Have you ever wondered if your snoring might be a sign of something more serious? Sleep is vital for maintaining mental well-being and has been shown to be correlated with mental health conditions. Any disruptions to your regular sleep pattern can result in a heavy impact your quality of life. Hence, probing the delicate connection between sleep apnoea and mental health will provide you with the necessary knowledge to take necessary steps to overcome this issue.

Here, we will discuss the link between sleep apnoea and mental health. Examine further the different types and symptoms of sleep apnoea, and the appropriate treatment plans to improve both your sleep and mental well-being. 

Sleep apnoea not only affects your physical health in multiple ways but your mental well-being too. This condition can influence your mood and behaviours, affecting your overall mental health alongside cognitive effects. Keep on reading to understand the comprehensive connections between sleep apnoea and mental health, to improve your sleep quality and hence your quality of life!

What is the link between Sleep Apnoea and Mental Health?

Sleep apnoea is an increasingly prevalent public health burden, predicted to worsen considerably over the next 2 decades.¹ Not only does it have definitive links to physical health issues such as obesity and hypertension, its significant impact on mental health also makes this an alarming situation.¹

There are three primary categories of sleep Apnoea: obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and treatment-emergent central sleep apnoea (TECSA).²

Obstructive sleep apnoea (OSA)

OSA, the most common form of sleep apnoea, arises when the upper airway becomes obstructed during sleep, causing temporary restriction in the flow of air into the lungs. This leads to constant restriction of the air flow into the lungs, leading to frequent awakenings throughout the night.³

OSA is found to affect more men than women, with one study in the US revealing a comparison of 24% men to 9% of women. OSA is closely related to factors such as metabolic changes, obesity, and hypertension, causing severe sleep fragmentation, poor sleeping patterns, and persistent fatigue, all significantly impacting your daily optimum function.³

Central sleep apnoea (CSA)

CSA is a less common form of sleep apnoea, where respiratory attempts are diminished due to the brain's failure to send the appropriate signals to the muscles that control breathing.⁴

Treatment-emergent central sleep apnoea (TECSA)

TECSA is another categoryof disordered sleeping, artificially induced through the treatment plan of obstructive sleep apnoea that elicits central sleep apnoea instead. In some cases, CPAP therapy can lead to the emergence of central sleep apnoea, including some surgical interventions as well, further complicating the disorder.⁵

What really is sleep apnoea?

Sleep apnoea is a sleep disorder distinguished by repeated interruptions in breathing during sleep. Common signs are loud snoring, pauses in breathing, gasping for air, regular morning headaches and troubles staying asleep. These disruptions can induce irritability throughout the day, struggles in paying attention and reduced productivity. It is important to note that not everyone with sleep apnoea will experience loud snoring.^2]

How does sleep apnoea occur?

Sleep apnoea happens in different ways based on its type. OSA occurs when the back throat muscles are in a relaxed state, which controls the soft palate. When these muscles become too relaxed, the airways become narrow and constricted, consequently lowering oxygen levels. This sends an emergency signal to the brain to briefly wake you up and reopen your airflow again.²

Although this is usually a brief moment, so brief that you won’t notice it occurring, however, it can repeatedly occur during the night, causing a serious irregular sleeping pattern.²

Central sleep apnoea, a less common form, occurs when the brain does not send sufficient signals to the muscles that control breathing, leading you to momentarily awaken from a short pause with no breathing.

What are the risk factors for sleep apnoea?

Risk factors for sleep apnoea vary but commonly include:

• Gender: Men are 2 to 3 times more likely to have sleep apnoea than women, although it can affect anyone including children²
• Age: Sleep apnoea being more common in those above 60 years old⁴
• Medical conditions: Those with previous brain issues including strokes, tumours, or brainstem-related issues, are at higher risk specifically for central sleep apnoea⁴
• Opioid usage: increases risk for central sleep apnoea, alongside other narcotic pain medications²
• Obesity, family history, genetics, excessive smoking, and drinking are also prominent risk factors^2,6

What are the impacts of sleep apnoea on mental health?

Sleep apnoea leads to disrupted and poor sleep, having a profound effect on mental health.⁶

Sleep deficiency can cause issues in controlling emotions, leading to mood swings, depression, and lack of motivation.⁷ A study performed by the Veterans Administration Healthcare System, discovered that over 20% of sleep apnoea patients had depression, 17% faced anxiety, and other major diagnoses including post traumatic disorder (PTSD).⁸

 Depression is also linked to insomnia, further exacerbating fatigued symptoms and worsening sleep apnoea.⁹ Untreated sleep apnoea could also lead to suicidal thoughts and psychological distress, highlighting the importance of early diagnosis.⁶

OSA also leads to hypoxia and sleep fragmentation, known to elicit mood deterioration and further worsen psychiatric disorders.³ Research has shown that individuals with OSA often experience decreased levels in serotonin, a neurotransmitter crucial for mood regulation. This serotonin depletion is also recognised in depression, highlighting the distinct connection between OSA and mental health disorders.⁶

The effects of sleep apnoea can extend beyond just the individual, which can potentially strain relationships due to symptoms like loud snoring. This might disturb a partner’s sleep, causing relational stress and further contributing to mental health challenges. 

In addition to mood disturbances, sleep apnoea can also affect cognitive functions.² Patients with serious OSA were also shown to exhibit reduced white matter fibre integrity in various sections of the brain.¹⁰

Treating Sleep Apnoea and Mental Health

Addressing sleep apnoea with effective treatment methods can significantly improve mental health.¹¹ 

CPAP therapy (continuous positive airway pressure) is a common approach, where a mask that is connected to a machine provides a steady flow of air to keep the airway open during sleep.¹² Effective CPAP treatment for a year has been shown to restore some if not all the white matter of the brain.¹⁰ However, a small number of patients previously diagnosed with obstructive sleep disorder developed central sleep apnoea with the usage of CPAP treatment.¹³

Some studies showed that CPAP therapy effectively reduced nightmare occurrence with those diagnosed with post-traumatic stress disorder (PTSD), indicating that treatment methods for sleep apnoea can also benefit mental health as well.³

As there is a connection with depression and OSA through the common neurotransmitter serotonin, utilising a common depression medication named selective serotonin reuptake inhibitors (SSRIs), is a hopeful tool to help treat OSA.⁶

Self-care

Whilst it is important to talk with your doctor for proper diagnosis and treatment methods, you can also do a few things at home to limit your symptoms of sleep apnoea.⁶ This includes limiting or quitting smoking and alcohol, increasing your exercise and sleeping on your side instead of on your back.⁶ Opting to sleep on the side instead of lying on your back could assist in better and easier airflow.⁶

Summary

Sleep apnoea does not just affect your sleep quality but can also affect your whole life. Sleep apnoea has significant relations to mental health, including depression and anxiety. It is essential to get sleep apnoea diagnosed as early as possible so it can be treated effectively and prevent further physical and mental health complications. 

FAQs

Is it important to detect sleep apnoea early?

Detecting sleep apnoea as early as possible is very important to prevent future destruction of your mental and physical health.⁶ If sleep apnoea is diagnosed, it allows patients to be more aware of their mental health during this time and utilise mental health services, which will also increase compliance to therapy treatments for sleep apnoea.¹

Is treating sleep apnoea enough to improve mental health?

Treating sleep apnoea can indeed elicit significant mental health improvements. However, recognising any possible underlying mental health conditions through early diagnosis can allow optimised treatments for sleep apnoea by increasing adherence from patients.