Does Sleep Apnea Affect Mental Health?

adhd adrenaline alzheimer's disease amnesia amygdala anxiety disorder blood-brain barrier brain functions cerebral small vessel disease cortisol cpap dementia depression dopamine gray matter heart disease high blood pressure hippocampus hypercapnia hypoxia inflammation insulin resistance mental disorders mental health mood disorder neurotransmitters obstructive sleep apnea oxidative stress prefrontal cortex serotonin sleep apnea stress stroke sympathetic nervous system white matter Oct 26, 2024

Nearly 1 billion adults — about 12 percent of the world’s population — suffer from obstructive sleep apnea (OSA). Among them, 425 million aged 30 to 69 have moderate to severe OSA. The sleep disorder is more common in men (up to 33 percent are affected) than in women (up to 19 percent).^1,2

Many studies have shown that having OSA increases your risk of various cardiovascular and metabolic problems. These conditions include high blood pressure, heart disease, stroke, and insulin resistance.^3,4

Research has also indicated a link between OSA and mental issues. Up to 55 percent of OSA patients have depression and/or anxiety. What’s more, around 25 percent experience cognitive dysfunction — that is, problems with attention, learning and memory, concentration, and decision making.^5,6,7

In this article, we’ll explore the impact of OSA on mental health. Plus, we’ll see if CPAP — the standard medical treatment for OSA — can help improve mental well-being among OSA patients.

What is obstructive sleep apnea (OSA)?
How does OSA affect the brain?
The complex role of the brain in mental health
Does CPAP help with mental problems?

Let’s start with the basics and define obstructive sleep apnea.

What is obstructive sleep apnea (OSA)?

Obstructive sleep apnea (OSA) is a chronic condition in which you often stop and restart breathing during sleep. OSA results from the partial or full physical blockage of your upper airway.^8,9

Whenever you stop breathing because of OSA, several events occur in your body. Your blood oxygen level rises (intermittent hypoxia), and your carbon dioxide level rises (hypercapnia). These changes then activate your sympathetic nervous system (SNS). Your SNS, in turn, prompts the release of stress hormones like adrenaline. The result is a faster heartbeat, higher blood pressure, and other physical reactions to help you deal with the stress on your body. Ultimately, these OSA events lead to frequent awakenings and fragmented sleep.^9,10

In OSA, every pause in breathing lasts for at least 10 seconds to several minutes, many times throughout the night. If you experience between 5 and 15 pauses per hour, you have mild OSA. Meanwhile, having 15 or more such episodes hourly means you have a moderate to severe form of the disorder.¹¹

How does OSA affect the brain?

To compensate for low oxygen levels, blood surges to your brain every time you stop breathing during an OSA episode. Then, when you resume breathing, the flow of blood suddenly drops to below-normal levels. These fluctuations cause profound changes in your blood pressure.¹²

Normally, your brain has a built-in mechanism for keeping blood flow steady despite blood-pressure swings. OSA, however, makes this system faulty. The result is inadequate blood flow, especially in small blood vessels deep within your brain. Over time, this insufficient blood supply can damage your white matter and gray matter. Making up half of your brain, white-matter tissue consists of nerve fibers that enable communication between various brain regions. On the other hand, gray-matter tissue is vital for controlling your memory and emotions. Abnormalities in white and gray matter often manifest as depression.^11,12,13

What’s more, chronic intermittent hypoxia (IH) promotes the development of cerebral small vessel disease (CSVD). CSVD includes various conditions stemming from damage to small blood vessels in your brain.¹²

Chronic IH promotes oxidative stress too. Oxidative stress is an imbalance in which harmful substances called reactive oxygen species (ROS) outnumber helpful compounds called antioxidants. Oxidative stress makes your blood-brain barrier (BBB) leaky. As a result, toxic substances can enter your brain, triggering inflammation. Inflammation, in turn, can worsen CSVD by further damaging your brain blood vessels. Ultimately, these changes can make your brain tissue lose structure and function, driving problems with your memory, attention, and other mental processes.^12,14,15

