Quick Takeaways:
- Sleep apnea and mental health conditions like anxiety and depression may occur together and can influence each other.
- Disrupted sleep can trigger or worsen anxiety and depressive symptoms, while mental health conditions can make sleep apnea symptoms feel worse.
- Treatment for sleep apnea, such as continuous positive airway pressure (CPAP) therapy, may improve both sleep quality and mental health symptoms in some people.
An astounding 89% of people agree that getting enough sleep makes them feel better about themselves and gives them more energy to spend time with loved ones.1
Unfortunately, sleep disorders like sleep apnea, where breathing repeatedly stops and starts during sleep,45 can impact your mental and emotional well-being. Understanding the connection between sleep apnea, anxiety and depression may help you recognise important symptoms and seek the right care.
Understanding the sleep apnea and mental health connection
First, it's important to understand these conditions before looking at how they are connected. Sleep apnea can lead to pauses in breathing that may last from 10 seconds to over a minute. These pauses can starve your organs from getting oxygen.
Alternatively, obstructive sleep apnea (OSA) is a condition where the muscles around the throat relax to the point of collapse, restricting airflow during sleep. Breathing may become shallow or stop for seconds to minutes at a time. Someone with OSA may experience:
- Excessive daytime sleepiness
- Morning headaches
- Feeling irritable or moody
- Difficulty concentrating, struggling to feel present during the day
- Snoring or gasping for air while they sleep
Anxiety causes people to feel overly nervous or worried about things in daily life, and these persistent feelings or thoughts can interfere with how a person lives their life. A person with anxiety may:2
- Feel excessively worried
- Have a hard time concentrating
- Experience pain, including headaches and stomachaches
- Find it hard to relax
- Have trouble falling asleep or staying asleep
Depression is a condition that causes severe symptoms that can affect a person's mood, thoughts, feelings, and how they handle day-to-day activities. Common symptoms of depression include:3
- Intense feelings of sadness, hopelessness, worthlessness or frustration
- Lack of energy
- Loss of interest in activities
- Trouble concentrating
- Pain, headaches or digestive issues
- Difficulty sleeping or sleeping too much
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 recognise 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.
How chronic sinusitis and obstructive sleep apnea (OSA) are related
Chronically inflamed sinuses can make it more difficult to breathe through your nose. A blocked nose can make you more likely to breathe through your mouth while you're sleeping. Breathing through your mouth can narrow the upper airway and increase the risk of airway collapse — a key characteristic of obstructive sleep apnea.3
- If you have OSA, chronic sinusitis may make your symptoms feel more noticeable. Breathing interruptions may occur more frequently at night, affecting your sleep quality. You might notice increased daytime sleepiness and difficulty focusing, and your loved ones might report frequent snoring that keeps them awake.26
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-harm3
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, socialising 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.19,16
Who is most at risk?
Anxiety and depression tend to affect women more.50,51 Women with sleep apnea also tend to have nonspecific symptoms such as insomnia, depression, fatigue, morning headaches and nightmares, which may contribute to lower rates of diagnosis and treatment compared to men.20 Because of the different ways women present, they are more at risk of being diagnosed with anxiety or depression when sleep apnea is the underlying issue.
Older adults with untreated sleep apnea may be misdiagnosed with dementia.21 The cognitive impairment and mood changes that can accompany severe sleep deprivation may look similar to those sleep apnea, leading to the wrong treatment approach.
Veterans and other individuals living with post-traumatic stress disorder (PTSD) face higher rates of both sleep apnea and mental health struggles. The nightmares, hypervigilance, and sleep disruption associated with PTSD may overlap with sleep apnea symptoms, making them worse. Additionally, the breathing pauses and oxygen drops from sleep apnea may be associated with more intense PTSD symptoms. Studies estimate that 67% to 69% of the veterans who have PTSD22 also have sleep-disordered breathing.
People with excess weight or obesity may experience a challenging cycle where weight gain contributes to sleep apnea, and sleep apnea makes it harder to maintain a healthy weight.23 Both conditions can contribute to depression.
Individuals with treatment-resistant depression, meaning depression that doesn't improve with standard antidepressant medications, may have undiagnosed sleep apnea.24 When depression treatments aren't working, screening for and treating sleep disorders could be useful.
