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At a Glance
Post-traumatic stress disorder (PTSD) and obstructive sleep apnea often occur together, and sleep apnea may worsen symptoms such as poor sleep quality, nightmares, and daytime fatigue. Treating sleep apnea may help improve sleep and reduce some PTSD-related symptoms for people who have both conditions.
People with PTSD often struggle with sleep problems like nightmares and insomnia. But many people don’t realize that about 40% and 75% of people with PTSD also have the sleep disorder obstructive sleep apnea (OSA). In fact, research suggests that sleep apnea is much more common in people with PTSD than in the general population.
When sleep apnea and PTSD occur together, the effects on sleep, mood, energy levels, and overall health can be significant. The good news is that treating sleep apnea may also help improve certain PTSD symptoms and sleep quality. Below, we’ll explore the connection between PTSD and sleep apnea, common symptoms, and why treating both conditions is important.
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The Connection Between Sleep Apnea and PTSD
According to experts, sleep apnea and PTSD have what is called a bidirectional relationship. This means having one disorder increases your risk of developing the other, or, if the other disorder is already present, makes it more severe.
PTSD is an ongoing mental health condition that can develop after a traumatic event. In addition to sleep problems, PTSD symptoms include flashbacks of the traumatic event, mood changes, increased stress, and trouble functioning at work or in relationships. Obstructive sleep apnea is a sleep disorder that involves repeated lapses in breathing during sleep. Symptoms include snoring, unrefreshing sleep, daytime tiredness, headaches, and irritability.
Because the two conditions are often found together, healthcare providers frequently screen people with PTSD for obstructive sleep apnea. Untreated OSA and PTSD may lead to a higher risk of other medical conditions, including cardiac arrhythmias, heart failure, heart attack, stroke, and depression. For these reasons, it's important to treat both disorders when both are present.
Can PTSD Cause Sleep Apnea?
PTSD doesn’t directly cause sleep apnea, though the two are clearly connected. Experts have posited that there are multiple ways PTSD could potentially cause or worsen sleep apnea symptoms.
Chronic Stress and Hypervigilance
When a person develops PTSD, they often become chronically stressed and hypervigilant, which means their nervous system remains ready to respond to threats in the environment. By ramping up the stress response, PTSD may make a person more likely to wake up from sleep in response to normal breathing changes. Then, this increased number of wake-ups fragments sleep, which can potentially cause or worsen breathing problems linked to sleep apnea.
Sleep Fragmentation and Breathing Problems
Studies show that up to 70% of people with PTSD experience sleep problems. Experts say that these sleep disruptions may make the airway more likely to relax and narrow, which can cause the lapses in breathing associated with OSA.
Fragmented sleep can also cause a sleeper to spend more time in light sleep stages, which can also contribute to the airway becoming blocked more often during sleep.
Shared Risk Factors Between PTSD and Sleep Apnea
People with PTSD don't always share classic risk factors for OSA, like obesity or older age. However, there are overlapping factors that impact both conditions. For example, people with certain types of PTSD are more likely to consume drugs or alcohol, both of which can worsen sleep apnea.
While more research is needed, some studies also suggest that heart-related risk factors, depression, and a history of taking antidepressants may play a role in the link between OSA and PTSD.
How Sleep Apnea Can Make PTSD Worse
Once obstructive sleep apnea develops in someone with PTSD, their PTSD symptoms generally become more severe. Research studies have uncovered multiple ways in which OSA can worsen PTSD.
Poor Sleep and Emotional Regulation
OSA repeatedly disrupts sleep, causing many short awakenings throughout the night. Because healthy sleep is a key part of processing traumatic events, these disruptions can worsen PTSD and block a person's ability to heal from trauma. People with PTSD may routinely feel negative emotions, like fear, guilt, or anger. Difficulty regulating these emotions can result in sudden expressions of anger, aggressiveness, or reckless behavior.
When the rapid eye movement (REM) sleep stage becomes disrupted or fragmented, sleep disturbances may become more frequent. People with both PTSD and OSA may experience more disruptions during REM sleep. Because REM sleep helps the brain process emotions and memories, including traumatic events, disruptions to REM may exacerbate symptoms of PTSD, such as stress and mood issues.
Sleep Fragmentation and Anxiety Symptoms
Untreated obstructive sleep apnea may make a person feel more stressed in general, as well as prompt nighttime awakenings that are accompanied by anxiety, a rapid heartbeat, and shortness of breath. OSA can also increase the chance a person remembers their nightmares, and may make nightmares related to choking, suffocation, or death more likely to occur, which can be anxiety-provoking for many and worsen PTSD.
The repeated awakenings caused by OSA also reduce a person's stress management skills by keeping them from the restorative sleep needed to prepare them to face life's stressors. Being unequipped to face daily stress could increase anxiety symptoms. Difficulty handling stress could also extend to PTSD symptoms themselves, making symptoms harder to manage and causing even more anxiety in response to symptoms as they arise.
