Sleep apnea causes you stop breathing when you’re asleep. These intermittent sleep disturbances can leave you with daytime fatigue and cloudy thinking. But can sleep apnea cause anxiety? According to the Anxiety & Depression Association of America, researchers are discovering more and more evidence of a relationship between anxiety and sleep disorders. Here are some of the facts about sleep apnea and anxiety.
Sleep apnea and anxiety co-occur at high rates.
How common is the connection between anxiety and sleep apnea? One of the best ways to answer this question is through a “meta-analysis”, where researchers pool multiple studies together to get a larger sample size.
A 2020 meta-analysis published by Behavioral Sleep Medicine combined findings from 73 independent studies and found that sleep apnea and anxiety occur together 32% of the time. The authors also note that this high association likely represents a bi-directional relationship between the two conditions, meaning that it's highly probable that they cause one another.
Untreated sleep apnea and anxiety both have a relationship with stress hormones.
Cortisol is called a “stress hormone” because it’s activated during periods of stress. Elevated cortisol can play a role in both anxiety and sleep apnea, especially if the latter is untreated.
In fact, a 2017 article published by The Journal of Clinical Endocrinology & Metabolism demonstrated that sleep apnea patients withdrawing from treatment with continuous positive airway pressure (CPAP) machines showed elevated levels of cortisol that climbed in tandem with sleep apnea severity.
Mayo Clinic also notes that the elevated cortisol levels associated with prolonged stress can result in the development of anxiety disorders.
From a clinical point of view, the association between sleep apnea, anxiety, and stress hormones makes sense.
“In obstructive sleep apnea, the tissues of the mouth, throat, and tongue can collapse, temporarily blocking the airway. In the meantime, the body is still trying to breathe and often breaks through the obstruction with a sudden gasp,” Bradley Eli, DMD, MS, a sleep medicine expert in Encinitas, Calif., tells WebMD Connect to Care.
This frightening feeling of struggling to breathe highlights the panic and anxiety that a person with sleep apnea may feel.
“It’s like someone putting their hands on your throat until you panic for air, and in severe cases, it can happen scores of times every hour. This takes a deadly toll on the body,” Eli says.
Treatment of sleep apnea reduces anxiety.
While anxiety and sleep apnea can be a significant burden, there’s some good news. Research now shows that sleep apnea treatment can significantly decrease associated anxiety levels.
In a 2020 clinical study published in Sleep and Breathing, researchers considered how patients who had both anxiety and sleep apnea reacted to CPAP treatment, which prevents airway obstruction by applying a constant flow of air through a mask. This study found a significant decrease in anxiety scores after only a couple of months of CPAP therapy.
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