Sleep Apnea and Depression: How Do They Relate?

Sleep apnea is a common sleep-related breathing disorder that affects a significant percentage of the population in the US and the rest of the world. It is characterized by a blockage in the airways during sleep, which causes pauses in respiration (sleep-disordered breathing) and reduces oxygen supply to the body.

As a result, individuals with sleep apnea often experience sleep disturbances and wake up feeling tired and in a bad mood.

Research has shown that sleep apnea can be a risk factor for depression, including MDD (major depressive disorder). Reviews have consistently reported higher rates of depressive symptoms in patients with OSA compared with the general population, and highlight overlapping symptoms that can delay diagnosis. 

Therefore, if you experience symptoms such as fatigue, memory problems, or lack of concentration, it's essential to consult a qualified medical practitioner to get a diagnosis. Being aware of the relationship between sleep apnea and depression can also help you better understand and manage your condition.

Can Sleep Apnea Cause Depression?

Sleep apnea is a sleep disorder that causes breathing to stop and start repeatedly. Repeated sleep apnea episodes can increase the risk of low blood oxygen — also called hypoxia — as well as hypertension and cardiovascular disease. If you experience loud snoring and excessive daytime sleepiness, even after a full night's sleep, you may have sleep apnea.

WatchPAT One Home Sleep Test

The two main types of sleep apnea are:

• Obstructive sleep apnea (OSA) or obstructive sleep apnea-hypopnea is the more common form, with a higher prevalence and incidence. It occurs when throat muscles relax and block the flow of air into the lungs.
• Central sleep apnea (CSA), which occurs when the brain does not send proper signals to the muscles that control breathing. This is more common in older adults with comorbid conditions, and it is treated by neurology specialists.
• Treatment-emergent central sleep apnea, or complex sleep apnea, which occurs when a person with diagnosed OSA experiences a conversion to CSA after receiving therapy for OSA.

Obstructive sleep apnea syndrome and depression have several common symptoms, such as tiredness and lack of enough sleep, which make it difficult to diagnose the exact issue. However, researchers, clinicians and psychiatry specialists have long suspected that these two health conditions have a link and have conducted research to prove it.

On Nov 6 2003, the Stanford University School of Medicine reported findings from a large epidemiology survey across five European countries showing that people with depressed mood were more likely to report breathing-related sleep disorders. 

Also, a CDC-linked analysis reported an association between symptoms of obstructive sleep apnea and major depression.

More recent research has also explored how OSA may be linked with poorer antidepressant response (treatment resistance) in some patients with depression.

So, while obstructive sleep apnea may not be a direct cause of depression, there is evidence that the presence of one of these conditions does increase the risk of developing the other.

Obstructive Sleep Apnea and Mental Health: Are There Other Effects?

Patients with untreated obstructive sleep apnea experience interruptions in breathing while they are asleep. As a result, the supply of oxygen to the brain is also temporarily cut off multiple times during the night. Over time, this can have a negative effect not only on the patient’s mental health but also on their cognitive abilities.

Mood Disorders and Sleep Apnea

Our body needs at least seven, ideally eight hours of sleep every day to keep it functioning at its best, which means that the lack of enough sleep usually has a negative effect on our moods. People with obstructive sleep apnea wake up multiple times at night due to feelings of suffocation, which prevents them from getting a good night’s sleep. This makes them wake up tired and stay cranky and irritable all day.

Experiencing mood swings is a common effect of sleep apnea—patients often have feelings of intense sadness, panic, or mania. However, in the absence of proper treatment, such mood swings can worsen into severe mood disorders like anxiety, depression, bipolar disorder, and so on.

Anxiety and Sleep Apnea

The interrupted sleep pattern and consequent insomnia caused by obstructive sleep apnoea can lead to the development of feelings of anxiety. And the issue doesn't end here—it is a well-known fact that a person suffering from anxiety often has trouble falling asleep.

The sleep deprivation caused by the combination of these two conditions can, in turn, lead to more severe consequences, including anxiety disorders and severe depression. Some research suggests untreated OSA can interfere with depression outcomes, which is why screening for sleep apnea is sometimes considered when symptoms persist.

A Decline in Cognitive Abilities

Studies have found evidence that severe OSA can lead to cognitive damage if left untreated for long. The reduced supply of oxygen to the brain results in the loss of gray matter, which can hamper the cognitive abilities of an affected person.

As a result, one may experience lack of concentration, loss of memory, poor attention, motor dysfunction, as well as impaired executive, verbal and visual-spatial skills.

This can interfere with simple tasks such as recalling something, learning something new, or even driving a vehicle. In short, a person with untreated obstructive sleep apnea is likely to experience deficits in their physical and physiological functioning, leading to an overall deterioration of their quality of life.

Depression Symptoms Associated with Sleep Apnea

The symptoms of obstructive sleep apnea and depression often overlap, especially because depression itself is a common issue resulting from sleep apnea. However, it is a good idea to be aware of the usual symptoms of both these conditions to ensure you get a correct diagnosis.

