Sleep Apnea and Depression: Symptoms, Therapies, Coping

Sleep apnea is a condition that causes intermittent interruptions in breathing during sleep. There is some evidence that sleep apnea is linked to mental health conditions, such as depression and anxiety. Untreated sleep apnea can lead to serious medical complications, such as heart disease, stroke, heart failure, and sudden death.

Sleep apnea is a common medical condition. Current estimates suggest that about 22 million adults in the US have sleep apnea. The most common type is obstructive sleep apnea (OSA), in which the airway is blocked during sleep.

Learn why sleep apnea affects mental health, to look for, how treatment can help, and ways to cope.

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Sleep apnea and depression

Researchers have noticed a possible link between sleep apnea and depression, especially major depressive disorder (MDD). However, it’s still unclear exactly how that association works and what causes it.

Which Condition Causes the Other?

The link between sleep-related disorders and mental health conditions is well-established. People with insomnia often have higher rates of depression and anxiety. Meanwhile, around 75% of people with depression have trouble falling and staying asleep. However, it’s not clear whether OSA causes depression or vice versa.

It’s most likely that the link between sleep apnea and depression, like the link between many sleep-related disorders and mental health conditions, is bidirectional. In other words, both conditions make the other worse.

Feeling sadness, hopelessness, or worry can make it harder to get a good night’s sleep. In turn, poor-quality sleep and sleep deprivation can increase the risk of developing depression and anxiety.

People with mental health conditions such as depression or anxiety may also find it harder to follow through with treatment and cope with everyday stress. They may try to cope by using psychoactive substances like alcohol or drugs. But unfortunately, this can make their mental health , and the of any co-occurring disorders get worse.

overlapping symptoms

Sleep apnea and depression have some symptoms in common, such as daytime sleepiness, memory loss, fatigue, irritability, difficulty concentrating, and mood swings. Both conditions can interfere with daily functioning. This can sometimes make it hard to tell which condition is causing which symptoms.

Other signs and symptoms of sleep apnea include:

  • Loud, frequent snoring
  • Gasping or choking for air during sleep
  • Not feeling rested even after a full night of sleep
  • Headaches or dry mouth upon waking

Additional signs and symptoms of MDD include:

  • Persistent feelings of sadness, worthlessness, hopelessness, or guilt
  • Sleeping too much or too little
  • Changes in appetite or weight
  • Loss of interest in usual relationships, hobbies, and activities
  • Thoughts of death or suicide

Effect of Sleep Apnea on Mental Health

There is a strong association between sleep apnea and mental health symptoms. Here are some recent findings of the link between OSA and depression:

  • A 2014 study in The Journal of Research in Medical Sciences found that over 46% of patients with OSA had symptoms of depression, while over 53% of people with OSA had anxiety. People with more severe cases of OSA were more likely to have co-occurring mental health symptoms.
  • A 2017 study found that undiagnosed severe sleep apnea was associated with depressive symptoms. The authors recommend screening for OSA in people with depression and vice versa. Both conditions should be screened for in people with excessive daytime sleepiness.
  • A 2021 study in Scientific Reports found that sleep apnea was an independent risk factor for MDD, even when controlling for other factors like age, sex, and comorbidities.

Untreated sleep apnea and depression also share some risk factors in common—especially obesity and being overweight—and can lead to some of the same health complications. These may include:

Ultimately, the relationship between sleep apnea and depression is complex.

Breathing interruptions from sleep apnea may disrupt your ability to fall asleep and your overall sleep quality, making you more prone to developing depression and other complications from long-term sleep deprivation.

Some researchers have also suggested that sleep apnea’s effects on oxygen saturation in the blood during sleep could contribute to the development of depressive symptoms.

What’s more, depression may make it harder for you to maintain a healthy weight or stay physically active, which can increase your risk of developing OSA.

CPAP benefits

Sleep apnea is typically diagnosed with a sleep study (overnight polysomnogram). During a sleep study, a sleep specialist records your eye and leg movements, heart rate and rhythms, breathing rate, and oxygen levels while you rest. This will help determine whether you have mild, moderate, or severe OSA.

