The purpose of this review is to describe our management approach to patients with treatment-emergent central sleep apnea (TECSA). The emergence of central sleep apnea during positive airway pressure therapy occurs in approximately 8% of titration studies for obstructive sleep apnea, and has been associated with several demographic, clinical and polysomnographic factors, as well as factors related to the titration study itself. TECSA shares similar pathophysiology with central sleep apnea. In fact, central and obstrcutive sleep apnea pathophysiologic mechanisms are inextricably intertwined, with ventilatory instability and upper airway narrowing occurring in both entities. TECSA is a “dynamic” process, with spontaneous resolution with ongoing positive airway pressure therapy in most patients, persistence in some, or appearing de novo in a minority of patients. Management strategy for TECSA aims to eliminate abnormal respiratory events, stabilize sleep architecture, and improve the underlying contributing medical comorbidities. Continuous positive airway pressure therapy remains a standard therapy for TECSA. Expectant management is appropriate given its transient nature in most cases, while select patients would benefit from an early switch to an alternative positive airway pressure modality. Other treatment options include supplemental oxygen, and pharmacologic therapy.