Treatment Studies For Osa: Reversibility Of Depressive Symptoms
The gold standard treatment for moderate to severe cases of OSAS is continuous or bilevel positive airway pressure which mechanically maintains the upper airways space open during sleep via the administration of ambient air with a certain pressure. The minimum necessary pressure level has to be titrated individually for each patient . Other treatments, especially for mild cases of OSA, include weight loss, dental devices or upper airway surgery . Different upper airway surgical procedures can be used for particular cases with craniofacial abnormalities .
Among the negative studies on CPAP therapy and its effect on depression, Borak et al. did not observe any improvement in emotional status after 3 and 12 months of CPAP therapy in 20 patients with severe OSA, similar to Munoz et al. who also did not show improvement of BDI scores in 80 subjects with severe OSA after 12 months of CPAP. Using subtherapeutic CPAP as the placebo control, Yu et al. and Henke et al. found no difference in improvement on depression scores between the treatment and the control group, over a short treatment duration . However, whereas Borak, Munoz and Henke do not find any effect of CPAP therapy on mood, Yu observed a positive effect on mood of both CPAP therapy and the subtherapeutic CPAP control group.
Tips For Coping With Depression
In addition to talking to a provider about treatments for depression, there are several steps you can take on your own:
- Exercise: Low-intensity exercise, even walking 10 minutes a day, can lead to improvements in mood and physical health. For some people with mild to moderate depression, exercise can work as effectively as an antidepressant.
- Support: Experiencing depression can feel isolating and hopeless, so remember that youre not alone. Spend time with others, talk about what youre experiencing, and try not to isolate yourself.
- Be realistic: Even with effective treatment, symptoms of depression may improve gradually.
Having depression can increase thoughts of suicide. If you or someone you know is in crisis, the National Suicide Prevention Lifeline provides 24/7, free and confidential support.
National Suicide Prevention Lifeline
How Osa And Depression Are Connected
The idea of OSA contributing to depression is firstsupported by the scientific and medical fact that when the body is deniedproper rest, it doesnt function at its best. Thats because it relies on aseries of cyclical events to maintain homeostasis proper sleep being one ofthem.
While some patients may suffer from OSA and depressionconcurrently, others may become depressed after theyve been deprived sleep fora prolonged period of time.
According to the medical journal, Sleep, insomnialinked to OSA has a significant correlation to depression. The results of morerecent studies were published in the Journal of Research in Medical Sciences,showing that 46% of the test group with sleep apnea also showed signs ofdepression.
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Sleep Apnea And Nocturnal Panic Attacks
Can sleep apnea cause nocturnal panic attacks?
A clinical study revealed that sleep apnea can cause nocturnal panic attacks. Clinicians also encountered parasomnias, delirium, personality change and violent outbursts in some OSA patients.
Many sleep apnea patients have dreams during a breathing pause while sleeping. Examples of dream experiences are:
- being choked by someone else during a play,
- being tied up or chained ,
- diving without oxygen tanks and gasping for breath .
For more info about dreams in patients with sleep apnea, please read Principles and Practice of Sleep Medicine.
The Role Of Inflammation In Sleep Apnea And Depression
It has been well-documented that individuals with depression have higher levels of inflammation overall than those without it. While this excess inflammation in depressed people is modest, literature reviews have found that it can have profound effects on depression levels.
For people with sleep apnea, study findings are mixed. Certainly, obese patients with sleep apnea have increased inflammation in their body, and weight loss can address both the inflammation and sleep apnea concurrently. While researchers know the connection between inflammation and sleep apnea exists, each study recommends more research to confirm.
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Does One Cause The Other
There is no direct causation between PTSD and sleep apnea. That is, it is not clear whether PTSD causes sleep apnea or sleep apnea causes PTSD. Instead, there is definitely a correlation between the two, in which having one can increase the intensity of the other.
For example, if you already have PTSD, then you are likely to experience more extreme sleep apnea. If you have sleep apnea, the strength of your PTSD symptoms will also increase.
