Central Sleep Apnea Clinic
Dedicated evaluation and treatment for central sleep apnea in Frisco, serving Dallas–Fort Worth. remedē® evaluation and referral, and ASV therapy.
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Schedule a consultation with Dr. Jain to discuss your treatment options.
“Central sleep apnea is different from obstructive sleep apnea. The problem is in how the brain controls breathing, not a blocked throat. That difference changes which treatments are likely to help, and patients today have more options than they did a decade ago.”
- Dr. Vikas Jain, MD, FAASM, Board-Certified Sleep Medicine Physician
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What Is Central Sleep Apnea?
Central sleep apnea (CSA) is a sleep disorder in which breathing repeatedly stops during sleep because the brain temporarily fails to send the signal to breathe. In obstructive sleep apnea the throat collapses and blocks airflow. In central sleep apnea the main problem is not a blocked airway: the respiratory drive itself pauses, so the chest and abdomen stop moving and oxygen levels fall until the brain restarts breathing, often with an arousal from sleep.
CSA is less common than obstructive sleep apnea but is frequently missed or mislabeled. It is strongly associated with heart failure, atrial fibrillation, prior stroke, and long-term opioid use, and it can also appear for the first time after a patient starts CPAP. Because the underlying mechanism is different, the treatments are different too. Dream Sleep Medicine runs a dedicated central sleep apnea program for patients across Frisco, Plano, McKinney, Allen, Dallas, and the wider North Texas region.
Central vs. Obstructive Sleep Apnea
Obstructive Sleep Apnea (OSA)
- • The throat collapses and blocks airflow
- • The body keeps trying to breathe against the blockage
- • Loud snoring, gasping, and choking are typical
- • CPAP, oral appliances, Inspire, and Genio all target the airway
Central Sleep Apnea (CSA)
- • The brain pauses the signal to breathe
- • No breathing effort during the pause
- • Snoring may be mild or absent; waking short of breath is common
- • CPAP helps some patients; others need therapy that stabilizes breathing control
Many patients have a mix of both. The proportion matters: when more than half of the breathing events are central and there are at least five central events per hour, the pattern meets criteria for central sleep apnea, and the treatment plan changes.
Who Develops Central Sleep Apnea?
Heart Failure and Atrial Fibrillation
Heart failure is the most common cause, and atrial fibrillation is strongly associated. Reduced heart function can produce a waxing-and-waning breathing pattern called Cheyne-Stokes respiration. Untreated CSA is associated with worse outcomes in heart failure.
Long-Term Opioid Therapy
Opioids blunt the brain's response to carbon dioxide. Patients on chronic pain medication, methadone, or buprenorphine frequently develop central apneas and irregular breathing that CPAP often does not correct. This form of CSA can come with carbon dioxide retention, which changes the choice of device.
Treatment-Emergent CSA on CPAP
Also called complex sleep apnea. Some patients with obstructive apnea begin having central events once CPAP opens the airway. A high residual AHI that the machine flags as mostly central can be a sign of this, but device scoring is not definitive, and an attended sleep study is needed to confirm it.
Stroke, Brainstem Disorders, and Other Causes
Prior stroke, brainstem conditions, kidney failure, high altitude, and certain medications can all disrupt breathing control. Some patients have primary (idiopathic) CSA with no identifiable cause.
Common symptoms of central sleep apnea
- Waking up short of breath, or a bed partner noticing pauses in breathing without loud snoring
- Unrefreshing sleep and daytime fatigue despite enough hours in bed
- Frequent awakenings, insomnia, or trouble staying asleep
- Difficulty concentrating and low daytime energy
- CPAP that "isn't working": persistent events on the download, or feeling worse on therapy
- In patients with heart disease: nighttime shortness of breath or worsening heart failure symptoms that may accompany CSA
How We Diagnose Central Sleep Apnea
Central sleep apnea cannot be reliably diagnosed from symptoms alone. Home sleep tests record fewer signals, do not stage sleep, and are not reliable for classifying central events, which is why the American Academy of Sleep Medicine advises against home testing when central sleep apnea is suspected or when a patient has significant heart or lung disease, long-term opioid use, or a history of stroke. Getting the diagnosis right is the foundation of every treatment decision that follows, so our program starts with a physician evaluation rather than a device.
Physician Evaluation
Dr. Jain reviews your cardiac history, medications, prior sleep studies, and any CPAP data to identify the likely driver of your central apneas.
In-Lab Polysomnography
An attended sleep study in our Frisco sleep lab measures breathing effort and sleep stage directly, separating central from obstructive events and quantifying the central apnea index.
Cardiac Assessment
Because treatment choice depends on heart function, we coordinate an echocardiogram with your cardiologist when one is not already on file.
Already on CPAP? Bring your machine or your download. A high residual AHI with mostly central events on a CPAP report is a common way central sleep apnea is first suspected, and it changes the plan.
The remedē® System: Phrenic Nerve Stimulation
The remedē System is the first FDA-approved implanted therapy for moderate to severe central sleep apnea in adults (approved in 2017). Rather than pushing air into the airway, it works on the breathing signal itself. A small device placed under the skin of the upper chest sends gentle pulses to the phrenic nerve, which controls the diaphragm. The goal is a more stable breathing pattern through the night with no mask, no hose, and nothing to put on before bed. Individual results vary.
Works on Breathing Drive
Stimulates the phrenic nerve so the diaphragm contracts in a steadier rhythm, helping reduce central pauses during sleep.
Starts Automatically
Therapy is programmed to start at night when you are lying down and stop in the morning. Nothing to wear or adjust each night. The generator battery is not rechargeable and is replaced after several years.
