If you are dealing with or have a loved one who is struggling with depression, you know one of the biggest problems this disorder poses involves sleep. With depression, people find it harder to fall asleep and stay asleep, leaving them feeling down and completely fatigued throughout the day.
Most of us who deal with depression write off the sleep issues to the disorder and call it a day… But research suggests that the dreaded lack of sleep that almost always comes along with depressive disorder means something more.
Multiple studies indicate that there is a connection between depression and sleep apnea, specifically obstructive sleep apnea. In fact, treating sleep apnea can reverse depression in patients who deal with both.
This connection could completely change your view on depression-related sleepiness. In addition, it opens doctors up to new treatments and understandings of both depression and sleep apnea.
We’ll discuss what sleep apnea is, why you need to worry about it in conjunction with depression, and what this means for the future of depression disorder treatments.
What is Sleep Apnea?
Sleep apnea is a common type of sleep-disordered breathing. The two primary forms of sleep apnea are obstructive sleep apnea, which involves physical blockages of the airway, and central sleep apnea, which is a neurological issue where the brain stops sending signals to breathe during sleep.
This article pertains mostly to the connection between obstructive sleep apnea and depression.
Obstructive sleep apnea is the more common of the two forms. It is characterized by frequent upper airway blockages that cause breathing to stop and start again. The upper airway is usually obstructed due to the soft tissues in the back of the throat relaxing, then collapsing, during sleep. Obstruction can also be caused by insufficient motor tone of the tongue, where it falls to the back of the throat and blocks the upper airway.
Obstructive sleep apnea is a growing issue in the United States as obesity rates rise. Many cases of obstructive sleep apnea are undiagnosed and left untreated; many write off their symptoms as insomnia or as being stress-related. But there are many risk factors associated with sleep apnea, such as cardiovascular disease and atrial fibrillation.
In addition, even psychiatric illnesses are associated with sleep apnea.
Symptoms of obstructive sleep apnea include, but are not limited to:
- Loud and disruptive snoring
- Reports from family members and/or bed partners that you snort, choke, gasp, or stop breathing in your sleep
- Excessive daytime fatigue
- Headaches, especially in the morning
- Waking up with dry mouth or sore throats
- Abrupt awakenings during the night where you need to catch your breath
- High blood pressure
- Nighttime sweating
- Mood changes and increased irritability
- Difficulty focusing throughout the day
- Nocturia (waking up frequently to use the restroom)
Sleep Apnea and Psychiatric Illnesses
Sleep apnea has long been linked to mental health, and more recent research is supporting the suggestion. Psychiatric illnesses often coexist with sleep apnea cases. Some of these illnesses include bipolar disorder, post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), dementia, insomnia, panic disorder, schizophrenia, anxiety, and depression.
One journal states that 69% of people with severe mental illness were automatically at a higher risk for obstructive sleep apnea. 14% of the study group had bipolar disorder. Insomnia is also prevalent in obstructive sleep apnea patients, between 39-42%. Obstructive sleep apnea also has a direct effect on certain brain functions, which can increase the risk of developing dementia, especially for those already at risk.
The sleep-breathing disorder has also been linked to anxiety disorder, specifically with nighttime panic attacks. Some studies have shown a link in anxiety disorders and daytime fatigue, a more common symptom of obstructive sleep apnea. Prevalence of obstructive sleep apnea in people with PTSD is also high; many veterans with PTSD who complain of nightmares and insomnia symptoms also have been diagnosed with obstructive sleep apnea.
Schizophrenia is also suggested to be connected to obstructive sleep apnea; one study showed that an obstructive sleep apnea diagnosis was made 6 times more often with schizophrenia patients than in patients with other mental illnesses.
Depression and Sleep Apnea
Depression symptoms and sleep apnea symptoms often overlap, which cause trouble in distinguishing what you might be experiencing: just one or both. Additionally, depression can in fact be a symptom of sleep apnea, which makes this issue even more difficult to clear up.
Some primary symptoms of depression include:
- Changes in appetite
- Sleep disturbances
- Irritability and moodiness
- Excessive fatigue
- Feelings of sadness, hopelessness, or worthlessness
- Trouble focusing
- Loss of interest in usual activities, hobbies, etc.
Because many symptoms overlap between the two disorders, sleep apnea is often misdiagnosed as depression or left undiagnosed.
At this point, mood disorders are commonly considered secondary to obstructive sleep apnea. This means that doctors usually assess for sleep apnea first before determining if you have depression. This helps differentiate whether the depression is caused by sleep apnea or by psychiatric illness and allows for a more accurate treatment plan.
A Dangerous Combination
People with depression are at a higher risk of having a sleep-breathing disorder such as sleep apnea, and vice versa. With this in mind, people with depression usually relate their sleep problems to their depression, which is valid, but can leave an underlying issue undiscovered.
Many medications that treat depression or aid in sleep can exacerbate symptoms of sleep apnea. Sedatives, especially, can make it more difficult to wake after an apneic episode, which could be fatal.
These two conditions coexisting with one another can be an incredibly dangerous combination, so it’s recommended you look into both issues before treating one or the other.
What Does Research Say?
Numerous studies have been conducted on the topic of connecting sleep apnea and depression, most of which do suggest a common link between the two.
A government study of almost 10,000 adults, released in 2012, concluded that the more frequently people have apneic episodes during sleep (this includes snorting, gasping, choking, or breathing cessations, but not any form of snoring) are more likely to show symptoms of depression.
