detecting and adjusting to the patient’s breathing needs and delivering the correct amount of oxygen. If the user is breathing fine, the device reduces the air it provides. It the patient’s breathing begins to pause, ASV increases the oxygen.
6. Phrenic Nerve Stimulation.  Phrenic Nerve Stimulation is a new FDA-approved therapy for moderate to severe central sleep apnea in adult patients.  Phrenic nerve stimulation is delivered by a pacemaker-like implantable device that stimulates a nerve in the chest (phrenic nerve) to send signals to the diaphragm to control breathing.  It monitors respiratory signals while you sleep and helps restore normal breathing patterns. Because the device is implantable and turns on automatically during sleep, it does not require wearing a mask.

   
   

   Phrenic nerve stimulation allows normal breathing to resume by stabilizing carbon dioxide, preventing apneic events and the subsequent period of rapid breathing.

   
   

    

   Of course, the most effective treatment will vary from patient to patient, so discussing these options with a sleep specialist is crucial in determining how best to alleviate central sleep apnea.

Bill's Personal Story about Sleep Apnea

Living with sleep apnea often includes using a CPAP machine, which helps keep airways open throughout the night. While the CPAP can dramatically improve your symptoms, it can also make traveling a bit of a headache. That said, don’t be tempted to leave the machine at home—you'll risk feeling tired on your trip. It’s actually easier than you might think to bring it with you—just follow this guide.

The holiday season can be kind of a mixed bag. While it's often a wonderful time of year to celebrate with family and friends, it can also be expensive, stressful, and busier than busy.

Kids Can Get Sleep Apnea?

Any person, any age, can fall victim to obstructive sleep apnea—from new-born infants to those over 100 years of age.

Sleep Disordered Breathing

Sleep disordered breathing (SDB) is a general term that includes breathing difficulties during sleep. Obstructive sleep apnea (OSA) is included in this classification, but also included are less severe (but still significant) breathing patterns, such as upper airway resistance and flow limitation.

Sleep apnea is a respiratory disorder that presents itself as a partial or complete closing of the airway during sleep. Many factors that affect breathing and the airway structure contribute to the risk of having sleep apnea.

OSA Symptoms in Children

OSA displays differently in pediatric patients than it does in adult patients.

Obstructive sleep apnea is the partial or complete repeated closing of the airway during sleep. Children need oxygen, the same as adults do. During sleep, the brain and body construct, repair, restore and regenerate itself.

 If the brain and body are not getting oxygen in adequate amounts, a child’s growth and development can be thwarted by this lack of oxygen. This lack of oxygen causes stress hormones to be released into the bloodstream.

Not only does the body and brain not have enough oxygen to do its jobs, it now has added “fight-or-flight” hormones coursing through the body, creating a disease-promoting environment.

Children’s rapid growth and development cause them to be even more vulnerable and susceptible to cell damage caused by this lack of oxygen during repetitive apneas.

Each child is an individual, and their response to the affects of sleep apnea will be different from another child’s. One child may have behavior problems as a result of OSA while another may be a star student but wet his bed at night.

It is estimated that 30% of children who are diagnosed with ADHD really have obstructive sleep apnea. Children can be shamed for bedwetting, when in fact it may be the result of sleep disordered breathing and should be treated medically.

If your child shows any of the signs, symptoms or behaviors stated in the long list above, please have them evaluated for a sleep problem. You may be saving your child and yourself years of physical and/or mental discomfort by finding out the real reason. 

Factors That Affect Pediatric Sleep Apnea

According to Dr. Mary Cataletto, in non-obese and otherwise healthy children under the age of 8 years old, the prevalence of OSA is one to three percent. Most children show symptoms of sleep apnea between 2-10 years of age. Those with severe obstructive sleep apnea are likely to show signs and symptoms at 3-5 years of age.

Snoring is the sound produced when air passes through a restricted airway caused by its partial closure. As the air passes through the restricted airway, the throat tissues in the airway will vibrate, causing the snoring noise.

Habitual snoring affects about 10 percent of children aged 2-8 years of age. If snoring begins within the first few months of life, the child’s chances are increased for sleep apnea.

Snoring can be a sign of sleep apnea or it can be just an annoying noise the person makes while sleeping, which does not adversely affect their sleeping, but may disrupt the nearby sleepers' sleep!

