Adaptive servoventilation (ASV) represents the most recent advancement in the treatment of Cheyne-Stokes respiration and other forms of central sleep apnea. ASV interferes with the pathophysiologic changes of hyperventilatory breathing disturbances, and has been proved to most efficiently treat central breathing disturbances in comparison with other positive airway pressure (PAP) options, oxygen, or drugs. However, ASV algorithms need to be refined to sufficiently address nonresponders. Because of its efficacy, ASV can be recommended for the treatment of most central breathing disturbances, especially hyperventilatory disorders, if a first trial of continuous PAP has failed.