Why severity and getting treatment matter
Sleep apnea severity is measured by the apnea-hypopnea index (AHI), which counts how many times per hour your breathing stops or becomes very shallow during sleep. An AHI score of 5–14 indicates mild sleep apnea, 15–30 indicates moderate sleep apnea, and an AHI of more than 30 indicates severe sleep apnea.25
Studies shown that people with more severe sleep apnea tend to report more depressive symptoms, with severe sleep apnea being associated with a higher risk of depression.26 Research also shows a correlation between sleep apnea severity and the frequency of anxiety, with more frequent breathing pauses during the night being associated with higher levels of anxiety during the day.27
Greater drops in oxygen levels during sleep can lead to greater strain on the body and brain. Lower levels of oxygen in the blood have been linked to morning depression — a heavy, sad feeling when you first wake up.28 The longer your sleep apnea goes untreated, the greater the mental health risks become.
Treatment approaches and outcomes
CPAP therapy and mental health
Continuous positive airway pressure (CPAP) therapy uses gentle air pressure to keep your airways open while you sleep. Research on CPAP treatment and depression or anxiety has shown encouraging results. One study demonstrated that less than 9 of the 213 people living with sleep apnea who had depressive symptoms still had symptoms after 3 months of consistent CPAP therapy.29 Another study showed a decrease in anxiety after 6 months of using a CPAP device consistently, with further improvement after 1 year.30
Research using brain imaging has shown CPAP therapy to help restore brain patterns that control mood and emotions.31, 32 In short, treating sleep apnea may help the brain manage feelings and emotions better.
Treating sleep apnea and mental health conditions together
Combining CPAP therapy with cognitive behavioural therapy for insomnia (CBT-I) can be helpful when sleep apnea and mental health conditions coexist. 53 CBT-I is a structured program that can help people identify and change thoughts and behaviours interfering with sleep. It teaches techniques for falling asleep, staying asleep and developing healthier sleep habits.
CBT-I may also help with comorbid insomnia and sleep apnea (COMISA), which is when someone is living with both insomnia and sleep apnea. In one study, participants using CBT-I who used their CPAP each night showed greater improvement in the severity of their insomnia.33
Other treatment options may include prescription medications to address a mental health condition. However, consult a doctor before taking antidepressant medications, due to various potential side effects.34
Mindfulness and relaxation techniques may help reduce stress and improve sleep quality.36 Deep breathing, meditation or progressive muscle relaxation can calm your nervous system, making it easier to fall asleep and reduce anxiety symptoms.
Collaboration between sleep specialists and mental health providers may lead to better results. By sharing information, they can create a comprehensive treatment plan that addresses all aspects of your health rather than treating each condition separately.
Long-term care and monitoring
Mental health symptoms should be checked regularly throughout sleep apnea treatment.37, 38 Continue talking about your sleep quality and emotional well-being with your healthcare providers. Some people may experience significant mood improvements immediately, while others may need to adjust their treatment plan or request additional mental health support.
Lifestyle changes can improve sleep and mental health. Examples include:
- Maintaining good sleep habits, like keeping a consistent bedtime, creating a comfortable sleep environment and limiting screens before bed.
- Getting regular exercise, which may help improve mood, sleep quality and physical health.
- Using stress management techniques, such as physical activity or creating routines, to help you cope with daily challenges without becoming overwhelmed.
Support groups provide opportunities to learn tips and strategies from people with similar experiences. Plus, connecting with others who understand the challenges of sleep apnea or managing mental health conditions can reduce feelings of isolation.
Even with continuous positive airway pressure (CPAP) therapy, monitoring lingering sleep problems is important.15
Talking to your doctor about mental health and sleep
Several barriers may prevent people from seeking treatment for sleep apnea and mental health conditions, including:
- Stigma about sleep disorders and mental health, which can delay getting help.39, 40
- Insurance coverage may not include all testing or therapy options.
- Lack of awareness among doctors who may not recognise the mental health connection to sleep apnea.
- Tracking your symptoms ahead of time can help your doctor fully understand your experience.
- Making a list of medications and supplements you're taking, so your doctor knows what might impact your sleep and treatment.
- Asking questions about anything you don't understand, including what tests might be recommended and how treatments work.
- Being honest about your symptoms so your doctor can make informed decisions.
This article is for educational purposes only and is not a substitute for medical advice. If you're experiencing symptoms of sleep apnea, anxiety or depression, consult with your doctor or a mental health professional.