Generally, sleep apnea leads to disturbed sleep. This is also why there are several associations between sleep apnea and depression, stress, drowsiness and a lack of productivity during the day.
When this is combined with PTSD, disturbed sleep can cause issues with several of the symptoms since proper sleep is one of the many requirements when it comes to reducing the symptoms of PTSD. When this requirement is not met, ones PTSD can become much worse.
It is important to have enough room to deal with PTSD as well as sleep apnea. Reducing ones symptoms might also reduce the symptoms of the other due to the correlation that exists between them.
There is, however, no proven relationship of cause between the two disorders.
What Is A Sleep Test
A sleep test is performed to differentiate snoring from sleep apnea or to diagnose the severity of the condition. It is performed overnight and is used to evaluate what the body is doing during sleep. A typical sleep study will include a number of components, including electroencephalogram electrooculogram electromyogram electrocardiogram right and left leg EMG nasal/oral airflow thoracic respiratory effort abdominal respiratory effort snoring SaO2 heart rate and video monitoring.
During a sleep test, the respiratory disturbance index is used to measure the severity of the sleep disorder. The RDI is a number that represents how many times breathing stops or becomes very shallow each hour and is an important index because it is very often associated with the disruption of sleep, as well as dangerous drops in blood oxygen levels. Generally, an RDI of five or below is considered normal, while an RDI over 40 may indicate severe disease.
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What Is Sleep Apnea
To start with, sleep apnea is a sleeping disorder that makes a person experience difficulty breathing when sleeping. It often arises from different factors that directly impacts the soft tissue of both the mouth and the nose.
Such breathing discomfort can result in headaches, insomnia, fatigue, and depression, all of which can affect the efficiency of daily living. With that said, the symptoms of this medical condition include snoring, irritability, attention problems, morning headaches, feeling short of breath after waking up and feeling tired even after having a full night of sleep among other things.
Going on, this condition can be treated by a person who suffers from it, deciding to make lifestyle changes such as losing weight by eating right and engaging an effective exercise routine. Such people also can use a breathing assistant device. All of which can affect your daily life.
Diagnosis And Treatment Of Sleep Apnea
The good news is that treating OSA may improve depression. And, in many cases, because symptoms of depression often overlap with symptoms of sleep apnea, there can be a risk for misdiagnosis. By partnering with your patients physician, you can properly treat sleep apnea and depression.
For those who are experiencing symptoms of depression, it is important for them to be screened for sleep apnea. You can begin this screening by asking if they are experiencing any of the following symptoms:
- Disrupted sleep
- Excessive daytime sleepiness
The solution is simpleoffer treatment for sleep apnea or depression right away. By treating sleep apnea, you can help to not only improve your patients sleep, but their depression as well. Whether treatment is for depression or sleep apnea, the end result will be the same: a better nights sleep and an improved well-being.
Mayoor Patel, DDS, MS
If you are offering dental sleep medicine services in your practice, what are you doing about depression? Gaining a better understanding of the connection between sleep apnea and depression is key to helping our patients get the best care possible. With proper treatment, we hope to not only provide relief from sleep apnea, but depression as well.
Mayoor Patel, DDS, MS, is the owner of Atlantas Craniofacial Pain and Dental Sleep Center of Georgia.
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Sleep Apnea Linked To Depression
People With Certain Types of Sleep-Disordered Breathing More Likely to Be Depressed, CDC Study Finds
March 30, 2012 — Snorting, gasping, or short interruptions in breathing during sleep may be linked to depression symptoms, new research shows.
The more frequently people snort, gasp, or stop breathing for short periods of time while asleep, the more likely they are to have symptoms of depression, according to a government study of nearly 10,000 adults released today.
Snoring, however, was not linked to depression symptoms in the study, which appears in the April edition of the journal Sleep.
New Study Links Sleep Apnea And Depression
In some cases, traditional methods for treating depression dont work and depressive episodes persist or worsen. Until recently, there didnt seem to be an effective way of treating this type of depression.
