Correcting this common problem can lift your mood and give you much more energy throughout the day. Here’s what you should know about sleep apnea and depression.
Cathy Hope hit fatigue in her mid-50s. Even after her usual eight hours of sleep every morning, she awoke exhausted. After a year, she had trouble breathing when she walked.
At 5 feet and 98 pounds, Hope didn’t fit the standard stereotype of a sleep apnea patient: an obese man with a rattling snore who falls asleep in office meetings. “I didn’t snore, and I didn’t have problems with sleepiness,” Hope said.
Still, an imaginative doctor diagnosed sleep apnea. After several months of treatment, her energy had completely returned.
It’s easy to attribute symptoms like tiredness or confusion to menopause or depression. But you should speak to your doctor about a sleep apnea evaluation, since your sleep may be contributing to the problem.
In an Australian study of 293 sleep apnea patients, for example, 213 had clinically significant symptoms of depression — nearly 73 percent. Other research shows that sleep apnea can affect your memory and ability to focus.
What is sleep apnea?
Sleep apnea is a breathing problem. Your brain may fail to send correct signals to your breathing muscles (also called central sleep apnea). More often, your airway collapses or is blocked because of fat or abnormalities in your throat and nasal passages (known as obstructive sleep apnea).
When your breathing pauses or becomes shallow, it disrupts your deep sleep. Although people don’t usually wake up, they become sleep-deprived and more vulnerable to:
- Cognitive dysfunction
- Type 2 diabetes
- High blood pressure
- Heart failure
- Car accidents from sleepiness at the wheel
A night of oxygen deprivation continues to affect you throughout the day, research suggests.
In serious cases, untreated sleep apnea can damage brain function permanently.
Symptoms of sleep apnea
- Loud snoring
- Breathing cessation during sleep
- Waking up abruptly and feeling out of breath
- Attention problems
- Excessive tiredness during the day
- Sore throat or dry mouth when you wake up
- Trouble sleeping
Who gets sleep apnea?
As you get older, your risk of sleep apnea increases. More than 43 percent of U.S. men between the ages of 50 and 70 have sleep apnea, as do almost 28 percent of women, according to one study. Other research shows that more than half of African Americans have sleep apnea in midlife.
You can also have sleep apnea in your 30s and 40s, especially if you are overweight.
What you can do
You should see a doctor for a diagnosis, if you suspect you have the condition and it might be causing your depression.
Your doctor may refer you to a sleep clinic for a sleep study, and possibly a mental health professional about your depression (even if the doctor does not believe you have sleep apnea).
You may also be able to take a test at home, attaching sensors to yourself to monitor your breathing while you sleep. Home tests are prone to false negatives, however, so if your home test is negative, ask for a test in a sleep lab, where you’ll stay overnight.
If you have frequent episodes of interrupted breathing, you can take several steps. You can get more exercise, lose weight, and stay away from alcohol.
In one study, exercise reduced the severity of sleep apnea by up to a third, even in people who didn’t lose weight.
Some people need to sleep on their side rather than on their back.
Over-the-counter nasal sprays or products that keep your nostrils open may help snoring and mild sleep apnea.
You may benefit from sleeping with a mandibular advancement device, which you put in your mouth to keep your lower jaw slightly forward.
Some people with severe cases get surgery.
The most effective remedy is a CPAP (continuous positive airway pressure) machine, which comes with a mask. The mask may cover both your mouth and nose or just your nose.
The machine will blow air into the mask to reach your throat and keep your airway open.
You may have heard that people don’t like CPAP machines. Some research, however, suggests that 75 percent of patients use their machine at least five nights a week.
The evidence that CPAP boosts mood in people who are anxious or depressed isn’t iron-clad. In the Australian study, the results were dramatic: Only nine of the depressed patients who went on to sleep regularly with a CPAP machine still showed symptoms of depression three months later. About 40 patients who were harboring thoughts of suicide before the treatment were no longer struggling with those demons.
A study of more than 300 women in Spain diagnosed with moderate-to-severe obstructive sleep apnea also showed improvement in their moods after three months on the device. A small study in Taiwan, mainly of men, concluded that CPAP improved mood as many as six months later, although surgery for sleep apnea (another treatment option) did not.
But it’s possible that some or all of the mood benefits from CPAP happen because patients expect to feel better. In a metanalysis of 31 relevant reports, researchers concluded that the jury is still out, since many studies didn’t meet the highest standards.
Overall, anxious and depressed CPAP patients did have improved mood after treatment, yet they didn’t do reliably better than people who were fitted with dental appliances or fake CPAP machines. That said, CPAP seemed more clearly beneficial in people who were more severely depressed.
The evidence that sleeping with a CPAP machine will protect your brain function is mixed. The device may be most helpful if you start young and use the machine for a long time.
If your doctor prescribes CPAP, commit yourself to using the machine regularly. Skipping nights, taking it off during the night, or stopping altogether could affect your health more than you think.
August 31, 2023
Christopher Nystuen, MD, MBA and Janet O'Dell, RN