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Subscribe to RSSExperiencing breathing problems during sleep may raise your risk of depression, a new study suggests.
Women with sleep apnea, in which breathing becomes shallow or pauses briefly during sleep, were 5.2 times as likely to have depression compared with women without the condition. Men with sleep apnea were 2.4 times as likely to have depression as men without the condition, according to the study from researchers at the Centers for Disease Control and Prevention (CDC).
Participants in the study who had other breathing problems during sleep also had an increased risk of depression. However, the researchers found no increased likelihood of depression among people who snore.
"Snorting, gasping or stopping breathing while asleep was associated with nearly all depression symptoms, including feeling hopeless and feeling like a failure," said study researcher Anne Wheaton, an epidemiologist with the CDC. "We expected persons with sleep-disordered breathing to report trouble sleeping or sleeping too much, or feeling tired and having little energy, but not the other symptoms."
Both depression and breathing problems during sleep are common, and both are underdiagnosed, the researchers wrote. Screening people who have for one disorder for the other could lead to better diagnosis and treatments, they said.
The researchers took into account other factors that might influence the results, such as age, sex and weight. The results are in line with those of the other studies, the researchers said.
The study found an association, not a cause-and-effect link. However, the researchers wrote that evidence from other research suggests that breathing problems during sleep may contribute to the development of depression. For example, one previous study found a link between the severity of breathing problems during sleep and the odds of later developing depression. And other studies have shown that people who received treatment for sleep apnea showed improvement in their depression.
"Mental health professionals often ask about certain sleep problems, such as unrefreshing sleep and insomnia, but likely do not realize that [breathing problems during sleep] may have an impact on their patients' mental health," the researchers wrote in their conclusion.
Although exactly how the link might work is unclear, it could partly be explained by the fact that people with breathing problems experience sleep that is fragmented, or may have low levels of oxygen in the blood during sleep.
The researchers used data collected from 9,714 adults who participated in the National Health and Nutrition Examination Survey, which is an ongoing study conducted by the CDC.
Participants were considered to have depression based on their answers to a questionnaire asking about how often they experienced symptoms of depression.
Six percent of men and 3 percent of women in the study reported having physician-diagnosed sleep apnea.
The study was limited in that participants' depression and sleep problems were measured at only one point in time, and in that it relied on self-reported symptoms. People may not be aware they have breathing problems during sleep, and there was no information about whether participants were being treated for depression.
The study is published in the April issue of the journal Sleep.
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Holy flaw Batman!
Self report is common in many studies. Ex: Rank how happy you have felt on the average this week: not at all, rarely, 50/50, often happy, or very happy. So face validity is a consideration but not necessarily a flaw as other techniques can be too burdensome.
The study results are not a surprise, people with severe sleep disturbances (often breathing related) can also exhibit symptoms of psychosis (hallucinations and delusions), so sleep breathing disturbances should always be ruled out with patients experiencing mental health difficulties. Quite often these problems occur in individuals who are morbidly obese, BUT not always so one should never assume.
So if you aren't getting enough REM in your sleep you get depressed. Makes sense to me.
add to it that the bulk (no pun intended) of sleep apnea sufferers are obese. study depression among obese persons without sleep apnea to put the depression of apnea sufferers in perspective.
maridanne: add to it that the bulk (no pun intended) of sleep apnea sufferers are obese.
While it is correct that many who suffer from apnea are overweight, the tone you use in your post is mean-spirited. To clarify a few things for you:
1) Excess weight is not the only cause of sleep apnea.
2) Sleep apnea suffers are always tired, and, due to this, they tend to eat more to provide energy which, in turn, causes weight gain.
3) The surgery for apnea may last only for 1 to 3 years before the condition re-presents.
4) CPAP machines, although ungainly, are the best solution for eliminating the symptoms of apnea.
5) Apnea suffers who get treatment (and, in the case of the CPAP machines - continue to use the equipment) lose an average of 12 pounds, without dieting, in the first 3 months.
6) The head to neck ratio of a baby at birth can accurately predict future sleep apnea.
7) A long-term lack of proper REM state sleep has been shown to significantly decrease serotonin and norepinephrine levels; neurotransmitters that regulate mood, thereby causing depression.
8) People suffering from depression often try to 'perk themselves up' by using sugary snacks or comfort foods which, invariably, are loaded with fats and calories - causing weight gain.
As a person who is certainly not obese (or even overweight - 5', 8" / 138 pounds) who has severe, obstructive sleep apnea I can tell you from experience - it is no fun. Before I was diagnosed the damage to my body was severe; a mild heart attack before age 45 and short term memory loss from oxygen deprivation to name two. So please, before you paint everyone suffering from sleep apnea with the same brush and write them off as having created this condition due to a lack of self-control which caused obesity, get the facts straight.
D Appel you are my new hero. Thank you for your very well thought out and articulated response to a nasty post.
@ D. Apple
Those are some interesting observations....but no where am I seeing any mention of people who were depressed BEFORE showing signs of Apnea.
This whole article appears to paint a picture that depression is solely caused by poor sleeping...and I know, personally, this is not the case.
Being an RPSGT, sleep apnea is what not only shows signs physically but also mentally. Most sleep cycles are about 90 minutes, going from light to deep (slow wave) to REM sleep and then repeating throughout a persons sleep. Apnea is cause for depression as it interrupts sleep cycles, not only deep sleep (the stage whereas HGH, body repair and so forth are only secreted, look at childrens percentage of deep sleep vs. adults vs. the elderly) but also more easily REM sleep; the only time the brain gets it's exercise in sleep and is responsible for mood, memory - too little and you're in trouble, too much and you're possibly getting into narcolepsy (some causes of it are too much dream sleep that makes you tired and burned out before you even wake up, not always the fainting goat kind).
