Sleep apnea & your mental health

In obstructive sleep apnea, the upper airway narrows or gets blocked, reducing or stopping airflow again and again through the night.

In central sleep apnea, the airway is open but the brain doesn’t send the right signals to the breathing muscles. Conditions that affect how the brain controls breathing can cause it.

Untreated sleep apnea can affect concentration, decision-making, memory and behavior control. It also raises the risk of stroke and heart attack.

Untreated sleep apnea is linked to heart disease, stroke, diabetes and depression.

A study of people newly diagnosed with sleep apnea found that 23% had clinical depression, and pooling seven studies gave the same figure. People with both had worse sleep quality and daytime functioning.

The “Sleep, mood & depression” guide explains more about how sleep and mood affect each other.

Fatigue, sleep problems and trouble concentrating are common in both sleep apnea and depression. Because of this overlap, one can be mistaken for the other.

This is one reason it helps to tell your provider about snoring or gasping at night, even if you came in to talk about mood.

Mood swings are a daytime sign of sleep apnea. Lack of quality sleep can make emotions and behavior harder to manage.

Waking up gasping or choking can be frightening and is sometimes confused with a panic attack. Loud snoring or gasping for breath at night is worth raising with a provider.

A review found evidence that sleep apnea may be more common in people with PTSD and in people with depression, though study quality varied.

In a review of medical records from almost 2.5 million veterans, those with sleep apnea were more likely to be diagnosed with a mood or anxiety disorder, most strongly PTSD and depression.

The “Sleep, pain & your body after service” guide covers VA sleep checks and support.

Pooling 42 studies, researchers found that adults with untreated sleep apnea had more trouble with episodic memory, such as recalling words or pictures right away and later on.

The authors noted these problems are likely to affect everyday life, like remembering conversations or where you put things.

Daytime sleepiness can make it hard to focus at work or school and slow your reactions.

Brain fog has many possible causes, and poor sleep is one of them. The “Brain fog: causes and what helps” guide covers others.

• Being older (though children and young adults can have it too)
• Being male (men are diagnosed more often)
• Carrying extra weight, especially around the neck
• Drinking alcohol or smoking
• Family history of sleep apnea
• Large tonsils, adenoids, tongue or neck
• Some health conditions, such as heart or kidney failure, thyroid problems or polycystic ovary syndrome (PCOS)
• Sleeping on your back

Genes help shape the size and structure of your skull, face and upper airway, which affects your risk.

Sleep apnea is a health condition, not a character flaw. Getting checked is a way of taking care of yourself.

Because symptoms can be different, it may be harder for women and their providers to recognize sleep apnea. Women may not report snoring, so they may not suspect it.

Fatigue, headaches and insomnia are listed as more common sleep apnea symptoms in women.

Sleep apnea is often more serious in the third trimester. It can lead to complications such as preterm birth and gestational diabetes, and symptoms may ease after delivery.

If you snore, gasp or feel unusually exhausted during pregnancy, mention it at your prenatal visits.

Hormone changes and weight changes around the neck can raise the risk during and after menopause. Menopause-related insomnia, headaches and fatigue can mask sleep apnea.

The “Perimenopause & menopause: understanding it” guide covers other sleep and mood changes in this stage of life.

• Behavior problems, such as being overactive or aggressive
• Problems with learning and memory
• Trouble paying attention at school

These signs have many possible causes. A provider can help work out whether sleep is part of the picture.

Signs in children can include bedwetting and worsening asthma, as well as snoring or breathing pauses.

The American Academy of Pediatrics recommends that all children and teens be screened for snoring, with a sleep study if they snore and have other signs of sleep apnea.

If your child snores most nights, mention it at their next checkup.

It can help to bring someone who has seen your symptoms, like a partner who has heard you snore or stop breathing.

The “Night-time notes from a loved one” worksheet gives them an easy way to write down what they notice.

Because sleep apnea and depression share signs, it helps your provider to hear the full picture: sleep, breathing, mood and thinking.

In a large CDC survey, people who snored or often fell asleep in the day without meaning to were more likely to report falling asleep at the wheel.

If you feel very sleepy, avoid driving until your symptoms are under control. Some places have legal rules about driving with sleep apnea, so ask your provider.

Treatment is linked with better daytime alertness, heart health, performance at home and at work, and quality of life.

Please talk with your clinical provider about which options fit you.

Try: “I’ve noticed you sometimes stop breathing and then gasp at night. It worries me. Would you be willing to get it checked?” Choose a calm moment in the day.

Notes from someone who has seen the symptoms can help at the appointment.

Offer to go to appointments, help with reminders, and celebrate small wins. Patience helps while someone adjusts.

With about 80% of cases undiagnosed, simply talking about sleep apnea with family, friends or coworkers can help someone else realize it’s worth checking.