Symptoms of Depression

Some of the most common signs of depression include the following:

• Unexplained sadness
• Feelings of hopelessness, emptiness, and apathy
• Feeling irritable
• Anger or frustration
• Feeling worthless
• Loss of interest in certain activities
• Concentration problems
• Memory issues
• Changes in eating habits (an increased appetite or reduced desire to eat)
• Trouble falling asleep (insomnia)
• Feelings of tiredness or fatigue
• Constant headaches.

Symptoms of Sleep Apnea

Some of the most common symptoms of obstructive sleep apnea include the following:

• Sudden pauses in breathing
• Snoring loudly
• Trouble falling asleep
• Difficulty in staying asleep (waking up suddenly due to suffocation)
• Feelings of breathlessness
• Waking up with a dry mouth or sore throat
• Tiredness and fatigue during daytime
• Feeling irritable
• Lack of attention
• Difficulty in concentrating
• Low energy
• Headaches.

As you can see, both these medical conditions have several similar symptoms, which could lead to delays in diagnosis. If you are under treatment for depression and experience difficulties in falling or staying asleep, fatigue, lack of concentration, or mood swings, you may think that these are the effects of your mental disorder and ignore them.

However, if these symptoms are the result of obstructive sleep apnea instead, your condition is likely to worsen with time as you aren't addressing the issue from the root.

What to Do If I Have Symptoms of Sleep Apnea and Depression?

The first step you need to take is to clearly communicate your symptoms to your doctor, who may refer you to a sleep medicine specialist to conduct a polysomnography (sleep study) and confirm whether you have obstructive sleep apnea or not. Depending on the result, the doctor may then suggest appropriate treatment options to address both of these issues.

Since there is a link between sleep apnea and depression, you won’t be able to cure yourself if you only receive treatment for one of these issues. So, since both these issues are treatable, it's best to start with sleep therapy while continuing with treatment for depression to improve your physical and mental health.

How Does Sleep Apnea Cause Depression?

Sleep apnea can contribute to the development or exacerbation of depression through various mechanisms. The intermittent disruptions in breathing during sleep can fragment the sleep cycle, resulting in persistent fatigue, irritability, and difficulties in concentration, common symptoms of both sleep apnea and depression.

Hypoxia, or low oxygen levels in the blood during apneic episodes, may negatively impact brain function and mood regulation. Sleep apnea has also been associated with stress system activation and inflammatory pathways that may influence mental health outcomes as per studies.

How to Treat Sleep Apnea and Depression?

While sleep apnea isn't entirely curable, receiving the right treatment can improve your condition to a considerable extent, enabling you to lead a healthy life and carry on with your usual activities. Treating sleep apnea can also help improve signs of depression, especially if it has contributed to the initial symptoms.

While sleep therapy is the most popular type of treatment recommended by healthcare providers for patients with sleep apnea, there are several additional steps you can take to improve your condition faster. Certain lifestyle changes combined with regular therapy can support both sleep quality and daytime functioning.

Improve Lifestyle

Some small lifestyle changes can have a huge effect on your health when it comes to managing sleep apnea and depression. The first thing that most doctors recommend is to lose weight, especially if you have obesity.

Many patients with sleep apnea tend to be overweight, and the presence of extra fat tissues in the throat results in upper airway blockage while they are asleep. Regular exercise can help with weight loss, which in turn can lessen the symptoms of sleep apnea to some extent.

Eating healthy can also improve sleep apnea. Make sure to avoid heavy meals right before sleeping, and consume food rich in fiber and nutrients instead. Limiting sugar-rich foods is also a good idea.

If you have trouble sleeping, you can try out some breathing exercises to improve your sleep quality. Additionally, it's best to avoid smoking if you have sleep apnea. Cigarette smoke can increase your risk of getting severe OSA, which can be potentially life-threatening. The same is true for alcohol, so make sure to avoid both.

Antidepressants and Therapy

If you have severe depression, it is absolutely necessary to seek therapy to help manage its symptoms. Make sure to reach out to a qualified psychologist or psychiatrist for help—they can tell you the steps you need to take depending on your specific symptoms.

However, if antidepressants are a part of your treatment, make sure to communicate to your doctor that you have sleep apnea: not all anti-depressants are suitable for sleep apnea patients, some of them could be harmful.

CPAP Treatment for Sleep Apnea

The most common and effective treatment for obstructive sleep apnea is the use of a continuous positive airway pressure or CPAP machine. These devices deliver a constant stream of pressurized air into your mouth or nostrils via a mask, keeping your airways open for a more stable night of breathing.

Before recommending CPAP therapy, your doctor will prescribe a sleep study to monitor and evaluate your breathing function while you are asleep. Based on these reports, they may prescribe a CPAP device to help ease your symptoms, and track your progress in follow-up visits. Reviews suggest CPAP may improve depressive symptoms for some patients, particularly when sleep quality and daytime sleepiness improve. 

• ResMed AirSense 11 AutoSet CPAP Machine
  
• AirSense 10 AutoSet with HumidAir
• AirMini AutoSet
  
• 3B Medical Luna G3 BiPAP 25A Machine
• ResMed AirView

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Excellent CPAP Expert and Customer Service Team

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