Improper hormonal secretion as well as deprevation of REM or the combination will certainly contribute to depression. Over the years, I've had patients that I've placed on CPAP, BIPAP therapy that upon presentation, were depressed, cranky, tired, loss of memory, etc... and have run into them in the neighborhood I'd worked later and voila... SOOOO much better. And, certainly obesity does play a major role, but as I've told all patients; if you have apnea during REM sleep, it's not obstructive, no surgery or weight loss will help and most surgeries for obstructive apneas are extremely painfull. Breathing machhines at night are best all the way around and the only thing that will help apnea during REM sleep. (Should add, OSA does get worse during REM sleep, but many patients have only apnea during REM)
Odd article, as this has been premised for many years now; don't know what's really needed for clinical verification, but it was part of my licensure exam so I'd suppose it was a known then. Perhaps a little boost for the sleep therapy community by pointing it out now, which I've no problem with.
The same information has been available for more than a decade. Research has shown that sleep apnea sufferers are affected by loss of blood oxygen during sleep and hormonal chages due to sleep deprivation, resulting in a variety of conditions such as Diabetes Miletus, high blood pressure, high cholesterol, depression, mid-body obesity and others. For some reason, very few studies look at the frequency of sleep disturbance, thereby missing the reason for the severity of the various effects of sleep apnea.
George A. Marquart
let me sleep on it
I think lack of sleep, depression and being over weight is a viscous cycle. I am all three! I can't remember the last night I was able to fall asleep in a decent amount of time, stayed asleep all night or woke up feeling refreshed. As a result I feel sluggish, grumpy and basically like crap all day. Which makes me feel like eating more because well...who the hell cares anyway! Even taking sleeping pills doesn't work because now they say that those pills cause you to gain weight..great.... I exercises more then most people I know my age, still doesn't help me sleep any better. I tried watching what I ate for 6 weeks, counted every itty bitty calorie, exercised every day...and I gained 3 pounds. Which depressed me, caused me to eat more, and upset me enough that I couldn't sleep....UGH!!!
Rhonda-806776. Get yourself a sleep test. For most of my life I felt the same way as you. I was sixty years old when I was diagonosed with sleep apnea, which I am sure I had all of my life. I cannot tell you how great I felt after wearing the mask and using a CPAP the first time.
George A. Marquart
Proper sleep hygeniene is often misunderstood and underrated. Quality sleep should be roughly 1/3 of our lives - most people require 1 hour of rest for every 2 hours of wakefulness. It's best if it can occur in one solid block. And, it's vital that people experience complete sleep cycles from Stage 1 (when we're nodding off) through Stages 2, 3 & 4 as well as REM. It's during stages 3-4, which typically account for about 16-31% of total sleep when the body - mind and body - can begin to recover both mentally and physically from the demands we've placed upon it during the day. During REM, our mood, memory and immune functions improve.
Not only can sleep studies be beneficial, so to can going to someone who understands sleep disorders and who can recommend non-medical and non-surgical solutions to help you sleep better.
I have had mental illness all my adult life, & while it hasn't been a miracle cure, CPAP has helped quite a bit w/ mental clarity & energy levels during my waking hours.
The really ironic thing about all this? I'm a respiratory therapist, & have assisted countless #s of pts w/ their CPAP/BiPAP set-ups. I didn't think that at a BMI of 26---overwt, but not Pickwickian---I could have sleep apnea, not at 48, but there you go. SaO2s as low as 75%----that scared the hell out of me.
BTW, it was my psychiatrist who sent me for the study.
So, what would you tell someone who was diagnosed with sleep apnea but couldn't stand using the machine? They sent one home with me, and I tried ernestly to use the machine for a couple of nights, but the pastic smell of the tube, the air blowing in my eyes, and the restriction of the "fighter pilot" mask on my face were too much. After a month, I took the machine back to them.
Will - see what a bed wedge can do for you. By elevating your whole back, you may find that your airway remains more open. Longer term, a much better solution is to look into an adjustable bed. I'm not saying, "hospital bed." You can find good adjustable beds at higher end mattress stores everywhere. Bed wedges can be found at many retail stores and medical supply stores.
If neither of these work for you, and you find that the CPAP - or BiPAP - is the only way to go, try wearing the mask for a while before you go to sleep so you can get accustomed to it. Eventually, the odor will be less noticeable.
Will.. I've worked with many patients struggling with adapting to a cpap, a parent included. It's not unusual for patients to take a couple of weeks to a month before they fully get used to it. It can feel horrible for the first few nights to a week, which can make one feel like getting used to it is impossible.
There are tons of things one can do to adjust and adapt to it, like while wearing it before bed do something that's distracting like read a book, write a letter, or listen to relaxing (to you) music. You could also try to find a physician that specializes in such and that will evaluate prescribing a week or two of meds to help you relax as you get used to it. It also helps to work with a medical psychologist that can teach you some non-medication based strategies to aid in your adaptation. There are no guarantees but I've seen significant improvements in quality of life for people who made it through the first month. Some have even said it completely changed their lives and they are happy again after being miserable for years.
Good Luck!
I, too, am unable to use cpap. I found a solution at my dentist office. It is a mouth piece called The Moses. It positions my tongue forward to keep my airway open. It has relieved my depression symptoms AND my migraines! I suggest looking into it for anyone that is unable to tolerate a cpap.