The first choice of treatment for sleep apnea is positive airway pressure (PAP) therapy. PAP therapy, which keeps your airways open with pressurized air and prevents apnea events, involves wearing a mask over your nose or nose and mouth while you sleep. The most common type of PAP device is a continuous positive airway pressure (CPAP) machine.

Regular use of a CPAP machine has many benefits for people with sleep apnea, including reducing the risk of stroke and heart disease. If you have both OSA and MDD, a CPAP machine may help you manage both conditions more effectively. A CPAP machine may benefit you by:

  • Improving sleep quality
  • Reducing daytime fatigue
  • reducing stress
  • Boosting mood
  • Restoring memory and concentration
  • Improving emotional stability

Other therapies

While CPAP is the main treatment for OSA, your doctor may recommend other therapies or preventive measures, such as:

  • weight loss
  • Positional therapy or sleeping on your side
  • Oral appliances constructed by a dentist
  • Surgery, in extreme cases

Treatment for Depression-Linked Sleep Apnea

If you have both MDD and OSA, it’s important to seek treatment for both conditions. Lifestyle changes, therapy, and medication can help you manage your depression-linked sleep apnea.

Lifestyle changes

Prioritizing sleep and overall health is key to coping with the symptoms of both sleep apnea and depression. Here are some lifestyle changes you can make in order to effectively manage both conditions:

  • Healthy weight loss through diet and exercise, especially because obesity is a risk factor for both conditions
  • Relaxation techniques, such as meditation and breathing
  • Good sleep habits, such as establishing a consistent bedtime routine and turning off all devices an hour before going to sleep
  • Quit smoking
  • Limiting intake of alcohol and other drugs
  • Not taking sedatives or tranquilizers unless prescribed

Medication and Therapy

Your doctor may prescribe antidepressants to help boost your mood and gradually improve your depressive symptoms. If you have OSA or any other co-occurring conditions, let your doctor know before taking any prescription drugs. Psychotherapy, such as cognitive behavioral therapy, can also help with symptoms of depression.

Summary

Sleep apnea is a common medical condition that causes intermittent disruptions in breathing during sleep. The most common type is obstructive sleep apnea (OSA).

Many people with OSA also have symptoms of depression. While there is a clear association between sleep apnea and depression, it’s unclear which one causes the other. Many researchers believe that there is a mutual relationship between the two conditions.

If you have both OSA and depression, it’s important to treat both conditions. The first choice of treatment for sleep apnea is positive airway pressure (PAP) therapy, usually with a continuous positive airway pressure (CPAP) machine.

Depression can be treated with prescribed medications, talk therapy, or both. Lifestyle changes, such as staying physically active and establishing a consistent bedtime routine, can help with both conditions.

A Word From Verywell

Mental and physical health are often closely linked. Sleep-related disorders such as sleep apnea can make your depression worse and vice versa. Talk to your doctor if you are experiencing symptoms of depression, sleep apnea, or both.

Frequently Asked Questions

  • How many hours of sleep do people with depression need?

    People with depression should try to get the recommended number of hours per sleep for adults each night, which is between seven and nine hours.

    However, depression can make it harder to stay and fall asleep. Some people with depression may sleep too much or too little, oversleep, or wake up too early.

  • Do all sleep apnea patients go through bouts of depression?

    Not all people with sleep apnea have depression. However, there is an association between obstructive sleep apnea (OSA) and depressive symptoms, and having one condition does put you at a higher risk of having the other. Some research suggests that about half of people with OSA also have symptoms of depression.

  • When should you adjust your CPAP machine?

    If you feel your CPAP machine is no longer fitting comfortably or that it is leaking air while you sleep, it may need to be adjusted. Your CPAP machine may also need attention if your sleep apnea symptoms are getting worse or failing to improve. If you are experiencing five or more apnea events per hour while wearing your CPAP device, it might need an adjustment.

  • Why does being overweight affect sleep apnea and depression?

    Being overweight is a risk factor for developing both sleep apnea and depression. Around two-thirds of people with sleep apnea are overweight or obese. Both conditions can also put you more at risk of gaining excess weight due to decreased physical activity related to daytime fatigue, depressed mood, and decreased energy.

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