More Risk Factors

According to Tanya Weinstock, obstructive sleep apnea is strongly associated with race. Black children younger than 18 years of age are 3.5 times more likely to develop OSA than white children.

There is a strong association of sleep apnea and environmental tobacco smoke, according to Dr. Weinstock. Children who live in parent-smoking households are more likely to have sleep apnea than children living in non-smoking households.

We have an obesity epidemic in our country. Pediatric obesity increases the risk of sleep disordered breathing 4 to 5 fold. OSA occurs in up to 60% of obese children.

Obesity is a significant problem for our culture, and pediatric obesity has many implications, including a propensity toward adult obesity, and increases in diabetes rates and cardiovascular problems (hypertension, heart disease and stroke).

Adenotonsillectomy 

Most children’s OSA is associated with large tonsils and adenoids. The first line of treatment in most children with OSA is adenotonsillectomy. This cures the OSA in about 75% of children. Some children, even after surgery, may still have airway obstruction due to large lymph nodes or other reasons.

Other children, such as obese patients and Down syndrome patients, may not be good candidates for surgery, requiring physicians to find other solutions for their OSA. For non-surgical candidates and those who have had surgeries that have not resolved the OSA, CPAP is the treatment of choice. 

CPAP Treatment

In children, CPAP is usually the second choice due to pediatric low compliance rate. Like some adults, children have difficulty having a mask on for 8 or more hours per night.

Carole Marcus, a pediatrics professor at Children’s Hospital of Philadelphia, states that treatment for children’s obstructive sleep apnea can improve the quality of life and behavioral issues. Even though it is difficult to get many children to be compliant and use the therapy for an entire night or on a consistent basis, Dr. Marcus found that pediatric patients using CPAP for only three hours a night showed a big difference.

The results of Marcus's study indicated that in spite of suboptimal adherence rates, there was significant improvement in neurobehavioral function in children after 3 months of CPAP therapy, even in developmentally delayed children.

Pediatric CPAP Masks

Years ago there were very few choices and designs for pediatric CPAP masks. Children would be given a petite or small adult mask and hope for the best. Of course, those masks did not fit a child properly and leaks developed which thwarted the quality of treatment, or discomfort caused the child to refuse to use it.

Mask manufacturers began making children’s masks a few years back to address the specific needs of children. 

With more and more children being diagnosed with sleep apnea as a result of the pediatric obesity epidemic, treatment for these children has become a major focus in the sleep medicine field. 

Mask manufacturers have developed different designs to give greater choice for patients.

Because children grow quickly, different pediatric masks fit different sized heads and faces. Until the last couple years, really small masks were not available. Currently masks available for infants to adolescents are on the market. Here is a list of the most current pediatric masks:

Respironics - Wisp Pediatric Nasal CPAP Mask - Philips Respironics (infants and up)

Respironics - Small Child Profile Lite CPAP Mask (1 year and older)

Circadiance - SleepWeaver Nasal CPAP Mask (2 – 7 years old)

ResMed - Pixi Pediatric CPAP Mask (2 years and older)

SleepNet - MiniMe 2 Nasal Pediatric Mask (2-12 years old)

ResMed - Mirage Kidsta Nasal CPAP Mask (7 years and older)

AG Industries - Nonny Pediatric Nasal CPAP Mask (fits children’s and small adults faces)

Respironics - Profile Lite Youth Size Gel Nasal CPAP Mask (fits children’s and small adult faces)

Pediatric masks accommodate a child’s needs, as well as appeal to a child’s nature. Respironics’ Wisp pediatric nasal mask has a giraffe print design on the frame to make things fun, and Circadiance’s SleepWeaver Advanced pediatric nasal mask incorporates a fabric cushion that seals gently to the face to protect delicate facial skin.

Summary

Children suffer from obstructive sleep apnea like adults do, maybe more so. Their rapidly growing and changing bodies and minds are susceptible to the lack of oxygen and needed nutrients that sleep apnea steals from them.

The first line of treatment is surgery, removing the tonsils and adenoids. If surgery is not successful in curing sleep apnea, or if other conditions are causing the disorder, CPAP is the treatment of choice.

In the last few years pediatric CPAP masks designed for children’s faces have become more readily available to treat the devastating disorder of obstructive sleep apnea.

Philips Respironics is another popular brand among CPAP users. They offer a variety of masks from nasal pillow masks to full-face masks.  This article will discuss the Wisp Nasal Mask and the DreamWear Nasal Cradle mask.