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Sleep Apnea and Nightmares

Mar 10, 2022
· 6 mins read

As it is, some of us do not experience nice dreams. But when you combine dreams with sleep apnea, you end up having nights where you wake up screaming, scared and unable to breathe. Sleep issues might manifest themselves in your dreams. The absence of oxygen in the case of obstructive sleep apnea makes it more disruptive than the others.

Let’s find out exactly how sleep apnea and nightmares are correlated.

Can Sleep Apnea Cause Nightmares?

woman waking up after a sleep apnea nightmare

Not everyone who has sleep apnea will experience nightmares. In fact, those with minor sleep apnea may be completely unaffected. However, evidence suggests that severe sleep apnea can cause nightmares, some of which may manifest in the real world, with your partner seeing you tossing and turning in your sleep.

A good number of sleep apnea patients have talked about nightmares where they experience sensations imitating suffocating or drowning. Considering what obstructive sleep apnea happens to be, it makes sense that the body's pain ends up following you into your subconscious.

The muscles of the tissues around the throat of sleep apnea patients tend to relax so much that the tissue collapses, blocking the passing of oxygen from the upper airways freely. This mainly happens at night, when you have fallen into a deep sleep.

During REM sleep, your body falls into a relaxed state, contributing to muscle relaxation and upper airway collapse. Yet, your brain becomes active on a subconscious level. So, while you may dream at any stage of sleep, it is more common when you are on your REM cycle.

As your body is dealing with the lack of oxygen, what could have started as a pleasant dream takes a nightmarish turn. Your sleep is disrupted as your body is under pressure. As a result, you wake up with fresh nightmares, and that’s what you end up remembering more, compared to the good dreams you might have had before that.

Sleep apnea patients can have good dreams again. However, if you are experiencing bad dreams, know that with proper CPAP treatment, both your sleep apnea and nightmares will disappear over time.

How Does CPAP Prevent Nightmares?

Resmed Airsense 11

Obstructive sleep apnea happens when your upper airway does not pass enough oxygen. So, the easy remedy is to continuously feeding the airway with pure air when it is unable to do so on its own. CPAP therapy is particularly effective in this aspect and is the most often used method of therapy to treat sleep apnea.

The continuous positive airway pressure (CPAP) device does exactly what its name implies. When you sleep with a CPAP mask on, you ensure that your upper airway is constantly supplied with pure air. It compensates for what your body is unable to give naturally through airways that are on the point of collapse due to muscle relaxation.

Because you have a decent supply of oxygen, you do not wake up throughout the night, nor does your body have the sensation of being unable to breathe. As a result, the uneasy feeling does not accompany you to sleep. As a result, if you dream, whether it is a good dream or a nightmare, it is not caused by sleep apnea.

There was a study conducted on veterans who had PTSD and were likely to have nightmares as a result. It appeared that among the participants, those with a higher frequency of bad dreams also tended to have sleep apnea.

Once they began their CPAP therapy, the number of times they would deal with nightmares improved drastically.

Another study suggested that instead of severe Obstructive sleep apnea causing one nightmare, it can reduce its occurrences. Except, this is in no way a good thing.

As it happens, this study looked at the Apnea-Hypopnea Index of the patients. The Apnea-Hypopnea Index assesses the severity of sleep apnea. The AHI is calculated by adding the number of apneas (pauses in breathing) and hypopneas (periods of shallow breathing) that occur on average each hour.

If you experience 5-15 events per hour, your sleep apnea is considered mild. Anything from 15-30 is considered moderate. If you have over 30 events you are considered to have severe sleep apnea.

Now, just as severe sleep apnea has the chance of giving you nightmares, it has the chance of freeing you from it too.

Lots of patients with severe sleep apnea have claimed they do not deal with nightmares as much. This could be because of the amount of time the patients have experienced sleep disruption. The more it happens, the more their cognitive functions could be lacking. Over time, this would make it hard for them to slip into the REM state. At one point, it is not their nightmare alone but remembering any kind of dream becomes hard for them.

How to Prevent Nightmares Even After Getting CPAP?

While this should not happen, if you are undergoing CPAP treatment and the nightmares still persist, do not worry. Some adjustments later, your nightmares should eventually leave you. However, it is important that you get a good night of sleep. Your physical, mental and emotional health is largely dependent on proper sleep.

Check If Your Mask Has Leaks

Resmed Airfit F20 full face cpap mask

Every component of a CPAP machine has an expiration date. This is due to the fact that all components must be replaced after a certain amount of time in order to prevent infection and material deterioration. Is it possible that the CPAP mask or cushion you're using for air delivery has reached its expiration date?

If it has, it is possible your mask has begun leaking. This means the air that is supposed to pass through your airways is leaking out before reaching you or is not reaching you as much as it should. And so, the cycle of sleep disruption begins again as your body is not getting the oxygen it needs in its sleep.

A CPAP mask past its date is not the only reason air could leak either. The mask you purchased could be too big for your face too. Your CPAP mask has to be the exact fit; otherwise, there is a chance of air leaking out that way too. So when you buy a CPAP mask, make sure to get your exact measurements down.

You will reduce your chances of a leaking CPAP mask this way.


Claustrophobia is a fairly common disorder. There are many people who might have never experienced it before but being attached to a machine at night can cause claustrophobia. Placing a mask at night on your face and trying to sleep is not a feeling you get used to.

This claustrophobic feeling could be what is causing your nightmares instead. In that case, we will suggest making yourself well acquainted with the mask. Wear the mask throughout the day for several hours if you can, long before you go to bed. Expose yourself enough to it so you don’t remember it is on your face. You can wear it while watching TV or taking a daytime nap.

Nasal or nasal pillows masks might be a good alternative you could try. Nasal pillow masks have 2 silicone prongs that go inside your nostrils. This is the least invasive of the 3 mask types. Nasal masks have a cushion that goes over your nose, leaving your mouth uncovered.

Clean Your CPAP Components

Paptizer UVC LED CPAP sanitizer

CPAP masks, tubing, and other components must be cleaned as frequently as possible. If this is not done, these components may wind up collecting allergies and microorganisms. The tubing that is designed to carry clean air to your mask could be contaminated with enough dust to foul the air. You would be getting unclean air instead of filtered air.

So, you could be creating your own nightmare at this point.

Keeping a regular cleaning regimen for your CPAP machine is extremely beneficial. Furthermore, if the components are so dirty that they cannot be repaired, do not be afraid to replace them.

Final Thoughts

It appears that sleep apnea and nightmares do have a strong relationship. It is not much of a surprise either. It stands to reason that if our body reacts so badly to the lack of sleep, our mind would react just as badly when our body is feeling discomfort while sleeping.

If you have been experiencing frequent nightmares recently, waking up at night at odd hours with a choking feeling and have not been able to go about your daily activities in the morning as you usually would due to fatigue, it would be a good time to book a doctor’s appointment.

Your symptoms could be the result of another sleep issue, or they could be the result of sleep apnea. Be sure to contact your doctor to find out if what you are experiencing is sleep apnea or another sleep disorder. You will have fewer nightmares if you start CPAP therapy early.

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