Studies evaluating the association between Central Sleep Apnea (CSA) and positional sleep apnea are not commonly described and are barely understood. We report a case of a 51-year-old-male with moderate Obstructive Sleep Apnea (OSA) and severe CSA probably secondary to brainstem compression, which responded to the adoption of strict lateral body posture. The addition of Continuous Positive Airway Pressure (CPAP) optimally resolved the remaining obstructive respiratory events. We suggest including Magnetic Resonance Imaging (MRI) in the work-up plan of patients with positional CSA.