Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Mental disorders, like depression, can make it harder to fall asleep. Conversely, sleep deprivation or insomnia can exacerbate preexisting mental conditions.
The link between sleep disorders and mental disorders, like depression, anxiety, and self-harm has been proven in numerous studies.
Many mood disorder symptoms, like those of depression, overlap with OSA. Symptoms like fatigue, loss of interest, lack of energy, and irritability are commonly seen with depression and sleep apnea.
The overlapping symptoms make diagnosing mental illness in patients with OSA much more challenging and vice versa.
Depressive symptoms are often dismissed as a result of poor sleep. Poor sleep is often overlooked as a result of depression.
As a result, patients end up underdiagnosed, undertreated, and with persistent symptoms of both depression and insomnia.
If sleep apnea is suspected, a sleep specialist consultation should not be delayed, especially if you have depressive symptoms.
Managing your sleep apnea can improve your mental health, reduce symptoms of depression and anxiety, and prevent other serious health conditions.
OSA & Depression
Poor sleep quality can in itself lead to a depressive mood. Bi-directionally, depression can lead to sleep deprivation and insomnia.
Many times it’s hard to tell whether you have clinical depression, sleep apnea, or both together. It’s a chicken and egg scenario. The symptoms can significantly overlap, and you can’t always know which disorder is causing symptoms. Overlapping symptoms of OSA and mental illnesses include:
- Constantly waking up from sleep
- Feeling tired and out of energy during the day
- Difficulty concentrating or completing tasks and chores
- Having trouble falling asleep or staying awake
- Easily angered over small things
- Difficulty staying interested in activities and hobbies
Depression often goes undiagnosed in people suffering from OSA because of the similarity in symptoms, including trouble sleeping and daytime fatigue.
Your depressive symptoms might be regarded as merely a result of poor sleep quality, sidelining an opportunity for a psychiatric evaluation.
Eventually, this could lead to more depression and even self-harm if mental health concerns are left unaddressed for a long time.
How OSA Causes Depression
People with OSA experience recurrent pauses in their breath, lowering oxygen levels and disturbing their sleep.
Not getting enough sleep can have severe physical and mental consequences like irritability, clouded thinking, and bad mood.
One study noted that the low oxygen levels resulting from OSA could cause changes and even loss in the brain tissue. These changes can cause neuronal damage and impair normal neurocognitive functions, causing or increasing the severity of mental problems.
Feelings of sadness, tiredness, or frustration can linger when OSA remains undiagnosed. Consequently, some patients may resort to self-harm when they cannot cope with these unresolved symptoms.
It’s also possible to have anxiety and depression before OSA. If OSA treatment does not improve these conditions, then a psychiatrist needs to investigate the underlying cause of the mental disturbances.
The Link: Depression & OSA
For many years, the relationship between OSA and depression has been investigated in literature:
- One overview concluded that untreated OSA could lead to permanent brain damage, exacerbating disorders like depression and anxiety
- A study showed that people with major depressive disorder (MDD) and PTSD had a high prevalence of OSA. The study also recommended the treatment of both mental illness and OSA for a better outcome.
- Another study pointed out that in a national sample of patients, major depression was associated with persistent snoring and paused breathing during sleep.
- One study on the correlation between anxiety, depression, and sleep apnea showed that 53.9 percent of adults with OSA suffered from anxiety, and 46.1 percent of them suffered from depression.
- According to another study, OSA was found in 14 percent of adults having suicidal tendencies or suffering from a major depressive disorder.
- A study investigating the effect of OSA treatment on the symptoms of depression and anxiety revealed that continuous positive airway pressure (CPAP) machines could help with depression. Treating OSA decreased depression symptoms by 20 percent in patients. On the other hand, the anxiety levels remained unaffected.
The finding referred to in the last bullet could be due to the anxiety some people experience when wearing a CPAP mask that regulates breathing when asleep. However, sleep experts can suggest several methods to help with anxiety when wearing a CPAP.
