The Link Between Sleep Apnea and Depression, Anxiety, and Mood

Even one night of restless sleep is enough to put a damper on your mood. But if you’re consistently not logging enough shut-eye, you may also find yourself feeling anxious and depressed.

If these symptoms sound familiar, it’s important to find a treatment that will help you feel better physically and mentally. Here’s how.

Excessive daytime sleepiness isn’t the same thing as feeling a little tired — it’s defined as a struggle to stay awake, function, and perform your day-to-day tasks at work and at home. And it can even happen while you’re driving, posing a significant danger. EDS isn’t a condition itself but a symptom of a larger, more serious sleep disorder, such as sleep apnea.

Some compelling research has shown a link between obstructive sleep apnea and an increased risk for mood disorders. For example:

• People with depression and post-traumatic stress disorder may also be more likely to have sleep apnea.

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• Frequent snoring and pauses in breathing are associated with a greater likelihood of depression.

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   The risk of depression was significantly higher for people diagnosed with obstructive sleep apnea.
• As many as 14 percent of suicidal adults with major depressive disorder were found to have obstructive sleep apnea, according to research based on a randomized clinical trial.

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“When you have an OSA event, you not only receive low oxygen but also have carbon dioxide retention, and carbon dioxide buildup makes your blood acidic,” says Dr. Dyken. “As this blood flows to your brain, your brain centers recognize that you’re not breathing and release neurotransmitters that trigger a microarousal so you take a breath.”

The problem is that you can have hundreds of these microarousals every night with apnea. “The neurotransmitters in your brain are [then] depleted when you wake up,” Dyken explains, “and during the day you feel run-down and sleepy, and you lack energy to do the things that might protect you from developing depression and anxiety.”

When a person comes into Dyken’s clinic to report having trouble sleeping, his first step is to find a diagnosis. “Someone who comes into our clinic with a low mood and fatigue will be signed up for a sleep study to test for OSA,” says Dyken. (These can be done at home or in a sleep clinic.)

If apnea is confirmed, doctors will begin to treat the sleep problem, he says, and continue to monitor your mental health.

If the symptoms of anxiety or depression do not improve with treatment of obstructive sleep apnea, a doctor may refer you to a psychologist or psychiatrist, preferably one who is also a sleep expert, says Dyken.

And while it’s not as common, there may be severe cases of sleep apnea in which a person experiences extreme depression and is suicidal, says Dyken. If you feel this way, you should be referred to a trained mental health professional as quickly as possible, he says.

If CPAP increases rather than helps reduce your anxiety or stress, there are some other treatment options. According to Dyken, these include:

• Hypoglossal nerve stimulation (an electrical device implanted under the skin that sends an impulse to the tongue, preventing airway collapse as you breathe)

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• Oral dental devices (which are fitted through a dentist and work by keeping your airway open)
• Weight loss (excess weight is linked to excess tissue in the back of your throat)
• Positional therapies (such as wearable devices that prevent you from rolling and sleeping on your back at night, as gravity in the back position tends to pull the tissues in the back of your throat closed)

Your mental health care provider may also recommend cognitive behavioral therapy, which involves targeting the thoughts that lead to depressive feelings and changing the behaviors that may make depression worse.

• Stick to a regular sleep schedule and wake up around the same time each day
• Seek out sunlight
• Exercise regularly
• Limit alcohol
• Ask friends and family for support

It’s true that sleep apnea and depression can be difficult to manage. But the good news is that with the right sleep apnea treatment — and, if necessary, depression or anxiety treatments — both conditions should improve.

• People with untreated obstructive sleep apnea (OSA) are more likely to develop mood disorders, including depression and anxiety.
• Treatment for OSA with a CPAP (continuous positive airway pressure) machine notably improves sleep quality and may significantly reduce depression symptoms for some individuals, although it's important to explore alternative interventions if CPAP increases anxiety or is difficult to use consistently.
• Lifestyle changes such as a regular sleep schedule, physical activity, and a healthy diet can help you better manage both sleep apnea and mood-related conditions.