Sleep Apnea, Night Terrors and Nightmares: The Connection Between Sleep and Drea...

Quick Takeaways

• Sleep apnea can lead to pauses in breathing and drops in oxygen
  levels, which may disrupt sleep and trigger vivid dreams or
  nightmares.¹
• Sleep apnea treatment can help some people experiencing
  nightmares and night terrors through continuous positive airway pressure
  (CPAP).^2,13 Lifestyle changes such as stress management and
  healthy sleep habits may help some people with mild sleep
  apnea.³
• CPAP therapy and other treatments may help restore normal REM
  sleep, which is where most dreaming occurs.⁴
• Talk to your doctor if you regularly wake up gasping, sweating,
  or have frightening dreams. These symptoms may be linked to an
  underlying sleep issue, such as sleep apnea.⁵ Waking up from
  a nightmare can be a jarring experience. Your heart races, and for a few
  seconds, a sense of panic may linger before you realize you’re in your
  own bed. Nightly disturbances like this can be a sign that you’re
  dealing with more than just bad dreams and may suggest that your body is
  fighting for air.

If any of this sounds familiar, you might be dealing with something
experts are starting to understand better: a potential link between
sleep apnea and nightmares. Learning how breathing can affect your
dreams is a step toward improving your rest.

What are nightmares and night terrors?

The terms nightmare and night terror are often used interchangeably
in casual conversation, but they’re distinct sleep disorders that tend
to happen during different stages of sleep.^6,7,8

Nightmares are dreams filled with strong negative emotions or
abnormal events that can wake you up.⁹ When this happens, you
may remember the dream clearly with vivid details. These dreams
typically occur during stage 4 rapid eye movement (REM) sleep, which is
characterized by high brain activity that is essential for emotional
regulation and memory processing.¹⁰

Night terrors are displays of panic or dread that may include crying,
screaming, thrashing, rapid breathing and open eyes.⁹
However, this occurs while a person is sleeping, and they may not
remember the disturbance the next day. In most cases, night terrors
happen during stage 3 non-rapid eye movement (NREM) sleep, usually in
the first third of the night.¹¹

What is sleep apnea?

Sleep apnea is a sleep disorder where your breathing repeatedly stops
and starts during sleep.¹ This can make it harder for your
body to get enough oxygen.

The most common form is obstructive sleep apnea (OSA), which is where
the muscles around the throat relax to the point of collapse,
restricting airflow during sleep.¹²

OSA symptoms include:⁵

• Excessive daytime sleepiness
• Morning headaches
• Feeling irritable or moody
• Difficulty concentrating or struggling to feel present during the
  day
• Snoring or gasping for air while you sleep

Your brain may briefly wake you to help reopen your airway so you can
start breathing again. These breathing pauses usually happen so quickly
that many people living with sleep apnea don’t remember them. However,
these tiny sleep disturbances can greatly impact your sleep quality —
and is why many people with sleep apnea experience low energy, brain fog
and daytime tiredness. Additionally, untreated sleep apnea can interfere
with healthy dream patterns, preventing you from getting the restorative
rest you need to feel energized and emotionally balanced.

How sleep apnea affects dreaming

The relationship between your breath and your dreams is intimate and
powerful. When your breathing is interrupted, your brain receives a
distress signal that can dramatically change the content and quality of
your dreams.¹³

Disrupted sleep cycles

Sleep is a cycle of stages that repeat throughout the
night.¹⁴ People with sleep apnea experience frequent
awakenings that can interrupt rapid eye movement (REM) sleep — the stage
associated with dreaming.^13,14 Under normal circumstances, a
person may cycle between non-REM (NREM) sleep and REM sleep every 90 to
110 minutes. However, the muscle relaxation that causes sleep apnea is
usually at its worst during REM sleep. This means that just as you drift
into a dream, your airway may collapse.

When sleep apnea stops you from spending time in REM sleep, your
brain may respond by increasing time spent in REM sleep.¹³
This can lead to dreams that feel incredibly intense and sometimes
overwhelming.¹⁵

Oxygen and the brain

Your brain is very sensitive to changes in oxygen levels. Breathing
pauses may lead to drops in oxygen, which can trigger a stress response
in the brain.¹⁶ In some cases, this may produce
anxiety-filled or fearful dreams.¹⁷ As oxygen levels fall and
carbon dioxide builds up, your brain tries to wake up to restore
airflow.

That sense of panic can influence your dream narrative. Researchers
have long noted that the content of nightmares in people with sleep
apnea often reflects their physical reality.¹⁸

Repeated awakenings can also blur the line between dream and reality,
leading to confusion or distress upon waking. Because these sleep
disruptions are often sudden and fueled by a surge of adrenaline (the
body’s fight or flight hormone), it’s not uncommon to wake up with a
pounding heart or sense of doom.¹³ These emotional hangovers
can linger into the next day, contributing to the anxiety and
irritability often felt by people living with untreated sleep apnea.

