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What Is Complex Sleep Apnea?

Many people have heard of obstructive sleep apnea (OSA) because it is the most common type of sleep disordered breathing. In general, if someone says that they have sleep apnea, it is usually OSA, which is caused by the collapse or obstruction of your airway during sleep. The second common type of sleep disordered breathing is central sleep apnea (CSA), which has different characteristics than OSA and which can be caused by a variety of different conditions. 


Recent research has identified a third type of sleep apnea—complex sleep apnea—which combines characteristics of obstructive sleep apnea (OSA) and central sleep apnea (CSA).  It is also known as treatment-emergent central sleep apnea because it develops when a person is receiving treatment for obstructive sleep apnea (OSA) and they suddenly develop central sleep apnea (CSA) symptoms. 


Complex sleep apnea (or treatment-emergent central sleep apnea) has appeared in patients being treated with continuous positive airway pressure (CPAP) appliances worn over the face to maintain an open airway. Even though these patients stopped choking and gasping, they would still stop breathing (or breathe ineffectively and shallowly) during sleep. It seemed that their body no longer received the right message from the brain to continue to breathe. 


In some cases, the person suffering from complex sleep apnea syndrome may experience a combination of short obstructive events and central apnea events that do not respond well to continuous positive airway pressure (CPAP) therapy. These factors complicate the treatment for this type of sleep disordered breathing, which is why it is called complex sleep apnea syndrome (CompSAS).


If you have been diagnosed with complex sleep apnea, please consult with Breath of Life Dental to learn if the Vivos Biomimetic Oral Appliance can get your sleep and life back on track. 

What Causes Complex Sleep Apnea?

In order to understand what causes complex sleep apnea (or treatment-emergent central sleep apnea), it is important to understand the other types of sleep disordered breathing first:  obstructive sleep apnea and central sleep apnea. This is because complex sleep apnea is a combination of obstructive and central sleep apnea events, and it usually occurs when someone who is being treated for obstructive sleep apnea develops central sleep apnea symptoms.

Obstructive Sleep Apnea

The most common type of sleep disordered breathing is obstructive sleep apnea. When you sleep, your body (and especially your muscles) release their tension and relax. But sometimes the muscles that support the back of your throat relax more than they should. When this happens, it causes your airway to narrow enough that you can’t draw in sufficient air. In some cases of obstructive sleep apnea, your tongue also drops back into your airway, further blocking your airflow and suffocating you. 


When you aren’t getting enough air, your brain recognizes the problem immediately and signals the emergency. You may start to strain to breathe, gasp or choke. Because you are not breathing properly, your blood oxygen level gets lower which signals to your brain that something is wrong. Finally, the emergency rouses you enough that you partially wake up and take a big breath. 


This problem repeats throughout the night. In fact, it can happen dozens of times per hour, and each incidence of choking is followed by your body waking up. You likely will not remember waking up multiple times throughout the night, but you will feel the effects in your body the next day. If left untreated, this condition can have serious consequences on your physical health and emotional wellbeing. 

Central Sleep Apnea

The less-common type of sleep disordered breathing is central sleep apnea. When you go to sleep, your brain sends signals to your respiratory muscles to keep you breathing automatically. But sometimes those signals are either ignored by your respiratory muscles or your brain does not send the signals in the first place. When that happens, you stop breathing intermittently, which is called central sleep apnea. This can occur all throughout the night and make you wake up repeatedly to breathe, just like with obstructive sleep apnea. 


There are two different categories of central sleep apnea (CSA) depending on whether your breathing is too slow (hypoventilation) or too fast (hyperventilation), and each type can be caused by several different conditions or factors. 


Hypoventilation type central sleep apnea, where your breathing is abnormally slow, can be caused by: 


  • Medical conditions that affect the brainstem, such as a brain infection, stroke, tumor, head or neck trauma, etc.
  • Narcotic medicines which both lower your brain’s ability to send the signals that control your breathing and also relax your muscles.
  • Neuromuscular diseases, such as amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). These conditions cause muscle weakness, including your respiratory muscles.


Hyperventilation type central sleep apnea, where your breathing is too fast, can be caused by: 



  • Cheyne-Stokes breathing, which is a distinct pattern of breathing commonly found in people with heart conditions such as heart failure and atrial fibrillation.
  • Altitude-induced periodic breathing, which happens when you ascend to an altitude above 8,000 feet, such as on a hike or when camping. The air at that altitude has a lower concentration of oxygen, which causes you to breathe harder. This can lead to CSA when you sleep.

So How Does Treatment Lead to Complex Sleep Apnea Syndrome?

The most common treatment prescribed to people who suffer from obstructive sleep apnea is called continuous positive airway pressure (CPAP) therapy. This therapy is achieved by using a CPAP machine, which is essentially an air pump with an attached face mask. When you go to sleep at night, you wear the mask because it provides continuous positive airway pressure. It does this by blowing a steady stream of air into the mask. 


