Sleep Apnea and Anxiety: What’s the Connection?

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Raj Dasgupta, MD

Anxiety and sleep apnea can worsen each other. Sleep apnea, a common condition, causes breathing to stop during sleep, with obstructive sleep apnea being the most prevalent type.

Around 22 million Americans have sleep apnea, and untreated cases can lead to severe health issues, including heart disease and even death, with an estimated 38,000 annual deaths linked to sleep apnea-related heart disease complications.

This article explores the connection between sleep apnea and anxiety, covering symptoms and treatment.

What is Anxiety?

Sleep Apnea and Anxiety

Anxiety is a feeling of worry and tension, often accompanied by physical changes like increased heart rate and high blood pressure.

Occasional anxiety is normal, but chronic or excessive anxiety may indicate an anxiety disorder, such as generalized anxiety disorder (GAD).

Symptoms of GAD, according to the DSM-5, include restlessness, excessive sweating, dizziness, fatigue, irritability, muscle tension, difficulty concentrating, intrusive worries, and sleep problems.

Other anxiety disorders include panic disorder and phobia-related disorders.

What is Sleep Apnea?

Sleep apnea is a condition where breathing stops or becomes shallow during sleep, with pauses called “apneas” lasting at least 10 seconds and occurring frequently, even up to 30 times per hour in severe cases.

Common symptoms include loud snoring, gasping/choking during sleep, daytime sleepiness, difficulty concentrating, morning headaches, and dry mouth.

If left untreated, sleep apnea can lead to various complications, including decreased work/school performance, increased accident risk due to daytime sleepiness, heart disease, heart failure, stroke, diabetes, high blood pressure, asthma, and atrial fibrillation.

How Anxiety Affects Sleep

Anxiety and sleep problems often go hand in hand. Insomnia, chronic sleep deprivation, and poor sleep quality can worsen anxiety, while stress and anxiety can disrupt sleep, making it difficult to fall or stay asleep.

For instance, anxious thoughts can keep someone awake at night, leading to compromised functioning the next day due to lack of rest.

The Anxiety and Depression Association of America notes that nearly all psychiatric issues involve sleep disturbances, with chronic insomnia increasing the risk of sleep-related disorders like sleep apnea.

Some individuals may develop sleep anxiety, experiencing distress about sleeping, which is a type of anticipatory anxiety involving a sense of dread.

How Sleep Apnea Is Connected to Anxiety

There’s a strong connection between sleep apnea and anxiety, with each condition aggravating the other. Sleep disturbances from sleep apnea can heighten stress and fatigue during the day, while anxiety can make it harder to fall asleep at night, exacerbating sleep apnea.

Research shows that sleep apnea and anxiety often occur together, with severe sleep apnea correlating with higher anxiety symptoms.

Studies also indicate that the incidence of anxiety and depression is higher in people with sleep apnea, particularly among female patients.

Additionally, many individuals with anxiety also experience symptoms of depression, with around 60% having both conditions according to the National Alliance on Mental Illness (NAMI).

Does Anxiety Contribute to Obstructive Sleep Apnea?

Anxiety doesn’t directly cause obstructive sleep apnea, the most common type of sleep apnea. It’s caused by physical muscle relaxation in the throat or palate.

However, anxiety is more prevalent among those with obstructive sleep apnea, and it’s more likely for them to experience anxiety and depression. While anxiety may not cause sleep apnea, it can disrupt sleep quality.

Research suggests that anxiety can affect how deeply and how long you sleep each night. If anxiety affects your sleep, consider addressing it by consulting your doctor, maintaining a healthy diet, and managing stress levels.

Does Anxiety Cause Central Sleep Apnea?

Central sleep apnea is a type of sleep apnea where your brain fails to send signals to control breathing while you sleep, leading to pauses in breathing for 10 seconds or more. It can be caused by various conditions like heart failure, stroke, or sleeping at high altitudes.

Since central sleep apnea involves problems with the central nervous system, the physical issues contributing to anxiety could also contribute to central sleep apnea.

Diagnosis and Treatment

To diagnose sleep apnea definitively, a sleep study (polysomnography) is conducted by a sleep specialist. This study measures various parameters such as oxygen levels, brain waves, heart rate, and leg movements overnight to assess the severity of sleep apnea using the apnea-hypopnea index (AHI).

The primary treatment for sleep apnea is positive airway pressure (PAP) therapy, typically administered through a continuous positive airway pressure (CPAP) device. This device helps keep the airways open during sleep by delivering pressurized air through a mask worn over the nose or mouth.

For individuals dealing with both sleep apnea and anxiety, it’s crucial to seek treatment for both conditions. Anxiety treatment options may include mental health therapy like cognitive-behavioral therapy, prescribed medications, and mindfulness techniques such as meditation.

Practicing good sleep hygiene can also help manage sleep problems, including sleep anxiety. Establishing a consistent bedtime routine, maintaining a comfortable sleeping environment, avoiding screens before bedtime, using white noise, limiting caffeine intake, and staying physically active during the day are all recommended habits.

Sleep apnea and sleep anxiety often exacerbate each other, but with appropriate treatment for sleep apnea and anxiety, both conditions can improve.

For mild cases of sleep apnea, you may use some anti-snoring devices or anti-snoring mouthpieces.

Other Tips to Manage Your Sleep Apnea and Related Depression and Anxiety

Here are some tips to help manage sleep apnea, depression, and anxiety:

  1. Avoid sedating medications if you have sleep apnea, as they can worsen symptoms.
  2. Consider cognitive behavioral therapy to address negative thoughts and behaviors associated with depression.
  3. Adopt healthy lifestyle habits like maintaining a regular sleep schedule, getting sunlight exposure, exercising, and limiting caffeine and alcohol intake.
  4. Don’t hesitate to seek support from friends and family.

Need professional help to diagnose and address your sleep problems? Schedule an online consultation with sleep specialist Dr. Owen Napleton.

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