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

Anyone can be a little irritable after a night of too-little shut-eye. But if you have sleep apnea, the effects on your mood may be far greater.

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.

People who have excessive daytime sleepiness (EDS) are more likely to have mental health conditions such as depression, according to the National Sleep Foundation (NSF). And if you have untreated obstructive sleep apnea (OSA) — a sleep disorder characterized by pauses in breathing throughout the night and a leading cause of excessive daytime sleepiness — that link becomes even more profound, says M. Eric Dyken, MD, a professor of neurology and the director of the Sleep Disorders Program at University of Iowa Health Care in Iowa City.

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, Sleep Apnea, and Increased Depression Risk

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. 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 apnea, according to a study published in February 2015 in the Journal of Clinical Sleep Medicine.
  • Frequent snoring and pauses in breathing are associated with a greater likelihood of depression, according to a study published in April 2012 in the journal Sleep. The risk of depression was significantly higher for people diagnosed with obstructive sleep apnea.
  • Among adults with obstructive sleep apnea, 53.9 percent and 46.1 percent of them have some degree of anxiety or depression, respectively, according to a study published in March 2014 in the Journal of Research in Medical Sciences.
  • As many as 14 percent of suicidal adults with major depressive disorder were found to have obstructive sleep apnea, according to a study published in September 2019 in the Journal of Psychiatric Research.
What Might Explain the Link Between Sleep Apnea and Depression and Anxiety

If your sleep is interrupted repeatedly during the night, you might experience a change in brain activity and neurochemicals that can worsen your mood, according to the NSF.

“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.”

Treating Sleep Apnea First or at the Same Time as 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.

There is some evidence that treating obstructive sleep apnea can help improve mood. According to the NSF, research has shown that treatment with a CPAP (continuous positive airway pressure) machine — i.e., a facial mask that pumps air into the nasal passages and keeps a person’s airway open — improves symptoms of depression.

A meta-analysis published in the May-June 2019 issue of EClinicalMedicine found that CPAP treatment reduced the odds of depression by 20 percent among people with moderate to severe OSA and cardiovascular disease. It was especially effective for those who had depression prior to treatment.

On the other hand, some have more anxiety when they have to use a CPAP machine, says Dyken. You may feel anxious about sleeping with a mask on your face or about the sensation of the air on your face or the sound of the machine. This may lead to a feeling of claustrophobia, anxiety, and panic, according to the American Sleep Apnea Association.

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)
  • 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)
Other Tips to Manage Your Sleep Apnea and Related Depression and Anxiety

Your doctor and mental health professional may also recommend a combination of psychotherapy and medication to manage your depression symptoms, according to the NSF. But if you have sleep apnea, you should avoid sedating medications, such as tricyclic antidepressants, which may make apnea worse, according to the NSF.

Your mental healthcare 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, according to the NSF.

Other lifestyle habits that can ease the symptoms of sleep apnea and depression include:

  • Sticking to a regular sleep schedule and waking up around the same time each day
  • Seeking out sunlight
  • Exercising regularly
  • Avoiding too much caffeine or alcohol
  • Asking 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.

Jessica Migala