The continuous positive airway pressure is strong enough to prevent your throat muscles from closing, even if they relax too much. It can also keep your tongue from blocking your airway and so prevent obstructive events from taking place. By using a continuous positive airway pressure machine, many people have been able to overcome their obstructive sleep apnea and get a good night’s sleep. 


However, in a small number of cases, treatment with a CPAP machine handles the person’s obstructive sleep apnea, but then they start experiencing central apnea events. This means that even though their airway is clear of obstructions, the person’s brain does not send the electrical signals to their respiratory muscles—or the brain does send the signals, but the respiratory muscles ignore them. So now the obstruction is out of the way, but the person develops treatment-emergent central sleep apnea (a.k.a. complex sleep apnea).

What Makes Complex Sleep Apnea so “Complex”?

Treatment-emergent central sleep apnea is also called complex sleep apnea because its exact causes and cures are as of yet unknown, and it requires different treatment than the other two types of sleep apnea. Another reason that this type of sleep disordered breathing is considered complex is because it can cause you to suffer from a combination of obstructive apnea events and central apnea events.


Treatment-emergent central sleep apnea, or complex sleep apnea, often happens as a result of treating obstructive sleep apnea with a continuous positive airway pressure (CPAP) machine. While obstructive apnea events will resolve with CPAP therapy, central apnea events will not. Because of this, a CPAP machine may not fully handle your complex sleep apnea symptoms. However, the majority of cases of treatment-emergent central sleep apnea do clear up on their own over time. 

Symptoms of Complex Sleep Apnea Syndrome

The biggest symptom of complex sleep apnea is the emergence of central apnea events during treatment with a CPAP machine for obstructive sleep apnea. 


In addition to the above, people who have complex sleep apnea (treatment-emergent central sleep apnea) can experience the same symptoms as those who have obstructive sleep apnea or central sleep apnea, including: 


  • Loud snoring
  • Waking up gasping for air or choking
  • Having headaches in the morning
  • Difficulty concentrating during the day
  • Excessive exhaustion during the day
  • Dry mouth or sore throat in the morning
  • Unexplained changes in mood
  • Sudden short temper or irritability
  • Unusually low sex drive
  • Difficulty getting to sleep and staying asleep
  • TMJ disorders
  • Higher blood pressure
  • Increase in cholesterol levels
  • Increase in blood sugar levels


If your obstructive, complex, or central sleep apnea symptoms are left untreated, they can get worse and lead to serious medical complications. 

What Increases Your Risk of Developing Sleep Apnea?

There are certain lifestyle factors that can increase your risk of developing obstructive, complex, or central sleep apnea as an adult, which is why part of your treatment plan may include changes to your health habits. These factors include: 

  • Obesity — Excess fat around your neck can put too much pressure on your airway when you lie down to sleep at night and cause obstructive sleep apnea. Maintaining a healthy weight is a good preventative measure against sleep apnea. 

  • Being male — Men are two to three times more likely than women to develop obstructive, complex, or central sleep apnea. Men should take extra precautions to maintain good health to avoid developing sleep apnea.

  • Old age — Sleep apnea occurs significantly more in older adults, likely due to our muscles getting weaker as we age. Routine exercise and a nutritious diet can help keep your muscles strong and prevent sleep apnea. 

  • Drug and alcohol use — Alcohol and sedatives are substances that relax your muscles, which can lead to obstructive sleep apnea. To help you prevent sleep apnea, you should reduce or completely quit using these types of substances. 

  • Smoking — Smokers are three times more likely to develop obstructive sleep apnea than nonsmokers. A great preventative step to reduce your risk of developing sleep apnea is to reduce or completely quit using cigarettes, vaping devices, or any other similar drug.

  • Medical conditions — Certain medical conditions can increase your risk of developing obstructive sleep apnea. These conditions include: congestive heart failure, high blood pressure, type 2 diabetes, Parkinson's disease, PCOS, and asthma. If you have any of these conditions, Dr. Seifi can help you figure out the best steps you can take to reduce your risk of developing sleep apnea. 

Medical Risks of Untreated Sleep Apnea

Many people think the biggest side effect of obstructive, complex, or central sleep apnea is feeling tired during the day, and that is a very common problem. However, sleep apnea can lead to other more serious medical issues that can negatively impact your health and wellbeing. It’s important to get your obstructive, complex, or central sleep apnea diagnosed and treated right away to reduce your risk of conditions such as: 


  • High blood pressure
  • Liver problems
  • Heart attack
  • Increased blood sugar
  • Increased cholesterol
  • Type 2 diabetes
  • Metabolic syndrome
  • Heart disease
  • Stroke


Dr. Maryam Seifi provides alternative treatment for adults and children who suffer from obstructive, complex, or central sleep apnea. Her goal is to help you get high-quality sleep because a rested body is the keystone of good health. Unlike traditional solutions for sleep apnea, such as continuous positive airway pressure (CPAP) or surgery, Breath of Life Dental (BOLD) uses proven, non-invasive treatments that address the underlying causes of your sleep disordered breathing. 

