What Sleep Apnea Can Do to Your Mental Health

Obstructive sleep apnea is common, often undiagnosed, and can bring on symptoms that look a lot like a mental health condition. It’s worth ruling out when depression, anxiety or trouble thinking clearly isn’t improving the way you’d expect, and the link between sleep apnea and depression is easy to overlook.

What It Is

In obstructive sleep apnea, the muscles of the throat relax during sleep and the airway narrows or closes, so breathing stops and starts many times a night. Each pause usually ends with a snort or gasp as breathing restarts, and most people don’t know it’s happening.

The result is broken-up sleep and less oxygen than your body needs. Someone can spend a full night in bed and still wake up unrefreshed.

How It Can Affect Your Mental Health

• Depression. Untreated sleep apnea can lead to depression or mood changes, and a review of long-term studies found people with sleep apnea were more likely to develop depression over time. The two also share symptoms, such as tiredness, low energy and poor concentration, which makes them easy to confuse.
• Anxiety. Sleep apnea is linked with anxiety, and one large study found a higher risk of later panic disorder. Waking up gasping or choking can be frightening in its own right.
• Thinking and memory. Poor-quality sleep can cause problems concentrating, making decisions and remembering things. These often get put down to depression, getting older or simply being busy.
• Irritability. People with sleep apnea may feel grumpy, impatient or irritable.
• Depression that isn’t improving. Sleep apnea is common among people with depression and often goes undiagnosed. If the apnea isn’t treated, some of the tiredness and fog may not lift with depression treatment alone.

That last point is the practical one. When depression treatment isn’t working as well as hoped, an untreated sleep problem is one of the things worth checking. Our post on treatment-resistant depression covers other things worth looking at.

Why It’s Missed So Often

• The usual picture is misleading. Many people picture an older, heavy man who snores loudly. Weight and age do raise the risk, but so do a narrow airway, a smaller lower jaw, large tonsils and family history, and sleep apnea can happen at any age.
• Women often have different symptoms. Loud snoring is more common in men, while fatigue, headaches and insomnia are more common in women. In one study, women with sleep apnea were more likely than men with the same severity to already be treated for depression.
• You usually can’t see it yourself. The pauses happen while you’re asleep, and someone who sleeps alone has no one to notice. Tiredness gets called depression, trouble focusing gets called stress, and each explanation sounds reasonable enough that nobody looks further.
• Sleep questions often stop at hours. It’s easy to answer “how are you sleeping?” with a number and leave out the snoring, gasping or headaches.

How often it goes undiagnosed can be striking. In a 1997 study of working adults, researchers estimated that 93% of women and 82% of men with moderate to severe sleep apnea had not been clinically diagnosed.

Signs Worth Mentioning

• Loud snoring, especially with pauses followed by a snort or gasp.
• Someone noticing your breathing stop and start while you sleep.
• Waking up unrefreshed even after enough time in bed.
• Morning headaches.
• Daytime sleepiness, including nodding off while reading, watching TV or driving.
• Waking up gasping or choking.
• Getting up often at night to urinate, a less well-known sign.
• Depression that isn’t improving, especially with a lot of fatigue and trouble concentrating.

Risk factors include higher body weight, a large neck, large tonsils, alcohol, smoking and family history. Not having them doesn’t rule sleep apnea out.

How It’s Diagnosed

Sleep apnea is confirmed with a sleep study, which can often be done at home or sometimes in a sleep lab. Your primary care provider or a sleep medicine provider can arrange testing, and they’re also the ones who manage treatment.

We don’t do sleep studies or treat sleep apnea ourselves. If your symptoms fit, our psychiatric nurse practitioners can talk it through with you and suggest you see your primary care provider or a sleep medicine provider. If you already suspect it, bring it up rather than waiting to be asked. If someone has seen your breathing stop at night, it can help to bring them along or ask them what they noticed.

Why Treating It Matters for Your Mood

The most common treatment is a positive airway pressure (PAP) machine such as CPAP, which keeps your airway open with gentle air pressure through a mask. Oral devices, lifestyle changes and other options help some people.

Treatment can help mood as well as sleep. A review of randomized trials found CPAP improved depression symptoms, with bigger improvements in people who had more depression symptoms to start with, and a large trial in people with sleep apnea and heart or blood vessel disease found CPAP lowered the odds of depression. The same trial didn’t find a clear effect on anxiety.

Treating sleep apnea doesn’t replace depression care. Someone who has both may need both treated, and finding the apnea is what makes that possible. That’s why diagnostic clarification matters: it can change what gets treated, not just how.

For adults in Burlington County and across New Jersey looking for a psychiatrist for depression treatment, our board-certified psychiatric nurse practitioners can look at the whole picture, sleep included, when mood isn’t improving.

A Note on Sleep Aids and Alcohol

If you have or might have sleep apnea, it’s worth knowing that alcohol and medicines that make you sleepy can make symptoms worse when taken before bed. The NHS advises not taking sleeping pills unless a doctor recommends them.

That’s one more reason it’s worth finding out why you’re sleeping poorly. If you have or suspect sleep apnea, tell anyone who prescribes for you, and talk with your provider before taking anything that makes you sleepy. Please don’t stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly.

Our post Sleep Disorders and Mental Health: What You Should Know covers other sleep problems that affect mood, and our sleep disorders page explains how we help.

Frequently Asked Questions

Can sleep apnea cause depression?

It can contribute. Untreated sleep apnea is linked with depression and mood changes, and long-term studies suggest people with sleep apnea are more likely to develop depression over time. The two also share symptoms like tiredness and poor concentration, so it’s worth checking for apnea when depression isn’t improving.

Can you have sleep apnea without being overweight or snoring loudly?

Yes. Weight raises the risk, but a narrow airway, jaw shape, large tonsils and family history matter too, and it can happen at any age. Women more often notice fatigue, headaches or insomnia than loud snoring.

How do I know if I should be tested for sleep apnea?

Talk with your primary care provider if you snore loudly, someone has noticed your breathing stop at night, you wake up gasping or unrefreshed, you have morning headaches or daytime sleepiness, or you get up often at night to urinate. Depression that isn’t improving, especially with heavy fatigue, is another reason to ask. A sleep study can often be done at home.

Will treating sleep apnea improve my depression?

It may help. Research shows CPAP can improve depression symptoms, especially in people with more depression symptoms to start with. It doesn’t replace depression treatment, and someone with both conditions may need both treated.

If tiredness, low mood or foggy thinking aren’t lifting, a psychiatric evaluation can help sort out what’s going on, and medication management can help you stay on track once you have a plan. Our depression guide covers the bigger picture.