At a Glance
While not everyone with sleep apnea develops anxiety, anxiety and mood disorders are more common among people with sleep apnea and vice-versa. Researchers have identified potential ways in which sleep apnea may contribute to anxiety, such as by causing low blood oxygen levels, fragmenting sleep, increasing inflammation, and altering brain structure. However, more research is needed to fully explain the connection between sleep apnea and mental health.
Because sleep apnea affects breathing and sleep quality, it can also have an impact on mood and mental health, including anxiety. Repeated disruptions during sleep and drops in oxygen levels can place stress on the body and make it harder to regulate emotions.
In this article, we’ll explore the connection between sleep apnea and anxiety, including how the two conditions may influence each other and what treatment options may help improve both.
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Does Sleep Apnea Cause Anxiety?
Sleep apnea doesn't directly cause anxiety in everyone who has the sleep disorder, but the two issues are closely linked. Though the exact prevalence is hard to pin down, the most recent data suggests that about a third of people with obstructive sleep apnea (OSA) have symptoms of anxiety.
What is clear, though, is that people who have sleep apnea are more likely to experience stress and other anxiety symptoms than those without sleep apnea. Similarly, sleep apnea has been linked to anxiety disorders, like panic disorder and generalized anxiety disorder.
How Does Sleep Apnea Contribute to Anxiety?
Researchers have proposed multiple ways sleep apnea may contribute to or worsen anxiety.
Fragmented Sleep
Sleep apnea fragments sleep by prompting short awakenings throughout the night, and fragmented sleep has been found to increase anxiety. It should be noted that fragmented sleep is not the same as sleep deprivation. A person with fragmented sleep may sleep for a healthy amount of time, but the interruptions to their sleep cause problems by altering their sleep architecture, or how much time is spent in each sleep stage.
Low Oxygen Levels
Researchers have also suggested that the intermittent hypoxia caused by sleep apnea could be a driver of anxiety. Intermittent hypoxia describes the periods of time a person with untreated sleep apnea experiences low oxygen levels during sleep, due to lapses in breathing.
These recurring periods of low oxygen levels can injure the brain, changing its structure. Low oxygen levels may also prompt inflammation in the brain and nervous system, called neuroinflammation, which can contribute to mental health changes, including anxiety.
Nervous System Activation
After a person with sleep apnea experiences a lapse in breathing during sleep, they may immediately experience the fight-or-flight reaction, which is part of the body's stress response. A fight-or-flight reaction leads to an increase in adrenaline and physical changes, like an increased heart rate.
This response usually occurs after a person encounters a threat, and the intention of the response is to prepare the body to fight or flee the threat, but in people with sleep apnea, the response occurs even though no threat is present.
Stress From Managing Symptoms
The symptoms of sleep apnea may themselves contribute to stress or anxiety. Because having sleep apnea can make a person tired throughout the day and cause mood swings or irritability, they may struggle to face obstacles and manage daily stressors.
Their symptoms may negatively impact their social relationships or ability to perform well at work, which could spur worry or even depressive symptoms, like a sense of helplessness.
Can Anxiety Cause Sleep Apnea?
Just as people with sleep apnea are more likely to have anxiety, research has shown that individuals with anxiety are more than twice as likely to have obstructive sleep apnea than those without anxiety. This is called a bidirectional relationship, because each factor makes the other more likely.
Experts have suggested that anxiety's impact on different parts of the brain, including parts that regulate breathing, may make the development of sleep apnea more likely. Worry about being able to sleep well or anxiety in general could further reduce a person's sleep quality, which could, in turn, increase anxiety even more. Over time, if the two disorders remain untreated, they could make each other worse.
In some cases, anxiety may also make it difficult for a person to stick with CPAP therapy, a common sleep apnea treatment. CPAP therapy involves sleeping with a mask over the nose or nose and mouth that connects to a machine that delivers air into the airway. Feelings of claustrophobia, which can involve worries about being trapped, suffocating, or choking, can make a person not want to use CPAP, because of the mask, air pressure, or both.
Who Is Most at Risk?
People with untreated OSA may be most at risk for also experiencing anxiety. The presence of chronic stress, chronic pain, or another disorder, like insomnia or depression, may worsen the situation, though studies have returned mixed results. Some experts have noted that certain people may be more likely to develop these conditions due to previous trauma or a genetic predisposition.
Does Treating Sleep Apnea Help Anxiety?
Research shows that in addition to treating sleep apnea, CPAP therapy helps reduce anxiety among people with the disorder. CPAP therapy has even been shown to reduce the number of panic attacks people with panic disorder have, thereby reducing their need for medication. CPAP treatment may help by addressing the potential contributors to anxiety, as well as by lowering cortisol.
That said, if a person has more severe anxiety symptoms or an anxiety disorder, they may still require an additional treatment directly aimed at the anxiety, like anti-anxiety medication. If a person has sleep apnea, anxiety, and depression, all three disorders may need treatment to be properly managed.
Some experts have suggested that, if chronic stress is present, reducing stress may also help with managing anxiety and depression experienced alongside sleep apnea. They suggest stress reduction approaches including regular exercise, relaxation techniques, spending time with friends, and engaging in hobbies.
When to See a Doctor
See a doctor if you suspect you have either sleep apnea or an anxiety disorder. A doctor can ask questions about your symptoms, evaluate your medical history, and order tests to determine what might be going on, which is the first step toward receiving treatment and relief.
The most common symptoms of OSA include loud snoring, lapses in breathing during sleep that can be observed by a bed partner, gasping, and snorting. You may also feel unrefreshed when you wake up, feel tired throughout the day, fall asleep unintentionally while doing a repetitive activity like driving or watching TV, have headaches, or experience irritability and mood swings.
Frequently Asked Questions
As with anxiety more generally, sleep apnea may increase the likelihood that a person has panic attacks, but not everyone who has sleep apnea has panic attacks. This makes sleep apnea a risk factor for panic disorder, not a direct cause. Studies also show that treating sleep apnea with CPAP therapy may reduce how often a person has panic attacks, as well as their need for medication.
Among people with both sleep apnea and anxiety symptoms, treating the sleep disorder with CPAP therapy has been shown to also reduce anxiety. However, people with anxiety disorders or more severe symptoms may also need to directly treat anxiety to manage it, such as with anti-anxiety medication, stress reduction techniques, or both.
Studies have found that the more sleep deprived a person is, the more anxiety they’re likely to experience. Among people with sleep apnea, it’s often fragmented sleep rather than a lack of sleep that contributes to anxiety. Fragmented sleep is sleep that’s interrupted multiple times by lapses in breathing throughout the night, altering the amount of time a person spends in each sleep stage.
Anxiety may be a symptom of sleep apnea for some people, but more common sleep apnea symptoms include loudly snoring, gasping during sleep, feeling tired during the day, and waking up unrefreshed or with a headache. Some sleep apnea symptoms also overlap with anxiety symptoms, such as irritability, trouble focusing, and forgetfulness.
Medical Disclaimer: This content is for informational purposes and does not constitute medical advice. Please consult a health care provider prior to starting a new treatment or making changes to your treatment plan.
Written by
Jay Summer, NBC-HWC, Contributing WriterJay Vera Summer is a writer, editor, and wellness coach. She holds a Bachelor's of Science in psychology and Master's degrees in both writing and public policy. As a wellness coach, she's certified by the Mayo Clinic and the National Board for Health and Wellness Coaching (NBHWC). She's been writing about sleep and other health topics for six years. Previously, she taught undergraduate writing courses for five years at the University of South Florida.