Both depression and OSA are rapidly growing problems in the U.S. and worldwide and can often overlap.
Ideally, it would help if you started by undergoing a sleep study where a sleep specialist can diagnose whether you have OSA. Your breathing and brain activity will be monitored to determine whether you have a sleeping disorder.
Once sleep apnea is confirmed, treatment using CPAP will begin. If your mental health status does not improve with OSA treatment, you may be referred to a psychiatrist or a psychologist.
Some patients with severe forms of OSA can experience suicidal thoughts. In these cases, it’s vital to start mental health treatment right away while also treating OSA symptoms to reduce the risk of self-injury.
Another approach is to start OSA treatment in conjunction with psychotherapy.
Treating OSA can dramatically improve the quality of your life. OSA management improves your sleep quality, but it can also improve your mental health, help treat depression, and prevent intrusive thoughts of self-harm.
- Sleep Apnea Information Page | National Institute of Neurological Disorders and Stroke. Accessed April 5, 2022. https://www.ninds.nih.gov/Disorders/All-Disorders/Sleep-Apnea-Information-Page
- Scott AJ, Webb TL, Rowse G. Does improving sleep lead to better mental health? A protocol for a meta-analytic review of randomised controlled trials. BMJ Open. 2017;7(9):e016873. doi:10.1136/bmjopen-2017-016873
- Jehan S, Auguste E, Pandi-Perumal SR, et al. Depression, Obstructive Sleep Apnea and Psychosocial Health. Sleep Med Disord. 2017;1(3):00012.
- Gabryelska A, Łukasik ZM, Makowska JS, Białasiewicz P. Obstructive Sleep Apnea: From Intermittent Hypoxia to Cardiovascular Complications via Blood Platelets. Front Neurol. 2018;9:635. doi:10.3389/fneur.2018.00635
- Kerner NA, Roose SP. Obstructive Sleep Apnea is Linked to Depression and Cognitive Impairment: Evidence and Potential Mechanisms. Am J Geriatr Psychiatry. 2016;24(6):496-508. doi:10.1016/j.jagp.2016.01.134
- Vanek J, Prasko J, Genzor S, et al. Obstructive sleep apnea, depression and cognitive impairment. Sleep Med. 2020;72:50-58. doi:10.1016/j.sleep.2020.03.017
- Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review | Journal of Clinical Sleep Medicine. Accessed April 5, 2022. https://jcsm.aasm.org/doi/10.5664/jcsm.4466
- Wheaton AG, Perry GS, Chapman DP, Croft JB. Sleep Disordered Breathing and Depression among U.S. Adults: National Health and Nutrition Examination Survey, 2005-2008. Sleep. 2012;35(4):461-467. doi:10.5665/sleep.1724
- Rezaeitalab F, Moharrari F, Saberi S, Asadpour H, Rezaeetalab F. The correlation of anxiety and depression with obstructive sleep apnea syndrome. J Res Med Sci. 2014;19(3):205-210.
- McCall WV, Benca RM, Rumble ME, Case D, Rosenquist PB, Krystal AD. Prevalence of obstructive sleep apnea in suicidal patients with major depressive disorder. J Psychiatr Res. 2019;116:147-150. doi:10.1016/j.jpsychires.2019.06.015
- Zheng D, Xu Y, You S, et al. Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular Endpoint randomised trial and meta-analysis. EClinicalMedicine. 2019;11:89-96. doi:10.1016/j.eclinm.2019.05.012
- Overcoming the Challenges of Breathing on CPAP – www.sleepapnea.org. Published January 2, 2017. Accessed April 5, 2022. https://www.sleepapnea.org/treat/cpap-therapy/troubleshooting-guide-for-cpap-problems/overcoming-the-challenges-of-breathing-on-cpap/
- Bishop TM, Ashrafioun L, Pigeon W.R. The Association Between Sleep Apnea and Suicidal Thought and Behavior: An Analysis of National Survey Data. J Clin Psychiatry. 2018;79(1):17m11480. doi:10.4088/JCP.17m11480