Memory, Concentration, and Mental Health Effects
Both obstructive sleep apnea and PTSD are linked to worsened memory and cognitive ability. Fragmented sleep caused by OSA makes it difficult for the brain to consolidate memories during sleep and solidify learning. Experts believe that these negative mental effects caused by sleep apnea not only worsen PTSD symptoms, but may also interfere with the ability of some PTSD medications to properly treat the disorder.
How to Treat Sleep Apnea and PTSD
For people with obstructive sleep apnea and PTSD, addressing one condition may indirectly improve the other. Treating PTSD can lead to better sleep, whereas treating OSA can lead to improvements in mood, quality of life, and other issues related to PTSD.
Treatment Options for Sleep Apnea
The primary treatment of obstructive sleep apnea is continuous positive airway pressure (CPAP) therapy. CPAP therapy involves wearing a mask while sleeping that’s connected to a machine via a hose. The machine is small enough to sit on the bedside table and provides a steady flow of air to prevent the airway from collapsing.
Although CPAP therapy offers the most effective treatment for obstructive sleep apnea, many people find it difficult to use their CPAP machine on a regular basis. Most studies estimate average CPAP use is about four hours per night.
Compliance with CPAP therapy in people with PTSD may be even lower due to sleep-related disturbances like insomnia, nightmares, and feelings of claustrophobia. But some studies have shown that veterans with both PTSD and OSA who use a CPAP machine may improve their symptoms while reducing up to 50% of PTSD-related nightmares.
If CPAP therapy doesn’t work or isn’t a suitable option, other treatments for OSA include other types of PAP therapies, oral appliances, surgery, and medication like Zepbound.
Treatment Options for PTSD
Treatment options for PTSD include a combination of trauma-focused talk therapy and medications called selective serotonin reuptake inhibitors (SSRI).
- Cognitive-behavioral therapy (CBT): CBT helps people recognize and adjust thoughts, feelings, and behaviors that are contributing to their symptoms.
- Exposure-based therapy: Exposure-based therapy involves analyzing difficult memories and situations in a safe environment to lessen the symptoms of PTSD.
- Eye movement desensitization and reprocessing (EMDR) therapy: EMDR combines techniques from CBT and exposure-based therapy while a healthcare provider uses their hand to guide the movement of a person’s eyes. EMDR has been shown to reduce anxiety and fear attached to stressful memories or triggers.
For people with PTSD and other conditions like traumatic brain injury, substance abuse, or underlying mental health disorders, talk therapy and medications may be tailored to their individual medical needs.
Lifestyle Changes for Sleep Apnea and PTSD
Along with PAP therapy, certain lifestyle changes may help reduce symptoms for both OSA and PTSD.
- Create a consistent sleep schedule: Going to sleep and waking up at the same time each day may help you get better quality sleep at night. Improving sleep hygiene may decrease sleep disturbances and PTSD symptoms. Avoid sleeping on your back, as it may aggravate OSA symptoms for some people.
- Relax before bedtime: Create a relaxing sleep environment by turning down the lights and keeping the room quiet at night. Practice stress management and relaxation techniques to help decrease PTSD and obstructive sleep apnea symptoms.
- Avoid alcohol and sedatives: Do not drink alcohol or take sedating medications before sleeping. These substances may disrupt sleep and worsen PTSD and OSA symptoms.
- Exercise and maintain a healthy weight: Physical activity during the day may reduce stress and promote rest at night, improving PTSD symptoms. People with OSA and obesity may benefit from weight loss to improve daytime sleepiness and decrease disease severity.
When to Talk to a Doctor
If you have PTSD, talk to a doctor about being checked for obstructive sleep apnea. Many experts believe that everyone with PTSD should be screened for obstructive sleep apnea, regardless of if they have traditional risk factors or noticeable symptoms. Screening for sleep apnea can help ensure that the sleep disorder isn't worsening your PTSD symptoms or interfering with PTSD treatment.
If you’ve been diagnosed with both PTSD and sleep apnea and are struggling to adhere to your CPAP therapy, talk to a doctor. CPAP therapy has been found to greatly reduce nightmares and other PTSD symptoms in people who have both disorders. It's common for people with PTSD to struggle with CPAP therapy, but your doctor can help you find ways to make the treatment more comfortable and easier to stick with over time.
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
Amber Garnett, Contributing WriterAmber is a freelance writer who resides in Seattle. Amber has worked as a clinical social worker in the medical field for over a decade. She loves long nature walks, traveling and reading poetry.
Reviewed by
Gerard J. Meskill, MD, FAASM, Medical ReviewerDr. Gerard J. Meskill is a neurologist and sleep medicine physician specializing in the diagnosis and treatment of sleep disorders, including narcolepsy, obstructive sleep apnea, and insomnia. He is board-certified in both neurology and sleep medicine and has extensive experience helping patients manage complex sleep conditions and disorders of excessive daytime sleepiness.
