Do you or someone you know snore loudly, wake up gasping for breath, have witnessed choking episodes or breathing pauses during sleep and feel excessively tired during the day, perhaps even falling asleep in certain situations despite getting a full night’s sleep? These could be signs of Sleep Apnoea, a serious sleep disorder that goes far beyond just snoring. Left untreated, it can increase the risk of high blood pressure, heart disease, irregular heart rhythm’s stroke, work related accidents and other health problems.
Not all sleep apnoea is the same. There are two main types —Obstructive Sleep Apnoea (OSA) and Central Sleep Apnoea (CSA) — and understanding the difference is key to obtaining the correct treatment. Both can exist together or separately.
Obstructive Sleep Apnoea (OSA): The Blocked Airway
OSA is the most common form of sleep apnoea, occurring when the throat muscles relax excessively during sleep, causing a physical collapse and obstruction of the airway.
Obstructed Airway
Key Signs of OSA:
✔ Loud, persistent snoring
✔ Gasping, choking, or snorting during sleep
✔ Frequent awakenings or restless sleep
✔ Daytime tiredness, morning headaches, or difficulty concentrating
Who’s at Risk:
- Overweight or obese individuals
- People with a large neck circumference (typically over 17 inches / 43 cm for men, over 16 inches / 41 cm for women)
- Those with a naturally narrow airways or enlarged tonsils/adenoids
- Smokers and heavy alcohol consumers (which relax throat muscles further)
- Men are more commonly affected than women, but the prevalence in women rises especially post-menopause
- Some sedative mediations can worsen sleep apnoea
Treatment Options:
- Lifestyle modifications – including weight loss, avoiding alcohol and sedatives before bed, and changing sleep positions
- Continuous Positive Airway Pressure (CPAP) therapy – delivers a steady stream of air pressure through a mask worn at night to keep the airway open during sleep
- Oral appliances (mouthpieces) that can hold the raw forward – often recommended for mild to moderate cases
- Surgical options may be considered in some cases if other treatments aren’t effective such as hypoglossal nerve stimulation, ear nose and throat procedures.
- Some awake promoting medication may be prescribed by a sleep medicine specialist
Central Sleep Apnoea (CSA): The Brain’s Signal to Breath Problem
Unlike OSA, CSA is not caused by a physical airway blockage but by the brain failing to send proper signals to the breathing muscles. This results in pauses in breathing without effort to breathe, known as central apnoeic or central hyponoeic episodes. Richard et al 2025 recent publication highlights that not all CPAP algorithms will detect and report central apnoeas and central hypopnoeas accurately under various leak conditions. In their study only one device was shown to detect central hypopnoeas consistency under all leak conditions (Sefam device). This does highlight a potential clinical issue where some devices may be underestimating the prevalence of central hypopnoeas and therefore the person with CSA may not be receiving optimised therapy.
Key Signs of CSA:
✔ Episodes of breathing cessation during sleep (without loud snoring)
✔ Waking up suddenly short of breath or with a choking sensation
✔ Insomnia or frequent awakenings
✔ Excessive daytime sleepiness and difficulty concentrating
✔ Morning headaches
Who’s at Risk:
- People with cardiac conditions, especially heart failure and atrial fibrillation
- Stroke survivors
- Those using opioid pain medications
- Individuals living at high altitudes (due to lower oxygen levels)
Treatment Options:
- CPAP therapy should be the first choice in adults with CSA (A CPAP device that can report all residual central apnoeas and hypopnoeas is recommended in people to have CSA on their initial sleep study)
- Non Invasive ventilation with a backup rate in adults with CSA
- Adaptive Servo-Ventilation (ASV)– a form of positive airway pressure therapy that adjusts pressure levels to stabilise breathing
- Treatment of underlying conditions (e.g., managing heart failure)
- Low-flow oxygen may be recommended in adults with CSA due to heart failure
- Oral Acetazolamide may be recommended in some patients
- Transvenous Phrenic nerve stimulation may be recommended where other therapies have failed
Why It Matters:
Both OSA and CSA interrupt sleep and reduce oxygen levels, putting additional stress on the cardiovascular system and increasing the risk of other health complications. If left untreated, they can lead to increased risks of hypertension, arrhythmias, stroke, and reduced quality of life.
What Should You Do:
If you suspect sleep apnoea:
🔹 Monitor your symptoms or ask your partner to observe your sleep patterns
🔹 Consult a healthcare professional or sleep specialist for a detailed assessment, which may involve an overnight sleep study (polysomnography)
🔹 Explore treatment options suitable for your specific type of sleep apnoea and severity
Sleep apnoea is more than just loud snoring—it’s a serious health condition requiring medical attention. Don’t ignore the signs. Your health (and your sleep) depend on it!
#SleepApnoea #HealthySleep #OSA #CSA #SleepHealth #CPAP #BetterSleep
References:
1. Treatment-of-CSA-in-Adults-CPG.pdf