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The Relationship Between Sleep Apnea and Depression

Doctorpedia Editorial Team Doctorpedia Editorial Team July 15, 2021
Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

Sleep apnea can be scary. Sleep apnea is a disorder that causes breathing difficulties during sleep. The condition is serious, and can cause complications ranging from fatigue to heart problems to type 2 diabetes. Researchers are now exploring a potential link between sleep apnea and depression.


Sleep apnea and depression – are they linked?


Because it can leave you fatigued, sad, and irritable, sleep apnea and depression are often linked. So what are the differences between sleep apnea and depression? Most importantly, what are the best treatments?


A study published in September 2019 in the Journal of Psychiatric Research examined 125 patients with major depressive disorder and suicidal tendencies. Researchers found that fourteen percent of them suffered from a type of sleep apnea called obstructive sleep apnea, or OSA. None of the patients were initially suspected to have the disorder.


Dr. W. Vaughn McCall, chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University, says sleep apnea could be responsible for many cases of treatment-resistant depression.


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Sleep Apnea - Symptoms

Sleep Apnea - Symptoms

“No one is talking about evaluating for obstructive sleep apnea as a potential cause of treatment-resistant depression, which occurs in about 50 percent of patients with major depressive disorder,” said McCall.


An older study came to a similar conclusion: in 2014, investigators found that out of 178 adults with sleep apnea, 46.1 percent of them “demonstrated depressive symptoms.”


One reason sleep apnea and depression may be closely connected is that the two share symptoms. Depressed people often report lower quality sleep –– even when they are getting seven to eight hours a night. Irritability, susceptibility to viruses, and lack of interest in activities that once brought joy are other symptoms that both conditions share. If you (and/or a partner) have noticed your apnea, the first step is a visit to a sleep disorders clinic. It’s difficult for a general practitioner to make an accurate diagnosis. 


However, from an insurance standpoint you may need a referral from your primary care physician. Regardless, the best way to see if you have the condition is to be observed sleeping. At the clinic, technicians will record your sleep. Over the course of around six hours of slumber, your brain waves will be measured by an electroencephalogram (EEG), while an electrooculogram (EOG) will record your sleep stages by measuring eye and chin movements. Meanwhile your heart rate and rhythm will be noted by an electrocardiogram (EKG) while bands across your chest will measure breathing. 


Your blood will be tested for oxygen and carbon dioxide levels. The plethora of devices involved is why staying overnight in a sleep clinic is generally preferable to home tests.


If you don’t have sleep apnea, the need may be to focus on mental health. The next step after the sleep disorders clinic will be meeting with a qualified therapist, either a psychologist or psychiatrist. Talk therapy, sometimes in combination with medication, can help with depressive episodes. 


Why could sleep apnea cause depression?


It’s known that lack of sleep can cause innumerable health conditions, which include obesity, heart disease and diabetes. But many aren’t aware that not getting enough sleep can affect mental health as well; beyond simply feeling fatigued or grumpy during the day. According to the National Sleep Foundation, poor sleep and depression are directly linked. 75 percent of people with depression also suffer from insomnia, which in turn makes their depression worse, creating a “vicious circle” scenario.


Since sleep apnea makes it extremely difficult to get a good night’s rest, it would be safe to assume that it would indirectly impact the mind as well as the body. If you’re constantly waking up in the middle of the night and gasping for air, it’s no wonder you’d wake up in the morning feeling irritable and groggy. And if you know the same thing will happen to you every night of the week, it’s easy to see how you’d become depressed over the long term.


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Sleep Apnea - Snoring vs Sleep Apnea

Sleep Apnea - Snoring vs Sleep Apnea

Is my depression caused by sleep apnea?


If you’ve been feeling down lately for no reason, you might want to see if you have sleep apnea.  Symptoms of sleep apnea include:


  • Awakening with a headache or dry mouth
  • Insomnia
  • Fatigue during the day
  • Waking up in the middle of the night gasping for air
  • Sweating at night
  • Constantly waking up to urinate
  • Waking up multiple times during the night
  • Difficulty concentrating or remembering things


If you do in fact happen to have sleep apnea, you can treat the condition through a number of therapies and lifestyle changes. You and your doctor will decide which method is right for you.


  • Wearing a PAP mask at night to promote breathing
  • Losing weight if you’re overweight or obese
  • Avoiding alcohol and sleeping pills
  • Sleeping on your side
  • Surgery, as a last resort


Of course, some people have both sleep apnea and depression. The course of treatment for these conditions often overlaps. Improved diet and increasing exercise will combat depression as well as apnea. 


Knowing what you have is the first step toward treatment and a better night’s sleep.

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