Getting quality sleep every night is critical for our physical, emotional, and mental health. But what happens when you suffer from a common sleep disorder such as sleep apnea? Can your sleep apnea cause depression or worsen it if you have already been diagnosed with a depressive disorder? Do your antidepressant medications make your sleep apnea worse? Keep on reading to learn more about sleep apnea, its impact on mental health, and the treatment options available to manage both sleep apnea and depression symptoms.

What is Sleep Apnea?

Sleep apnea is a sleep disorder characterized by repeated interruptions in breathing during sleep. These interruptions, known as apneas, can last from a few seconds to minutes and may occur several times per hour.

The three main types of sleep apnea include:

  • Obstructive sleep apnea (OSA)
  • Central sleep apnea (CSA)
  • Complex sleep apnea syndrome

Obstructive Sleep Apnea (OSA) is the most common form of the disorder. It occurs when the throat muscles relax excessively during sleep, causing a temporary blockage of the airway. Central Sleep Apnea (CSA) is less common and involves a failure of the brain to send proper signals to the muscles that control breathing. Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, is a combination of both obstructive and central sleep apnea.

Sleep apnea is often associated with loud snoring, gasping, or choking sounds as the body struggles to restore airflow. Despite these disturbances, individuals with sleep apnea are often unaware of their condition, as it occurs during sleep. However, the consequences of untreated sleep apnea can be severe, leading to daytime fatigue, cognitive impairment, and an increased risk of cardiovascular diseases.

How Common is Sleep Apnea?

Sleep apnea is a widespread condition affecting millions of people around the world. In the United States, it is estimated that about 22 million Americans suffer from sleep apnea, with approximately 80% of moderate to severe cases remaining undiagnosed. The prevalence of sleep apnea tends to increase with age, and it is more common in men than women. However, post-menopausal women are at a higher risk, and the gender gap in prevalence narrows with age.

Several factors contribute to the risk of developing sleep apnea. Obesity is a significant risk factor, as excess weight can lead to fat deposits around the upper airway, which can obstruct breathing. Other risk factors include a family history of sleep apnea, smoking, alcohol use, and certain medical conditions such as hypertension and diabetes.

What Are The Symptoms of Sleep Apnea?

Sleep apnea symptoms can vary depending on the severity of the condition and the type of sleep apnea. However, some common symptoms include loud snoring, gasping or choking during sleep, excessive daytime drowsiness, morning headaches, difficulty concentrating, and mood changes.

Snoring

Loud snoring is often the most noticeable symptom of sleep apnea, particularly in OSA. It occurs due to the partial blockage of the airway, leading to vibrations as air passes through. Additionally, individuals with sleep apnea may wake up abruptly with a sensation of choking or gasping for air. This is the body’s response to a lack of oxygen during an apnea episode.

Excessive Daytime Sleepiness

Due to frequent sleep interruptions, individuals with sleep apnea often experience excessive daytime sleepiness, even after what may seem like a full night’s sleep. Other common symptoms of sleep apnea are morning headaches caused by the lack of oxygen during sleep and dry mouth or sore throat due to mouth breathing while asleep.

Cognitive Impairments

Sleep apnea can also cause symptoms that affect an individual during waking hours. It can lead to cognitive impairments, making it difficult to concentrate, think clearly, or remember things. Furthermore, individuals with sleep apnea may experience irritability, anxiety, or depression-like symptoms due to chronic sleep deprivation.

Is Snoring and Sleep Apnea the Same Thing?

Snoring and sleep apnea are related, but they are not the same thing. Snoring is a common condition where the airway partially closes during sleep, causing the tissues in the throat to vibrate as air passes through. While snoring is often harmless, it can sometimes be a sign of a more serious issue, such as sleep apnea.

Sleep apnea, on the other hand, is a sleep disorder characterized by repeated interruptions in breathing during sleep. The most common type, obstructive sleep apnea (OSA), occurs when the airway becomes completely blocked, leading to pauses in breathing. These pauses can last from a few seconds to a minute and can happen multiple times throughout the night, disrupting sleep and lowering oxygen levels in the blood. In other words, snoring can be a symptom of sleep apnea, but not everyone who snores has sleep apnea.

Can Sleep Apnea Negatively Impact Your Mental Health?

Sleep is essential for mental health, playing a vital role in emotional regulation, cognitive function, and overall well-being. Disruptions to sleep, such as those caused by sleep apnea, can have profound effects on mental health. One of the most significant mental health concerns associated with sleep apnea is depression.

Sleep Apnea and Depression

Research has shown a strong link between sleep apnea and depression. One study, in particular, found that snoring alone was not associated with depression symptoms in men or women, but those individuals suffering from disordered sleep that includes snorting and stopping breathing were strongly associated with probable major depression for both men and women.

More research is needed to fully understand the exact mechanisms linking sleep apnea and depression, but some specialists believe that the repeated interruptions in sleep caused by apneas lead to chronic sleep deprivation, which may trigger or worsen depression. This may be because sleep is essential for the regulation of neurotransmitters such as serotonin and dopamine, which play crucial roles in mood regulation. Sleep disruptions can lead to imbalances in these neurotransmitters, likely contributing to the development of depressive symptoms.

Another theory is that the physiological stress caused by repeated episodes of hypoxia (low oxygen levels) during apneas can affect areas of the brain involved in mood regulation. Chronic hypoxia can lead to inflammation and oxidative stress, which have been implicated in the pathophysiology of depression.

Furthermore, the daytime fatigue and cognitive impairments associated with sleep apnea could lead to a diminished quality of life, social isolation, and feelings of helplessness, all of which can contribute to depression. The constant struggle with excessive daytime sleepiness can make it difficult for individuals to engage in daily activities, work, or maintain relationships, leading to feelings of frustration and overwhelm.