How Obstructive, Complex, and Central Sleep Apnea Are Diagnosed

If you suspect you may have obstructive, complex, or central sleep apnea, you should see your doctor or dentist to evaluate your symptoms and determine if sleep apnea is the likely cause. 


If your doctor or dentist suspects obstructive, complex, or central sleep apnea, they may refer you to see a sleep specialist. Sleep specialists work at sleep disorder centers and can provide thorough evaluations to determine the exact type of sleep apnea you have. In order for the sleep specialist to make a proper diagnosis, you may need to stay overnight at the sleep center so they can monitor your breathing and other body functions while you sleep. 


Once you have an official diagnosis, Dr. Seifi can work with you on a custom treatment plan to handle your sleep apnea symptoms, address the causes of your sleep apnea, and help you get the deep and restful sleep you need for a healthy body.

Common Treatments for Sleep Apnea

There are a wide variety of treatments available for adults and children who are suffering from obstructive, complex, or central sleep apnea. The best treatment for you will depend on your overall health, your comfort level, and the severity of your sleep apnea symptoms. 


The most common treatments for sleep apnea include: 

  • Continuous positive airway pressure (CPAP)

    A CPAP machine applies continuous airflow via a face mask throughout the night while you sleep. The pressure of the airflow is strong enough to overcome any barriers from obstructive sleep apnea. This treatment can help relieve your symptoms and allow you to get a good night’s sleep but will not correct the causes of your obstructive, complex or central sleep apnea. It also increases your risk of developing complex sleep apnea.

  • Bilevel positive airway pressure (BiPAP)

    This machine provides airflow through a face mask just like a CPAP machine, but at two separate pressures—one for inhaling and one for exhaling. A BiPAP machine is commonly used to treat obstructive, complex, or central sleep apnea by using air pressure to keep your airway open during sleep and to encourage continuous breathing.

  • Uvulopalatopharyngoplasty (UPPP)

    This procedure involves removing tissue from your mouth and throat to widen your airway. The surgeon will remove some of your uvula, which is the soft flap of tissue that hangs down in the back of your throat. They may also remove part of your soft palate and tissues from your pharynx, which is essentially the part of your throat below your sinuses and above your windpipe. 


    Hence uvulo- (your uvula) palato- (your soft palate) pharyngo- (your pharynx) plasty (to alter the shape of a body part). This surgery can improve your obstructive sleep apnea symptoms, but it may not be useful to treat central sleep apnea or complex apnea. 

  • Upper airway stimulation (UAS)

    An upper airway stimulation device is a small electronic device similar to a pacemaker.  The UAS device serves two functions: it detects your breathing, and it can stimulate the nerve that controls your tongue via a small electrical pulse. A surgeon will implant the device into your chest. Once it fully heals (which may take about a month), you will turn on the device when you go to sleep so it can detect if your tongue is blocking your airway. It will send a small electrical signal to the nerves to move your tongue and unblock your airway. This device is generally used to treat obstructive sleep apnea, not complex or central sleep apnea. 

  • Jaw surgery

    If your obstructive, complex, or central sleep apnea is caused by a small airway, your doctor may recommend jaw surgery to alter the shape and size of your lower jaw, upper jaw, or hard palate. This will help increase the size of your airway and give your tongue more room to rest properly in your mouth, which can eliminate the cause of your obstructive sleep apnea. 

  • Lifestyle changes

    Habits like smoking, frequent drinking, and using sedative-type drugs can make your sleep apnea worse because they relax your muscles. This can make obstruction more likely, and it can also interfere with your brain’s signals to your respiratory muscles. Quitting smoking, drinking, and using strong sedative drugs can improve your overall health and may reduce your obstructive, complex, or central sleep apnea symptoms. 

  • Sleeping on your side or stomach

    If you start sleeping on your side or stomach, gravity will help you keep your airway unblocked by your tongue. Sleeping on your side or on your stomach can also reduce snoring and mouth breathing, which can lead to sleep apnea. When you sleep on your back, your tongue can fall back into your airway and cause obstructive sleep apnea, so changing your sleeping position is a simple solution that may help relieve your symptoms.

  • Losing weight

    If you carry excess weight on your neck, then there is more pressure on your airway when you lie down at night to go to sleep. Losing weight can help get rid of excess fat around your neck, relieve that pressure, and help reduce your sleep apnea symptoms. 

