a man with sleep apnea falling down a rabbit hole surrounded by a CPAP machine, a heart, a brain, and a type 2 diabetes blood test strip

Down the Sleep Apnea Rabbit Hole: Mental Health

There’s a kind of rabbit hole we can fall in when we begin to learn about a chronic health condition.

Obstructive sleep apnea (OSA) is one such condition. It’s chronic because it happens every time you sleep and can only be managed through therapy. Very rarely does it simply go away or cure itself.

What seems like a mechanical problem of breathing during sleeping turns out to be far more complex in its reach inside our overall health. You may not know, for instance, that having OSA and not treating it is associated with a wide variety of other chronic health conditions.

For instance, people with OSA may also develop a hidden case of high blood pressure. Another surprising condition tied to untreated OSA? Type 2 diabetes.1

But what about mental health issues? Can OSA contribute to those, too?

Obstructive sleep apnea and mental health

Unfortunately, the answer is yes.

Research to identify associations between OSA and mental health issues has taken place for a long time. Most recent studies show a clear link between OSA and the increased risk for mood disorders like depression.2

In fact, OSA factors into a number of mental health concerns besides major depression disorder (MDD), such as generalized anxiety disorder (GAD), schizophrenia, bipolar disorder, post-traumatic stress disorder, substance abuse, and panic attacks.3

Depression and OSA

The symptoms experienced by people with MDD or OSA are often the same.3

In fact, someone with complaints of mood disturbance like depression may, after going through an OSA screening, discover they also have a hidden case of sleep apnea.

A large research study from the VA found that people with MDD face a 5-fold greater risk for having OSA, with more than half of patients with OSA in their study meeting the criteria for MDD. This can be the case for people with chronic insomnia, also well known for its overlap with major depressive disorder (MDD).4,5

It appears that low serotonin levels link both conditions, in differing ways. The brain uses serotonin to regulate mood, so low levels imply poor mood. Serotonin also serves a neurochemical role in the nerve function of the upper airway while breathing during periods of sleep.6 Insufficient serotonin could be part of the complex set of conditions leading to OSA.

Even after controlling for obesity - a known risk factor for developing OSA - the VA study authors found strong associations between OSA and both mood and anxiety disorders.

Anxiety and OSA

Similarly, those with OSA are almost two times as likely to develop GAD. One study also showed that the more severe the case of OSA, the higher the chance for symptoms of anxiety. In fact, the majority of people (two thirds) who suffered from anxiety in that study also dealt with severe cases of OSA.6,7

When OSA affects your mental health

If OSA and depression or anxiety are diagnosed in a single individual, what’s the best way to move forward?

Generally, the best protocol is to treat OSA as the primary condition, as it may be the root cause of your depression or anxiety.8 Once it’s treated, there’s a good chance that the depressive or anxious symptoms will lighten up or even go away.

Also, use of certain antidepressant and anti-anxiety medications (such as benzodiazepines and other sedatives or hypnotics) could actually exacerbate an existing case of OSA. This may explain why your doctor may wish to at least start with a form of positive airway pressure (PAP) therapy (such as CPAP) first, before treating the mental health symptoms.9

Research confirms that CPAP use can greatly improve the severity of depression and anxiety, especially in women.8,9

Don’t go it alone

It can be difficult to know when having one mental or physical health problem may bring on a secondary problem, though it happens. Chronic illness is like that, unfortunately. One set of health problems can lead to a domino effect over time.

For instance, people with OSA may experience problematic sleep caused by ongoing stress unrelated to their OSA. Life during a pandemic is a major example of stress-induced insomnia and disturbed sleep affecting millions in 2020.

If you’re unsure about the root cause of your sleep problems, don’t guess why or ignore the situation.

Simply mention your concerns to your primary doctor or sleep specialist. With their help, you can determine whether you have new mental or physical health concerns requiring treatment. The answer may be no...but if it’s yes, your healthcare professional can pinpoint any potential links to OSA.

Ultimately, identifying and treating the problem - and getting more and better sleep - should be your goal.

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