The role of CPAP and other treatments

When it comes to nightmares, if the cause is sleep apnea, then
treating the condition can help provide relief from bad dreams. For some
people with undiagnosed sleep apnea, the path to more peaceful dreams
begins with finding the right treatment.

What is CPAP therapy?

Continuous positive airway pressure (CPAP) therapy uses a mask that
fits over your nose and/or mouth, connected to a machine that delivers a
steady flow of air.²⁰ This air is designed to keep your
airway open and reduce breathing pauses while you sleep.

CPAP therapy can help reduce breathing pauses, support healthy oxygen
levels and restore normal sleep patterns for people with obstructive
sleep apnea (OSA). By preventing the breathing pauses that disrupt your
sleep, CPAP allows your brain to cycle naturally
through light, deep and rapid eye movement (REM) sleep without
interruption. And when you sleep better, your physical and mental health
can benefit.²¹

With regular use, CPAP therapy may contribute to fewer nightmares,
calmer dreams and better morning alertness.^22,23 While some
people may experience a temporary increase in dream vividness when they
first start therapy, this typically settles down as the brain catches up
on quality sleep.²⁴

Other treatment options

While CPAP is the leading treatment for OSA, other options may be
available.²⁵ It’s up to you and your doctor to decide on a
treatment plan that best suits you. Other treatments include:

• APAP and bilevel therapy: APAP automatically
  changes air pressure throughout the night based on your breathing
  patterns. Bilevel therapy uses two pressure settings, one for inhaling
  and a lower one for exhaling. Your doctor will recommend whichever type
  best suits your sleep apnea diagnosis.
• Oral appliances: These custom-fitted mouthpieces
  are made by a dentist. They hold the jaw slightly forward during sleep
  to keep the airway from narrowing.
• Surgery: Surgery is typically an option when
  physical differences like enlarged tonsils or a deviated septum is a
  contributing factor. As with any surgery, your doctor will weigh the
  potential benefits against the risks before recommending it.
• Lifestyle changes: For people with mild sleep
  apnea, lifestyle changes like increasing cardio exercise, losing weight,
  reducing alcohol intake, limiting caffeine intake, managing stress and
  adjusting sleep position may help reduce symptoms.

When to talk to your doctor

It’s easy to dismiss bad dreams as a normal part of life, especially
when we’re stressed. However, certain signs can suggest that your
nightmares may be a symptom of an underlying health condition like sleep
apnea.

Consider speaking to your doctor if you have the following
symptoms:⁵

• You experience frequent nightmares⁷, gasping
  or choking during sleep. If your dreams consistently involve
  themes of struggling to breathe, being underwater or being trapped in
  small spaces, your brain may be reacting to real physical
  sensations.
• You feel exhausted or irritable despite sleeping through
  the night. Waking up feeling unrefreshed, having morning
  headaches or battling excessive daytime sleepiness are signs that your
  sleep quality may be poor, even if you think you slept through the
  night.
• Your partner notices gasping or pauses in your
  breathing. Often, a bed partner is the first to notice the
  signs of sleep apnea. If they report that you stop breathing, gasp for
  air or thrash around in your sleep, take their observations
  seriously.

A doctor may recommend a sleep test to determine if you have a sleep
disorder that’s disrupting your rest.¹⁹ A sleep test is an
overnight study used to determine if you have a sleep condition. It
provides a picture of your health by collecting information such as
oxygen levels, heart rate, brain waves and breathing patterns while you
sleep.

Living well with restful sleep

The connection between sleep apnea and nightmares highlights how
deeply our physical health is intertwined with our mental and emotional
well-being. When you struggle to breathe at night, your mind can
struggle to find peace. But this connection also offers hope. Getting
treatment has helped many people with sleep apnea reduce the symptoms
that come with it.¹³

Treating sleep apnea may help reduce nightmares and support more
positive, restorative dreaming.²³ When your brain gets the
oxygen it needs, it can naturally drift through sleep cycles. This
allows the brain to perform essential nightly tasks — processing
memories, regulating emotions and repairing the body — without the
interruption of a survival alarm.

Improved oxygen levels and more balanced REM sleep may help you wake
up feeling more refreshed and focused. For people with obstructive sleep
apnea, consistent CPAP therapy use can help some people notice more
restful nights and peaceful dreams.²³ Taking care of your
sleep is an act of self-care that ripples through every hour of your
waking life.

Take a 5 minute sleep assessment to learn more about your sleep health.

References:

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