What Do I Do When I Am Diagnosed with Sleep Apnea? 

If you are diagnosed with obstructive, complex, or central sleep apnea, you should schedule your appointment with Dr. Maryam Seifi at Breath of Life Dental (BOLD). Dr. Seifi has been using the revolutionary Vivos system of oral appliance therapy to help people with obstructive, complex, and central sleep apnea in Maryland. By following this system, you can achieve better sleep and improve your overall health without the need for an invasive surgical procedure. 


Dr. Seifi has seen fantastic results in her patients through using the Vivos system. The best part is that unlike a CPAP machine, once you finish your treatment with the Vivos system, you will no longer have to use your oral appliance to get a good night’s sleep! This is a permanent, long-term solution to obstructive, complex, and central sleep apnea that will enable you to get the deep, restful sleep you need for a long and healthy life.


Are you ready to see the amazing results for yourself? Call Breath of Life Dental (BOLD) at (301) 818-2653 to schedule your consultation with Dr. Seifi today. 

How Does the Vivos System Work to Treat Sleep Apnea?

First, Dr. Maryam Seifi will give you a thorough examination to determine the exact cause of your obstructive, complex, or central sleep apnea. This could be a combination of several factors, such as: 

  • A small airway
  • Misaligned jaws
  • Too small of an upper arch
  • Underdeveloped mandible


Depending on your specific needs, Dr. Seifi will recommend one of the Vivos oral appliances. These custom-fitted oral appliances treat the underlying causes of sleep apnea by changing the shape and position of your jaws and palate. If you have ever seen someone get braces, it is similar to how traditional braces reposition your teeth. 


The Vivos appliance will apply gentle, continuous pressure to your arches and palate to expand your airway (also called maxillary expansion). The Vivos oral appliance can correct the alignment of your jaws to provide more room in your mouth for your tongue, which will reduce the risk of your tongue obstructing your airway at night. And if you have complex or central sleep apnea, Dr. Seifi can work with you on a combination of lifestyle changes, oral appliance therapy, and other steps to improve your sleep apnea symptoms and help you get a good night’s sleep.


The best part of this incredible treatment is that the Vivos oral appliances are removable which makes them easy to clean. Visit Dr. Seifi at Breath of Life Dental (BOLD) today to see the life-changing results of the Vivos system for yourself. 

How Does the Vivos System Work to Treat Sleep Apnea?

First, Dr. Maryam Seifi will give you a thorough examination to determine the exact cause of your obstructive, complex, or central sleep apnea. This could be a combination of several factors, such as: 

  • A small airway
  • Misaligned jaws
  • Too small of an upper arch
  • Underdeveloped mandible


Depending on your specific needs, Dr. Seifi will recommend one of the Vivos oral appliances. These custom-fitted oral appliances treat the underlying causes of sleep apnea by changing the shape and position of your jaws and palate. If you have ever seen someone get braces, it is similar to how traditional braces reposition your teeth. 


The Vivos appliance will apply gentle, continuous pressure to your arches and palate to expand your airway (also called maxillary expansion). The Vivos oral appliance can correct the alignment of your jaws to provide more room in your mouth for your tongue, which will reduce the risk of your tongue obstructing your airway at night. And if you have complex or central sleep apnea, Dr. Seifi can work with you on a combination of lifestyle changes, oral appliance therapy, and other steps to improve your sleep apnea symptoms and help you get a good night’s sleep.


The best part of this incredible treatment is that the Vivos oral appliances are removable which makes them easy to clean. Visit Dr. Seifi at Breath of Life Dental (BOLD) today to see the life-changing results of the Vivos system for yourself. 

What Are the Benefits of the Vivos System for Treating Complex Sleep Apnea?

You can get excellent sleep apnea treatment without CPAP therapy or surgery. When you wear your Vivos oral appliance as directed, you can handle the causes of your obstructive, complex, or central sleep apnea. This solution provides incredible benefits: 

  • All-natural pain relief
  • Nonsurgical treatment
  • Non-invasive treatment
  • No medication required
  • Comfortable and discreet treatment
  • Easy to use oral appliance
  • No noise disturbing your sleep
  • Permanent, life-changing results
  • Improved quality of sleep
  • FDA approved treatment
  • Works for obstructive sleep apnea
  • Works for central sleep apnea
  • Works for complex sleep apnea


On average, your obstructive, complex, or central sleep apnea treatment with the Vivos system will take 12-24 months to complete. And once you are finished, you will no longer need to wear your oral appliance. Thanks to this incredible technology, you will be able to get the deep, uninterrupted sleep you need to improve your health and wellbeing.

Find Out More About the Vivos Appliance

Attend a free seminar or request a personal consultation with Dr. Maryam Seifi. Call (301) 818-2653, email info@breathoflifeteam.com or submit an online request. The consultation price is $150.

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