Depression & Sleep Disorders

For people with mild to severe sleep disorders, feelings of depression and anxiety are all too common. In the last decade, a number of studies have shown a link between one such disorder, Obstructive Sleep Apnea (OSA), and depression. OSA is characterized by complete airway obstruction. Problems begin when sleepers experience apneas, where breathing stops, and hypopneas, where breathing is shallow due to an obstruction. Apneas and hypopneas occur when the tongue and muscles relax during sleep, the lower jaw falls back toward the throat and the airway becomes blocked. The silence may end with a loud snort, cough or gasp. This causes the sleeper to wake briefly and begin breathing. After falling asleep again, the muscles relax and the airway becomes blocked once more. This cycle can occur hundreds of times per night.

Those experiencing OSA will often report symptoms of insomnia, disrupted sleep, and excessive daytime sleepiness. However, many will also note symptoms affecting their mental health, such as depression, severe anxiety, mood swings and temperamental behavior. This same connection has been made by researchers as well. A 2009 study in the Journal of Psychosomatic Research found a high rate of OSA in people with depression and insomnia. 39% of those studied had 15 or more breathing pauses per hour of sleep, which constitutes moderate sleep apnea. Furthermore, a 2006 study in the Archives of Internal Medicine, found that people with mild sleep apnea were twice as likely to have depression than those without OSA. The risk only increased with the severity of the sleep apnea.

While the above samples were smaller and more specific, a 2012 study by the Center for Disease Control and Prevention (CDC), which studied 9,714 Americans, noted that the likelihood of depression increased in those with sleep-disordered breathing. Studies such as these show a much higher rate of depression in those with sleep disorders like OSA than in the general population. This could be because disrupted sleep can lead to changes in one’s emotions as well as clinical depression and anxiety. Chronic insomnia and disrupted sleep may also alter the neurochemicals and brain activities that control one’s thoughts and moods. Depression can be disabling, according to the National Institute of Mental Health, and will often impact one’s work and family life, causing feelings of sadness, hopelessness, and suicidal thoughts.

The good news is that when OSA is treated, symptoms of depression may improve dramatically. In fact, a 2007 study in the Journal of Clinical Sleep Medicine, which looked at 50 adults with severe OSA, found that 4-6 weeks of treatment lowered symptoms of depression in 94% of those studied. Even after one year, 88% of participants who received continued treatment for their OSA still enjoyed fewer symptoms of depression.

Because the relationship between sleep and depression is a complex one, the authors of the 2012 CDC study suggests that physicians screen for depression in those suffering from OSA, or vice versa. If you are experiencing symptoms of either of these conditions, you may want to consider asking your physician for a sleep study. In a sleep study, doctors will monitor your pauses in breathing to determine whether or not you have OSA and, if so, how severe it is.

Treatment options for OSA include lifestyle changes, surgery, Continuous Positive Airway Pressure (CPAP) and Oral Appliance Therapy. While CPAP is one of the most common treatments for OSA, Oral Appliance Therapy has proven to be an effective, scientifically-based treatment alternative that patients may find more comfortable and easier to use. The purpose of the appliance is to hold the jaw in a position that allows the airway to remain as open and firm as possible during sleep. Oral appliances are similar to athletic mouth guards but less bulky and completely non-invasive. Oral sleep appliances are covered by most medical insurance plans and Medicare.

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