Obstructive, Central, and Mixed Apnea: Understanding the Three Types of Sleep Apnea

Most people think of sleep apnea as just loud snoring, but it’s actually a potentially dangerous sleep disorder. And here’s something even fewer people realize — there isn’t just one type of sleep apnea, but three: Obstructive Sleep Apnea (OSA), Central Sleep Apnea (CSA), and Complex Sleep Apnea Syndrome (CompSA).

Sleep apnea is more common than you might think — research suggests it affects up to 30% of men and 17% of women, with about a third of the global population experiencing some form of it. But despite how widespread it is, sleep apnea doesn’t look the same for everyone.

It’s important to understand the differences between the types of sleep apnea, especially if you or someone you love has sleep apnea. Not only can it help you make sense of your symptoms, but it can also guide you toward the right treatment.

Below, we’ll break down the different types of sleep apnea, what causes them, and how they’re treated.

The three types of sleep apnea include:

• Obstructive Sleep Apnea (OSA): Caused by a blockage in the airway when throat muscles relax too much.

• Central Sleep Apnea (CSA): Caused by the brain failing to send signals to the muscles that control breathing.

• Mixed Sleep Apnea, or Complex Sleep Apnea (CompSA): A combination of both OSA and CSA, often appearing after starting CPAP treatment. It is heavily linked to pre-existing neurological issues.
  
  

All of these fall under the umbrella of a sleep disorder.

Let’s take a step back for a second. To start broadly, sleep disorders are conditions that affect sleep quality and duration and can result in significant health complications.

Common sleep disorders include:

• Insomnia

• Parasomnias (which include sleepwalking and night terrors)

• Narcolepsy

• Restless leg syndrome (RSL)
  
  

Disordered sleep breathing is a subcategory of sleep disorders. and refers to a group of breathing problems that happen while you are sleeping. These disorders involve disrupted sleep patterns and reduced levels of oxygen.

All forms of sleep apnea are types of disordered sleep breathing. Another form of disordered sleep breathing is upper airway resistance syndrome (UARS), a milder form of blockage in the airway. This condition can sometimes progress into OSA.

All sleep disorders can have serious consequences if left untreated. 

Obstructive Sleep Apnea (OSA) is the most common type of sleep apnea. It happens when soft tissues in the throat collapse, blocking airflow and making breathing very hard to impossible. This leads to pauses in breathing, snoring, and gasping for air while sleeping.

Imagine trying to drink through a straw that keeps collapsing — it makes it harder for air to get through. When you have OSA, something similar is happening with your throat. 

• Being overweight: Extra fat around the neck can put pressure on the airway. If you are obese, your risk of OSA increases.

• Age: It becomes more common as people get older.

• Family history: Genetics can play a role in your risk of OSA.

• Large tonsils or a small airway: Some people naturally have narrower airways or more neck muscle or soft tissue, which can cause OSA.
  
  

While middle-aged adults are most commonly affected, OSA can occur at any age.

Knowing the symptoms is an important step in identifying if you need further medical advice. Key symptoms of obstructive sleep apnea include:

• Loud snoring

• Waking up choking or gasping for air

• Feeling exhausted during the day

• Morning headaches

• Dry mouth in the mornings

• Mood swings

• Brain fog

Obstructive sleep apnea can be treated! Depending on the severity of the OSA, it can be treated rather easily and affordably. It is very important to consult your doctor before spending too much money, as they will be able to give you the best advice.

Common OSA treatments include:

• Continuous Positive Airway Pressure (CPAP) Therapy: This machine keeps your airway open by providing a steady stream of air. This is the gold standard for treating severe OSA.

• Bilevel Positive Airway Pressure (BiPAP) Therapy: This machine is similar to a CPAP. But unlike a CPAP, which delivers a constant stream of air, a BiPAP has two pressure settings.

• Oral appliances: Appliances like mouthguards can help position the jaw to keep the airway open, improving some OSA symptoms.

• Positional sleep changes: Sleeping on your side, sometimes with the help of a good quality pillow, can help keep your airways open at night. 

• Lifestyle changes: Losing weight, quitting all forms of smoking, and avoiding alcohol before bed can help prevent snoring and lessen the effects of OSA.
  
  

Some people use a combination of the above treatments — for example, you might find it helpful to quit smoking and use a mouthguard while sleeping on your side. 

Central sleep apnea (CSA) also involves interrupted breathing throughout the night.. But unlike OSA, where airway blockage leads to breathing interruptions, CSA occurs because your brain fails to control your respiratory system.

Simply put, your brain sort of forgets to tell your muscles to keep breathing. This leads to long pauses where the body doesn’t take in any air, which causes your body to go into a panic, sending alarm signals to the brain to kick-start your body’s breathing again.

So, why does your brain stop telling your muscles to breathe? Here are some possible causes of CSA:

• Heart conditions: Congestive heart failure is a common trigger for CSA.

• Brainstem problems: The brainstem controls breathing. If it’s damaged — say, from an accident, disease, or oxygen deprivation — it can affect breathing signals.

• Certain medications: Opioid pain medications can disrupt normal breathing patterns by interfering with breathing signals.
  