It is likely that chronic sleep deprivation and the physiological stress resulting from sleep apnea can lead to changes in brain function that increase the risk of depression. This is particularly true for individuals who already have other risk factors for depression, such as a family history of the condition or a history of trauma.

In other cases, sleep apnea may exacerbate existing depression. Individuals with depression often experience sleep disturbances, which can include insomnia, hypersomnia, or non-restorative sleep. The addition of sleep apnea to these existing sleep problems can further disrupt sleep and worsen depressive symptoms. The fatigue, cognitive impairments, and mood changes associated with sleep apnea can make it even more difficult for individuals with depression to manage their symptoms, making their condition even more challenging.

Can Antidepressants Make Sleep Apnea Worse?

The traditional approach to the treatment of depression often involves the use of antidepressant medications. However, there is some evidence to suggest that certain antidepressants may worsen sleep apnea or contribute to the development of central sleep apnea in some individuals. Some of these medications may affect the respiratory system, potentially leading to changes in breathing patterns during sleep.

For example, some antidepressants may reduce muscle tone in the upper airway, which could increase the risk of airway obstruction during sleep, potentially worsening sleep apnea. Additionally, some SSRIs and SNRIs may affect the central nervous system’s control of breathing, potentially resulting in central sleep apnea.

The effects of antidepressants on sleep apnea may vary depending on the type of antidepressant, the dosage, and the individual’s overall health. That means not all individuals with sleep apnea who take antidepressants will experience a worsening of their condition, and not everyone who takes antidepressants may develop sleep apnea. Therefore, it is crucial for individuals with both sleep apnea and depression to work closely with their healthcare providers to monitor their symptoms and adjust their treatment plans as needed.

What Are the Most Common Treatment Options for Sleep Apnea and Depression?

Effective treatment of sleep apnea and depression often requires a comprehensive approach that addresses both conditions simultaneously. Here are some treatment options for managing sleep apnea and depression:

  • Continuous Positive Airway Pressure (CPAP) Therapy: CPAP therapy is the most common and effective treatment for OSA. It involves wearing a mask over the nose and/or mouth during sleep, which delivers a continuous stream of air to keep the airway open. CPAP therapy can significantly reduce the frequency of apneas and improve sleep quality. Getting good sleep is an important factor to help alleviate some of the symptoms of depression.
  • Weight Management: For overweight or obese individuals with OSA, weight loss can be an effective way to reduce the severity of sleep apnea. Even a modest weight reduction can significantly improve airway function and overall health.
  • Cognitive Behavioral Therapy (CBT): CBT is a type of psychotherapy that can be effective in treating both depression and insomnia. CBT for insomnia (CBT-I) focuses on changing negative thoughts and behaviors related to sleep, while CBT for depression (CBT-D) focuses on addressing the underlying thought patterns that contribute to depression. CBT can be an effective way to manage both conditions, particularly when combined with other treatments.
  • Medication Management: For individuals with depression, antidepressant medications can be an important part of treatment. However, it is essential to work closely with a healthcare provider to choose the right medication and monitor for any potential effects on sleep apnea. In some cases, adjustments to medication dosage or a switch to a different type of antidepressant may be necessary.
  • Lifestyle Changes: Making certain lifestyle changes can help improve both sleep apnea and depression. These changes may include avoiding alcohol before bed, quitting smoking, establishing a regular sleep schedule, and creating a relaxing bedtime routine.
  • Surgical Options: In some cases, surgery may be recommended to treat sleep apnea. Surgical options may include removing excess tissue from the throat, repositioning the jaw, or implanting devices that help keep the airway open during sleep. Surgery is only typically considered when other treatments have not been effective.

Getting Help for Sleep Apnea and Depression

Even though the relationship between sleep apnea and depression requires further research, it is clear that depression and sleep disorders such as sleep apnea can cause very similar symptoms, such as fatigue, difficulty concentrating, and mood swings. These can affect your physical and mental health and reduce your quality of life.

If you are experiencing any of these symptoms, talk to your primary healthcare provider or mental health professional. By getting help, you may be better equipped to identify the root cause of your symptoms and get appropriate treatment for your sleep disorders (such as sleep apnea), depression, or both.

If you are not sure where to begin or are struggling with other mental health conditions, reach out to APN. Our team of trained mental health professionals is here to help you identify what is causing your symptoms. We can work together with your healthcare provider to develop a treatment approach that allows you to achieve short-term relief and long-term remission of your depression symptoms. To learn more about APN and all the cutting-edge mental health treatments available, contact us today at 424.644.6486 or complete our online contact form to get started.

References

  • Correia, Ana Salomé et al. “Oxidative Stress in Depression: The Link with the Stress Response, Neuroinflammation, Serotonin, Neurogenesis and Synaptic Plasticity.” Antioxidants (Basel, Switzerland) vol. 12,2 470. 13 Feb. 2023, doi:10.3390/antiox12020470
  • “Efficacy of Antidepressants in the Treatment of Obstructive Sleep Apnea Compared to Placebo. A Systematic Review with Meta-Analyses.” Sleep & Breathing = Schlaf & Atmung, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/31720982/. Accessed 4 Sept. 2024.
  • “Sleep Apnea: What It Is, Causes, Symptoms & Treatment.” Cleveland Clinic, 13 June 2024, my.clevelandclinic.org/health/diseases/8718-sleep-apnea.
  • Wheaton AG, Perry GS, Chapman DP, Croft JB. Sleep disordered breathing and depression among U.S. adults: National Health and Nutrition Examination Survey, 2005-2008. Sleep. 2012 Apr 1;35(4):461-7. doi: 10.5665/sleep.1724. PMID: 22467983; PMCID: PMC3296787.