Depression, Anxiety, and Obstructive Sleep Apnea

Sleep problems are a common reason that people see their doctor. Depression and anxiety are also among the biggest public health problems in the world. Depression is estimated to cost China RMB 52 billion yearly in terms of lost work days and other factors, ^[1] and China’s suicide rate is among the world’s highest even according to official government media outlets.^[2] In fact, depression-related deaths (such as suicides) are now believed to exceed traffic fatalities just as in the United States.^[3] The World Health Organization states that depression is the leading cause of disability worldwide.^[4]

While it is well-known that depression and anxiety can cause difficulty sleeping, can the opposite also be true? That is, can sleep problems, such as obstructive sleep apnea, cause depression and anxiety?

The short answer is “yes.” Furthermore, these conditions often occur at the same time. Up to 20% of people coming to their doctor with a breathing-related sleep disorder or a major depression disorder will also have the other condition.^[5]

Obstructive sleep apnea (often just called sleep apnea) is a sleep disorder in which breathing is repeatedly interrupted during sleep. Most organizations, including the National Sleep Foundation^[6] and the National Institute of Neurological Disorders and Stroke,^[7] define “apnea” as a breathing pause that lasts at least ten seconds. The problem is usually a mechanical one in which the muscles in the back of the throat do not keep the airway open enough. When insufficient air gets through, the airway is said to be “obstructed” (hence the name obstructive sleep apnea).

Respiratory pauses (often causing snorting or gasping for air in the middle of the night), snoring, and daytime sleepiness are the main symptoms of sleep apnea. The risks of untreated sleep apnea are significant. Frequently disrupted sleep results in low blood oxygen levels, which can lead to high blood pressure (hypertension), heart disease, daytime fatigue (leading to unsafe drowsy driving), irritability, mood and anxiety problems, headaches, and memory problems. The prevalence of sleep apnea is higher in men than in women but can be found in both genders and in all age groups.

From a mental health perspective, anxiety and depression are more common in people with obstructive sleep apnea than in the general population for both men and women.^[8] A survey involving 9,714 adults found that frequent snorting/stopping breathing by itself was associated with probable major depression.^[9]

Here is the good news: Obstructive sleep apnea is a treatable condition. Depression and anxiety are also treatable conditions. The key is early detection and treatment before your life or that of a loved one’s life is at risk. If you suffer from any of the problems discussed above, I strongly recommend a comprehensive medical and psychiatric evaluation. This is particularly true if the presence of obstructive sleep apnea is contributing to an insufficient clinical response to appropriate depression medications.^[10] Furthermore, undiagnosed obstructive sleep apnea may make some treatments used in mood and anxiety disorders (such as benzodiazepines) more dangerous. This underscores the importance of considering sleep disorders, such as obstructive sleep apnea, in the evaluation of anybody suffering from depression or anxiety.

Dr. Korngold is a board certified American Psychiatrist at Beijing United Family Hospital and Clinics. Dr. Korngold specializes in mood disorders, psychotic disorders, psycho-oncology, substance abuse, individual psychotherapy, and couples therapy. He has experience treating patients and families from a broad range of cultural backgrounds. For an appointment with Dr. Korngold, please call 4008-919191.