Sleep Apnea and PTSD: Are They Related?

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Raj Dasgupta, MD

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after a traumatic event like war, assault, abuse, terrorism, or disasters.

About 7 to 8 percent of people may experience PTSD in their lifetime. Symptoms include flashbacks, memory issues, feeling on edge, and sleep problems. Insomnia and nightmares are common, but there’s also a strong link between PTSD and obstructive sleep apnea (OSA).

OSA causes breathing interruptions during sleep, leading to daytime sleepiness and feeling unrefreshed even after a full night’s sleep.

What is Obstructive Sleep Apnea?

Sleep Apnea and PTSD

Obstructive sleep apnea (OSA) is a common sleep problem where throat muscles relax during sleep, causing brief pauses in breathing called “apneas.” This leads to frequent waking throughout the night, leaving people gasping for air and chronically sleep deprived. OSA often goes undiagnosed and can lead to other health issues.

Symptoms of obstructive sleep apnea include:

  • Loud snoring
  • Gasping for breath while sleeping
  • Morning headaches
  • Daytime drowsiness
  • Dry mouth in the morning
  • Depression or anxiety
  • Mood swings
  • Forgetfulness and difficulty concentrating

What is PTSD?

PTSD, or post-traumatic stress disorder, is a condition that some people develop after going through a traumatic experience, like combat for veterans. It can make you feel like you’re in danger even when you’re not.

People with PTSD might have flashbacks of the trauma, feel on edge, and withdraw from others emotionally. In severe cases, it can lead to destructive behavior.

The Link Between PTSD and Sleep Apnea

Having both PTSD and sleep apnea is quite common. Roughly 12 to 90% of people with PTSD also have obstructive sleep apnea (OSA), which affects 17 to 22% of the general population. Those with both conditions tend to have more severe PTSD symptoms.

Sleep-disordered breathing, often a sign of untreated OSA, is seen in 95% of fire evacuees and 91% of crime victims. Veterans, who are up to three times more likely to have PTSD, also have a higher likelihood of sleep apnea. For example, 69% of Vietnam veterans with PTSD had sleep-disordered breathing.

While sleep apnea risk typically rises with age, young veterans with PTSD may face an increased risk. For instance, 69% of young Iraq and Afghanistan war veterans screened positive for OSA.

Having PTSD and sleep problems like OSA can worsen depression, increase suicide risk, lead to more substance abuse, and reduce quality of life. Additionally, developing OSA before age 70 raises the risk of early death.

Does PTSD Cause Sleep Apnea?

Does PTSD cause sleep apnea, or is it the other way around? It’s not entirely clear. People with severe obstructive sleep apnea (OSA) are more likely to have severe PTSD, and vice versa. Each increase in PTSD severity boosts a veteran’s risk of OSA by 40%.

The disrupted sleep from sleep apnea worsens PTSD symptoms by causing sleep deprivation. Even if not fully awake during OSA episodes, the body’s stress response still affects sleep quality, mood, and decision-making, hindering CPAP therapy, the main OSA treatment.

Quality sleep, especially REM sleep, aids in reducing fear linked to traumatic memories. During REM sleep, fear extinction occurs, where the brain unlearns fear associations. Nightmares disrupt REM sleep, impeding fear extinction. Those with both PTSD and sleep apnea are at higher risk of disturbed sleep, with some experiencing most apneas during REM.

The link between PTSD and sleep apnea may involve lower growth hormone levels in PTSD, which leads to more nighttime awakenings. Chronic stress from PTSD also contributes to frequent awakenings.

Treating Sleep Apnea and PTSD

For people with PTSD, better sleep is part of treatment. This includes sticking to a sleep schedule, calming bedtime routines, and cutting back on caffeine and alcohol.

Sleep apnea is treated with weight loss, CPAP therapy, or surgery. CPAP therapy involves wearing a mask connected to a machine that keeps airways open during sleep.

Consistent CPAP therapy can help with both sleep apnea and PTSD symptoms like anxiety and nightmares.

Many with PTSD find CPAP uncomfortable, leading to poor adherence. But studies show sticking to CPAP improves PTSD symptoms.

CPAP reduces nightmares by up to 50% and improves daytime sleepiness, especially for severe PTSD cases.

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

Lifestyle Changes for Sleep Apnea and PTSD

To improve sleep and manage symptoms of both sleep apnea and PTSD:

  1. Stick to a regular sleep schedule: Going to bed and waking up at the same time every day can improve sleep quality.
  2. Practice good sleep hygiene: Create a calming sleep environment and avoid activities that disrupt sleep.
  3. Avoid sleeping on your back: This position can worsen sleep apnea symptoms for some.
  4. Relax before bedtime: Reduce stress and anxiety with relaxation techniques to ease symptoms.
  5. Stay away from alcohol and sedatives: These can interfere with sleep and exacerbate symptoms.
  6. Exercise regularly: Physical activity can reduce stress and promote better sleep, especially for PTSD.
  7. Maintain a healthy weight: Weight loss can improve symptoms and reduce daytime sleepiness in sleep apnea.

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

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