Placed Like a Pacemaker
Placed through a vein by a cardiac specialist through a small incision below the collarbone, in a procedure similar to pacemaker placement. It does not require open-chest surgery.
Who may be considered for remedē
- Adults with moderate to severe central sleep apnea confirmed on an attended sleep study (the FDA indication)
- Most studied in CSA related to heart failure or with no identifiable cause; considered case by case in CSA from other causes such as opioid therapy
- Often considered when CPAP or ASV was not tolerated or did not work, or when ASV is not appropriate because of reduced heart function. Some insurers also require that PAP therapy was tried or is not appropriate.
- No active infection, and medically able to undergo a transvenous device procedure
The remedē pathway at Dream Sleep Medicine
What the evidence shows
In the pivotal randomized trial of 151 patients that led to FDA approval (Costanzo et al., The Lancet, 2016), 51% of patients receiving remedē therapy achieved at least a 50% reduction in their apnea-hypopnea index at six months, compared with 11% in the control group, with improvements in oxygen levels, sleep quality, and daytime sleepiness. Follow-up studies reported that these improvements were sustained over several years in participants who continued therapy. No trial has shown that remedē reduces mortality or hospitalization, and about one in ten patients had a serious implant- or therapy-related event in the first year, most often a lead that needed repositioning. Individual results vary, and Dr. Jain will discuss what the data mean for your situation.
Other Central Sleep Apnea Treatments We Offer
Adaptive Servo-Ventilation (ASV)
ASV is an advanced form of positive airway pressure that monitors your breathing breath by breath and delivers a variable amount of support to smooth out the waxing-and-waning pattern of central apnea. It is often the first device therapy we consider for opioid-related CSA, idiopathic CSA, and treatment-emergent CSA that persists despite several weeks of CPAP. We titrate it with attended in-lab studies in our own sleep lab.
Important safety note: A large trial (SERVE-HF) found that ASV increased the risk of cardiovascular death in patients with symptomatic heart failure and a reduced ejection fraction (45% or less). For that reason we confirm heart function before prescribing ASV, and we do not use it in patients who fall into that group. remedē offers an important alternative for some of these patients.
Treating the Underlying Cause First
Central apnea often improves when its driver is addressed. For heart failure, guideline-directed medical therapy and rhythm management with your cardiologist come first, and the sleep plan is built around them. For opioid-related CSA, reducing or rotating the medication with your pain physician can make a large difference. We coordinate this directly with your other specialists rather than treating sleep in isolation.
CPAP, Bilevel ST, Oxygen, and Medication
CPAP itself resolves central apnea in some patients, and treatment-emergent central apnea frequently clears after several weeks of consistent CPAP use, so patience and close monitoring are sometimes the right answer. For others, bilevel therapy with a backup rate (in selected patients), supplemental oxygen at night, or medications such as acetazolamide (an off-label use, usually short-term or as an adjunct) may be appropriate. Dr. Jain selects among these based on your sleep study, your heart, and your preferences.
Why Choose Dream Sleep Medicine for Central Sleep Apnea
A physician-led central sleep apnea program
Central sleep apnea patients need a board-certified sleep physician who can read the subtleties of an attended study, understands the cardiac and pharmacologic drivers, and can draw on the full range of therapies, including the ones that require coordination with cardiology.
What our program provides
- Accurate diagnosis: In-lab polysomnography in our own Frisco sleep lab, interpreted by Dr. Jain
- Coordinated CSA care: remedē evaluation and referral, ASV titration, bilevel, oxygen, and medication management
- Cardiology coordination: Direct communication with your cardiologist and the implanting electrophysiology team
- CPAP data review: We read your existing CPAP downloads to look for treatment-emergent and residual central apnea
- Long-term follow-up: Repeat testing to confirm the therapy is actually working, not just prescribed
Who should be evaluated
- •Heart failure or atrial fibrillation patients with poor sleep, fatigue, or nighttime breathlessness
- •Anyone whose CPAP report keeps showing a high residual AHI
- •Patients on long-term opioid therapy with daytime sleepiness or witnessed pauses
- •Patients told they have “complex” or “mixed” sleep apnea without a clear plan
- •Heart failure patients for whom ASV is not appropriate
Schedule a Central Sleep Apnea Evaluation
If CPAP has not worked, or you have heart disease and your sleep is not right, a central sleep apnea evaluation may be the step that has been missing. We see patients from across the Dallas–Fort Worth area and accept referrals from cardiologists, pain physicians, and primary care. Self-referrals are welcome; some insurance plans require a referral.
This page is for general information and is not a substitute for individual medical advice. Treatment decisions depend on your evaluation. remedē is a registered trademark of ZOLL Respicardia, Inc.
Last reviewed: November 2026 by Dr. Vikas Jain, MD, FAASM, Board-Certified Sleep Medicine Specialist
Related Services
Sleep Apnea Treatment
Comprehensive evaluation and treatment for obstructive sleep apnea, from CPAP to implants.
In-Lab Sleep Study
Attended polysomnography in our Frisco sleep lab, the standard for distinguishing central from obstructive apnea.
CPAP Alternatives
All treatment options beyond CPAP for patients who cannot tolerate or do not respond to it.
Inspire Therapy
Hypoglossal nerve stimulation for obstructive sleep apnea. Not a treatment for central apnea.
Insurance & Billing
Plans we accept and how coverage works for sleep testing and advanced therapies.
Ready for Better Sleep?
Schedule a consultation with Dr. Jain to discuss your treatment options and get personalized care.
Contact Us (214) 308-1525Dream Difference
- Average wait time: Days, not months.
- AASM Accredited Lab
- Interpreted by Board Certified Sleep Specialists