There has been a growing interest in the field of sleep apnea depression. Several studies have shown a link between depression and sleep disorders, including sleep apnea. Research indicates people with insomnia are at ten times greater risk of becoming depressed that those with more normal sleep patterns. However, the causal relationship between sleep apnea and depression is difficult at best to verify. Do sleep disorders cause depression or does depression contribute to sleep disorders? Or a mix of both? More specifically, can sleep apnea and sleep deprivation lead to sleep apnea depression?

Well, first of all, sleep apnea does cause certain symptoms that are usually associated with depression. Understanding the impact of sleep apnea on emotions and your state of mind can help in the research related to how sleep apnea depression can result. We know that sleep apnea can place a tremendous amount of physical stress on a person. Since an individual with sleep apnea may stop breathing as many as 10 to 50 times per hour, his or her blood chemistry gets drastically altered with decreased oxygen levels and correspondingly high levels of carbon dioxide. This can have deleterious effects on mood, memory and general equilibrium. In addition, lack of high quality sleep has been shown to cause increased levels of daytime fatigue, irritability, anxiety and stress. Sleep apnea can also cause high blood pressure leading to heart and kidney damage as well as stroke. If that isn’t bad enough, up to 74% of moderate to severe sleep apnea sufferers awake in the morning with a sleep apnea headache, further compounding their physical ailments and mood. So, we know sleep apnea causes many severe physical ailments but what about sleep apnea depression? Depression, specifically, has to be isolated and evaluated. A lot more research needs to be done in.

Sleep Apnea Depression Research

Fortunately, sleep apnea depression research is now being conducted. In 2003, Stanford University researcher Maurice Ohayon, MD, PhD conducted a telephone survey of 18,980 people in Europe spread across Germany, the United Kingdom, Portugal, Italy and Spain.  The survey included questions about the respondents’ sleep quality, sleep schedules, breathing related sleep disorders, mental disorders and medical conditions and found for those individuals with depression that they were at five times greater risk of having sleep disordered breathing (OSA was the most common type of breathing ailment). Dr Ohayon concluded that any physician treating patients with depression should conduct further tests to determine if that patient has sleep apnea or another breathing related sleep disorder.

More recently, another study conducted at Johns Hopkins looked at the relationship between depression and obstructive sleep apnea (OSA) and daytime sleepiness i.e. does OSA or daytime sleepiness contribute to depression. Doctors Christine Gourin and Stacey Ishman first looked at 53 patients with OSA and found that about 35% had depression inventory scores indicating they were depressed. However, when these patients’ apnea-hypopnea index (AHI) scores were analyzed, their depression scores did not correlate well. In other words, for patients with depression, those with more severe sleep apnea might be expected to have greater levels of depression. They didn’t.

Next, the physicians looked at the patients’ levels of daytime sleepiness and voila, there it was! Patients reporting higher levels of daytime sleepiness had greater levels of depression. The more sleepy they were, the worst they felt. To further test their theory, the doctors looked at OSA patients that had sleep apnea surgery to determine if treating their sleep apnea would reduce incidences of depression. They found that post surgery, most OSA patients reported less daytime sleepiness and all reported reduced levels of sleep apnea depression.

They looked specifically at surgical treatment to eliminate the poor compliance that affects roughly 50% of patients using CPAP treatment. Since non-compliance is not an issue with surgery, they could be more certain their analysis was accurate. . Their hunch was verified. By treating the patient’s sleep apnea, they reduced their levels of daytime sleepiness which in turn reduced their levels of sleep apnea depression.

Sleep deprivation is a major problem. In addition to its role in sleep apnea depression, chronic daytime sleepiness is a serious condition. Up to 40% of Americans report some instances of daytime sleepiness. 60% of us report having some type of sleep problem every week. Aside from the well-known effects of sleeplessness including depression, impediments in learning, problem-solving and concentration, it can also lead to work related injuries and vehicular accidents on the road. Reports showed that sleep apnea patients are three times more prone to motor vehicle accidents because they can fall asleep unexpectedly when behind the wheel. As many as 100,000 car accidents are attributed to sleepy drivers every year. According to statistics, an estimated 70 million Americans suffer from sleep disorders, and 60 per cent of them have chronic disorders. About $15.9 billion adds up every year to the national health bill in the Unites States alone.

Sleep Apnea Depression Testing & Treatment

Not everyone with depression has sleep apnea. Depression has many possible causes that go well beyond the scope of this post. But, if you are feeling depressed and you have any of the classic symptoms of sleep apnea such as snoring, obesity, daytime sleepiness or irritability and/or morning headaches you should speak with your doctor. Ask him/her if your depression could be caused by sleep apnea. Discuss whether you are a candidate for a sleep apnea test also called a polysomnography. Overnight tests in a sleep apnea clinic might be prescribed. If your doctor agrees, find out if you are a good candidate for home sleep testing. You may be able to get tested at home and avoid the expense and inconvenience of a sleep lab.

If you are diagnosed with OSA, your doctor has many available treatment options. The gold standard and most common sleep apnea treatment is Continuous Positive Airway Pressure or CPAP. Pressurized air delivered though a sleep apnea mask or mouthpiece prevents the soft tissue in the throat from collapsing and blocking the airway. It works very well but as previously noted, about 50% of people don’t comply with treatment. For those seeking CPAP Alternatives, dental appliances such as mandibular advancement splints can be an effective alternative. They work by re-positioning the jaw and/or tongue preventing airway blockage. For others, surgery is a good option. Talk with you doctor to determine the best treatment for your sleep apnea depression.

Medications are still the first line of treatment for many individuals with depression. If you have been diagnosed with depression and you suspect you may have sleep apnea depression, see your medical provider. Find out if you have sleep apnea and if sleep apnea treatment can help resolve your sleep apnea depression.