  

Sleep studies are essential in distinguishing CSA from OSA, as they analyze breathing patterns and brain activity during sleep.

Knowing the symptoms of CSA is key to identifying if you might need further medical attention.

The core symptoms of central sleep apnea are:

• Periods of silent breathing pauses: Unlike the loud gasping and snorting of OSA, central sleep apnea is much quieter. The signature pausing of breathing is still present.

• Waking up feeling short of breath: If you wake up struggling to breathe, yet you are not gasping loudly or feel like your throat is sore, it could be a symptom of CSA.

• Trouble staying asleep and insomnia: Insomnia and Fragmented Sleep Syndrome — the inability to fall or stay asleep — are associated with CSA.

• Excessive daytime sleepiness: Daytime fatigue and difficulty concentrating are telltale signs that you are not getting a restful enough sleep, which could be due to CSA.

The common forms of treatment for CSA include:

• CPAP or BiPAP therapy: These machines are generally used to treat OSA, but they can sometimes be helpful for people with CSA.

• Adaptive Servo-Ventilation (ASV): This is a more advanced device that adjusts air pressure based on breathing patterns.

• Treating underlying conditions: If CSA is caused by heart failure or neurological issues, treating the root problem can help.
  
  

Central sleep apnea is typically associated with other underlying conditions, so if you are concerned you might have it, you should talk to a doctor. 

CSA isn’t just about disrupted sleep — it can seriously impact your overall health. When your brain fails to send the right signals to breathe, your body is deprived of oxygen, leading to a range of complications. Here’s why untreated CSA is a real concern:

• Heart problems: Increased risk of high blood pressure, irregular heartbeats, and heart failure.

• Low oxygen levels: Repeated drops in oxygen can strain vital organs.

• Daytime fatigue: Poor sleep quality can lead to excessive tiredness, raising the risk of accidents.

• Cognitive issues: Memory loss, brain fog, and difficulty concentrating are common side effects.

• Increased health risks: Untreated CSA is linked to a higher risk of stroke and metabolic disorders.
  
  

The good news? CSA is treatable. Recognizing the symptoms early and seeking medical help can prevent serious complications and improve your quality of life.

Complex Sleep Apnea (CompSA) — also known as mixed sleep apnea — is a condition in which both OSA and CSA are present. It typically begins when someone who is diagnosed with OSA begins CPAP therapy but continues to experience breathing pauses.

It seems that prolonged OSA leads to CSA, although there’s no scientific consensus on why this actually happens. 

Some risk factors for mixed sleep apnea are similar to those for OSA and CSA, like being overweight or smoking.

There are other risk factors that are specific to CompSA:

• Having severe OSA

• Being over 65 years old

• Having heart conditions or neurological disorders

• History of stroke

• Patients on CPAP therapy who continue to have breathing pauses

• Using opioid medications, particularly if you already have OSA

Because it’s a mix of both types, treatment often involves:

• ASV (Adaptive Servo-Ventilation) therapy: This is a more advanced version of CPAP that helps regulate both airway obstruction and brain signal issues. It can also adjust airflow based on detected respiratory patterns.

• Monitoring and adjusting CPAP settings: A specialized device might not be necessary if you can find the settings on your CPAP machine that can treat your CompSA.

• Medical management: Addressing any underlying heart or brain conditions that are comorbid with both CSA and CompSA.

• Lifestyle changes: Basic changes like exercising regularly, quitting smoking, and side sleeping can all help reduce the symptoms of all forms of sleep apnea.
  
  

It is important to work with a medical professional to find the best solution for you. If you’re treating your OSA but still experiencing many of the symptoms, ask your doctor if you have CompSA.

The three types of sleep apnea have one thing in common — when left untreated, they can have serious impacts on your health.

Sleep apnea increases your risk of developing the following health issues:

• High blood pressure: Repeated oxygen drops put stress on the heart.

• Increased risk of stroke and heart disease: Poor oxygen levels strain the cardiovascular system.

• Memory and concentration issues: Poor sleep affects brain function.

• Daytime fatigue and accidents: Tiredness increases the risk of car crashes and workplace injuries.
  
  

You can learn more by reading our article about the dangers of snoring. 

If you're in a hurry, here's a table that simplifies the three types of sleep apnea: 

Sleep apnea isn’t just about snoring — it’s a serious health condition that can impact your daily life and long-term health.

The good news is that sleep apnea is treatable. Ask your doctor about the best way forward — from a CPAP or BiPAP machine to simple lifestyle changes, and over-the-counter options can really change your life.

We stock a variety of clinically proven snore solutions, including our Somnofit-S Anti-Snore Mouth Guard+ and the Posiform Anti-Snore Pillow. These products are clinically proven to reduce snoring and improve sleep quality.

If you think you might have any form of sleep apnea, don’t wait until it wreaks further havoc on your health. Make an appointment to speak with a doctor about your treatment options. This is the first step in helping you sleep better, feel better, and live better. 

The content in this article is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a licensed healthcare provider with any questions you may have regarding a medical condition or treatment options. Please consult a qualified healthcare professional for personalized medical advice or concerns about snoring, sleep disorders, or related health issues.