How sleep apnea and mental health influence each other
Sleep apnea and mental health conditions frequently appear together.
Studies show that about 35% of people living with obstructive sleep
apnea (OSA) also experience symptoms of depression. Similarly, 32% to
43% of people with OSA experience anxiety.4,5
Depression and anxiety can also worsen sleep quality and complicate a
sleep apnea diagnosis, making it important to recognize and address both
sleep apnea and mental health conditions.
How sleep apnea affects the brain and mood
When breathing stops repeatedly throughout the night due to sleep
apnea, it keeps you from getting the deep, restorative sleep your brain
needs to function. Repeated breathing pauses can cause oxygen levels in
your blood to drop, changing how your brain controls mood.6
Your brain uses chemicals like serotonin and dopamine to help keep
emotions steady. When oxygen levels go up and down, that balance can get
thrown off.46
Sleep apnea interruptions also disturb deep sleep and rapid eye
movement (REM) sleep, which are essential for mental health.7
REM sleep is when dreaming typically occurs, and when your brain
processes emotions and memories47. When sleep apnea wakes you
repeatedly, you miss these restorative sleep stages. Disturbed sleep can
leave you feeling emotionally
drained and more vulnerable to anxiety and depression.
Untreated sleep apnea can also trigger inflammation throughout the
body. Research has linked chronic inflammation to mood
problems.8 Stress hormones, particularly cortisol, also rise
when you don’t get adequate sleep.9 Elevated cortisol levels
can intensify anxiety, making it harder to feel calm during the
day.10
Your body runs on an internal clock called a circadian rhythm, which
regulates when you feel alert or sleepy. This rhythm also influences
hormone production, body temperature and mood.11 When sleep
apnea repeatedly disrupts your sleep, it throws these rhythms off,
affecting how you feel emotionally and how well you handle stress.
Telling the difference: sleep apnea vs. mental health conditions
Sleep apnea and mental health conditions share many symptoms, making
diagnosis more complex. Both conditions can cause mood changes and leave
you feeling tired, irritable, and unable to concentrate.48
This overlap means people may receive treatment for depression or
anxiety when the root cause could be untreated sleep apnea. In some
cases, a person may be living with both sleep apnea and a mental health
condition, making diagnosis even harder.
Symptoms that suggest sleep apnea would be frequent snoring (that
keeps you or your loved one up) or pauses in breath during sleep
(usually noticed by a bed partner). Signs that point more toward anxiety
may include persistent worry, and excessive fear that interferes with
daily life.2 Depression symptoms can include persistent
sadness, loss of interest in activities you once enjoyed, feelings of
hopelessness and sometimes thoughts of self-harm.3
However, sleep apnea, depression, and anxiety can overlap, so it’s
easy to mix them up. They may share symptoms like:
- Daytime tiredness or low energy
- Trouble sleeping or staying asleep
- Irritability or feeling on edge
- Trouble focusing or “brain fog”
- Morning headaches
- Low motivation or less interest in usual activities
- Restlessness or feeling keyed up
- Mood changes like sadness, worry or frustration
How sleep apnea contributes to anxiety and depression
The link with anxiety
Sleep apnea can mirror anxiety symptoms. For example, a person with
sleep apnea may wake up with a racing heart, gasping for air, which can
feel similar to a panic attack.14
For some people, these physical sensations may contribute to feelings
of anxiety or panic, creating a connection between their sleep disorder
and anxiety symptoms. Even if you don’t fully wake up, your body may
register these breathing pauses as threats, activating your “fight or
flight” stress response.49 Plus, ongoing sleep deprivation
can make your brain more reactive to stress.6
The link with depression
Deep sleep helps with emotional recovery by allowing your brain to
process the day’s experiences, consolidate memories and restore
emotional balance.15 When sleep apnea prevents you from
reaching or maintaining deep sleep, it can be harder to bounce back from
emotional challenges.
Chronic fatigue from untreated sleep apnea leads some people to
withdraw from daily activities.16 When you’re constantly
exhausted, socializing may feel like too much effort, hobbies might lose
their appeal and even completing basic household tasks can seem
overwhelming. This withdrawal can deepen feelings of isolation and
depression.
The brain fog and difficulty concentrating that may come with sleep
apnea can affect your performance.17 When you can’t think
clearly or remember things, it can make tasks you previously didn’t find
difficult challenging. You might feel less capable at work or in
personal relationships, which can contribute to depressive thoughts.
Low oxygen levels during sleep affect serotonin and dopamine, brain
chemicals that play essential roles in mood regulation.6,46
People who sleep six or fewer hours per night are 2.5 times more likely
to suffer frequent mental distress,18 and constant tiredness
may contribute to feelings of hopelessness and reduced quality of
life.16,19