The effects of OSA go beyond your brain tissue and blood vessels. The sleep disorder also disrupts the balance of neurotransmitters in your brain. Ultimately, imbalances in these neurotransmitters can greatly impact your mental health.^10,16,17,18

The complex role of the brain in mental health

Different parts of your brain work together to control various mental functions. But each part has its own specialty.¹⁹

For example, near the center of your brain lies your amygdala. This small, almond-like structure plays a key role in processing your emotions, especially fear and anxiety. When your amygdala doesn’t work as it should, you might develop a mood or anxiety disorder.²⁰

Helping manage your amygdala’s emotional responses is your prefrontal cortex. This part, which sits behind your forehead, influences your ability to control your behavior and impulses and plan ahead. It affects your personality as well. Damage to your prefrontal cortex may lead to conditions like attention deficit hyperactivity disorder (ADHD), bipolar disorder, or schizophrenia.²¹

Farther out, nestled near your temple and ear is your hippocampus — an S-shaped structure responsible for your memory and learning. Your hippocampus works with your amygdala to connect your memories to your emotions. At the same time, your prefrontal cortex relies on information stored in your hippocampus to make informed decisions. An impaired hippocampus is linked to amnesia, Alzheimer’s disease, and dementia. The prefrontal cortex and hippocampus are especially prone to damage by CSVD resulting from OSA.^12,22

Maintaining neurotransmitter balance is a crucial factor in your mental health. Neurotransmitters are chemicals in your brain that carry signals between nerve cells. These substances help regulate many functions, including mood, motivation, and stress response.²³

For instance, serotonin plays a key role in mood regulation. Low levels of this neurotransmitter are linked to depression. OSA-induced IH can interfere with the production and function of serotonin. Similarly, dopamine is vital for motivation, reward, and pleasure. Low dopamine can contribute to conditions like addiction and schizophrenia. IH hinders dopamine signaling by decreasing the sensitivity of dopamine receptors in your brain.^16,17,23

Meanwhile, the hormone cortisol provides your body with the energy to face stressful conditions or escape from danger. But long-term excess of cortisol can damage your amygdala and hippocampus, promoting anxiety disorders. Low oxygen levels in OSA can activate your hypothalamic-pituitary-adrenal (HPA) axis, driving an excessive release of cortisol.^18,24,25

Also involved in your stress response is adrenaline. However, imbalances in this hormone and neurotransmitter can help drive concentration and memory problems, as well as post-traumatic stress disorder (PTSD). IH combined with frequent awakenings due to OSA, repeatedly activates your SNS, raising adrenaline levels.^10,26,27

Does CPAP help with mental problems?

A study investigated the effect of CPAP therapy on depression, anxiety, and cognitive function in OSA patients. Out of the 81 participants in the study, only 59 adhered to the prescribed one-year CPAP treatment. In the end, these adherent patients showed some improvements in both depressive and anxiety symptoms. They also demonstrated better overall attention, task switching, and verbal fluency.²⁸

It’s crucial to note that for CPAP to have any benefits, you need to use it every time you sleep — even during naps — at home or anywhere else. The problem is, around 67 percent of OSA patients with a CPAP prescription eventually discontinue treatment. While side effects are the main reason cited for non-adherence, cost and ease of use also play a role.²⁹

Conclusion

OSA takes its toll on your brain structure and function in multiple ways, potentially leading to mood disorders and cognitive impairment.

CPAP therapy can improve depression, anxiety, and mental functions in OSA patients, but adherence is key. Unfortunately, side effects, cost, and discomfort make it difficult for most patients to stick to CPAP treatment long-term.

The good news is, there’s a better solution! Discover the natural way to address the root cause of sleep apnea and protect your brain and mental well-being too. Sign up for the Snoring Diet Solution now.

References

Does Sleep Apnea Affect Mental Health?

Get notified whenever we publish a new blog post!

Enter your email to get notified whenever we publish a new blog post!