According to a study from the Center of Disease Control and Prevention (CDC), obstructive sleep apnea and its symptoms are associated with major depression. Anne G. Wheaton, the lead author of the study, wrote, “snorting, gasping or stopping breathing while asleep was associated with nearly all depression symptoms, including feeling hopeless and feeling like a failure… We expected persons with sleep-disordered breathing to report trouble sleeping or sleeping too much, or feeling tired and having little energy, but not the other symptoms.”
This study showed that the likelihood of depression increased with the frequency of apneic instances. The results showed that out of the 6% of men and 3% of women who were properly diagnosed with obstructive sleep apnea, the 7% of men and 4% of women who reported apneic episodes occurring at least five nights a week were three times more likely to show signs of major depression.
According to Wheaton, some possible explanations for the link include diminished oxygen to the brain and frequently-interrupted sleep. Wheaton believes that screening for both disorders when one is present could help address the high number of undiagnosed cases of sleep apnea and depression.
Another study written by Dr. William V. McCall, chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University, argues a similar connection.
The study suggests that obstructive sleep apnea is a main cause for unsuccessful treatments in patients with depression. In addition, McCall argues that screening for obstructive sleep apnea and treating it accordingly could relieve the major symptoms of depression.
McCall states, “no one is talking about evaluation for [obstructive sleep apnea] as a potential cause of treatment resistant depression, which occurs in about 50% of [people] with major depressive disorder.”
McCall studied 125 people with depression with the purpose of seeing if treating insomnia symptoms would improve the depression. But in conducting the study, he realized that 14% of the subjects had undiagnosed obstructive sleep apnea, some of which were non-obese women. This completely contrasts the demographic group, overweight men, that is at a much higher risk of obstructive sleep apnea. This indicates that depression has a bigger connection to obstructive sleep apnea than what was previously thought.
What This Means for Treatment
It is believed that treating sleep apnea will help with the depression symptoms. Right now, there are multiple treatment options for sleep apnea.
In the past, CPAP therapy was the primary treatment option, but it comes with many issues. A safer, more comfortable and convenient alternative has rapidly changed the treatment plans of sleep apnea and has helped patients live a more comfortable life with sleep apnea. This treatment is known as oral appliance therapy.
Oral appliance therapy involves wearing an oral appliance during sleep. It fits similar to a sports mouth guard or night guard for teeth grinders. The purpose of it is to push the lower jaw down and forward to prevent the soft tissues in the back of the throat from collapsing and causing a blockage.
Home treatment in addition to oral appliance therapy promotes a better quality of life. Some home treatments that are recommended for coping with sleep apnea include:
- Changing Sleeping Position
Sleeping on your back increases the likelihood of having an airway blockage. Try sleeping on your side instead. It can work wonders! There are different pillows designed to help with this.
- Exercising Regularly
Exercising releases endorphins, those happy hormones you’ve probably heard of once or twice. It helps with depression symptoms and aids in weight loss, which is crucial to easing sleep apnea!
- Avoiding Alcohol and Caffeine
Alcohol and caffeine are stimulants that can keep you up at night, so try to avoid drinking either after a certain hour. Caffeine shouldn’t be consumed after 2 pm, and alcohol shouldn’t consumed any later than 3 hours before your normal bedtime. In addition, alcohol can make depressive symptoms worse and can be dangerous during particularly bad periods, so it’s best to stay away from it altogether.
- Using Essential Oils
Essential oils are great home remedies for pretty much anything; they are all natural and safe and easy to use. Some oils interact with the body in ways that can promote healthy, restful sleep. Lavender oil is particularly good for sleep. You can rub it on your neck, chest, and feet before bed and diffuse it on your nightstand to help you sleep easier. Essential oils are also helpful for depression; certain oils are known to boost mood. Lemon, wild orange, and grapefruit oils are all energizing oils that promote focus on a better mood. Keep in mind that essential oils are not regulated by the FDA, so do your research on quality control before buying! We recommend Doterra.
In terms of dealing with treatment resistant depression, the connection between depression and obstructive sleep apnea could change treatment plans for the better.
For example, most people with treatment resistant depression undergo many different tests to discover the underlying condition that is causing the resistance. Some of these tests could be MRI scans to even spinal taps, and can be very costly and stressful.
The link between the two disorders, though, indicate that sleep tests should come first in patients with depression. Sleep tests, especially at-home studies, are significantly less invasive, less costly, and overall, might get you to an answer faster.
Take Control of Your Depression Today
Depression can definitely be difficult to deal with, but you can control it with the right help. The first step? Looking into sleep apnea. If you’re struggling with depression and are having issues sleeping, we recommend visiting a sleep specialist here at Advanced Sleep Solutions of Virginia. We have a highly trained team here that is dedicated to both your physical and mental health, and we want to make sure you have a strong support system ready to help you.
We want you to get the best sleep possible, so you can succeed in whatever you do! As a patient, your comfort and convenience is our first priority. We make the process of diagnosing and treating sleep disorders, chronic snoring, and more, as easy as possible with at-home sleep studies, online scheduling, and a secure telemedicine portal where you can speak with a professional at any time!
Struggling with depression? Worried about sleep apnea or your sleep health? We’ve got you covered. Schedule an appointment with us online or call us at (703) 689-2480 for a free consultation.