A new study conducted at Georgias Augusta University suggests that theres a link between obstructive sleep apnea and depression. In cases where this holds true, treating sleep apnea may help alleviate the depression as well. This is significant, as according to Dr. William V. McCall, who co-authored the study, over half of the people with major depression also suffer from obstructive sleep apnea.
In the study, the researchers recruited 125 people with depression who also suffered from insomnia. The original purpose of this study was to determine if treating the insomnia would alleviate the depression. However, in evaluating the subjects, they found that many of them 17 of the 125 also suffered from undiagnosed sleep apnea.
Although these subjects comprised 14 percent of the group, most of them showed no obvious symptoms of the sleep disorder. Daytime drowsiness and obesity were not prevalent, which was why these individuals werent initially excluded from the study. Further investigation found that up to 52 of the study participants had major depression that had proven resistant to treatment. Within that group, eight of those subjects were also found to suffer from obstructive sleep apnea.
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Study Confirms Link Between Sleep Apnea And Depression In Men
New research presented at the 2015 American Thoracic Society International Conference in Denver, CO, reports a link between sleep disorders and depression in men.
Previous research has observed an association between sleep apnea and depression. For instance, a 2012 study published in the journal Sleep claimed to be the first nationally representative survey taking in 9,714 American adults to examine this relationship. That study found sleep apnea symptoms were associated with probable major depression, regardless of weight, age, sex or race.
In the new study, researchers from the University of Adelaide in Australia studied 1,875 male participants between the ages of 35 and 83 over a period of 5 years.
The study found that excessive daytime sleepiness and severe obstructive sleep apnea were individually associated with the prevalence and onset of depression with the combination of both associated with even greater risk.
Obstructive sleep apnea is estimated to affect 1 in 2 men and 1 in 5 women, but up to 82% of cases are undiagnosed, according to the researchers.
Men with an undiagnosed sleep disorder and excessive daytime sleepiness which is a primary symptom of sleep apnea were found to be four times more likely to have depression than peers who did not have a sleep disorder. Men with a diagnosed sleep condition, meanwhile, were found to be twice as likely as peers without a sleep disorder to have depression.
Anxiety And Lack Of Sleep
Before fully answering the question, can lack of sleep cause anxiety, its important to understand the two-way connection between sleep and your mental/emotional state. Some people dont qualify for an anxiety disorder diagnosis, but still feel anxiousness that at least occasionally interferes with their ability to get a good nights sleep. In other cases, a diagnosable anxiety disorder produces significant symptoms of insomnia or other sleep disturbances. However, not all anxious people or people with anxiety disorders experience disruptions in their ability to get decent rest. Resources Anxiety and Depression Association of America: Sleep Disorders National Sleep Foundation: The Complex Relationship Between Sleep, Depression and Anxiety Sleep Health Foundation: Anxiety and Sleep
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How To Sleep With Anxiety
Sleep problems are extremely common for those struggling with anxiety. Ideally, youll need to focus on reducing your anxiety and stress in general so that youre less consumed by the negative thoughts and experiences, and can drift off to sleep more easily.
There are tips and strategies you can use to get more rest with anxiety. Consider the following:
Mental distractions can also be beneficial, especially for heavy sleepers. Some people find that turning on radios, podcasts, or television sets, and putting the volume as low as possible so that you can barely make out the words can be helpful. Your mind tries to listen to the distraction, causing it to stop focusing on the stressful thoughts, and ultimately youre able to fall asleep.
This solution does not work for everyone, however.
Another important thing that you can do is to create a bedtime routine. It can be difficult to go through your daily activities and then get into bed and just turn everything off. By giving yourself an hour before you want to fall asleep to go through the same motions every night you train your brain and your body to prepare for sleep. This in turn can make it easier to both fall, and stay asleep.
Unfortunately, these tips are likely not enough. You still need to stop experiencing anxiety so that sleep comes much more naturally.
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The Relationship Between Sleep Apnea And Mental Health
Last month we learned about the significant link between obstructive sleep apnea and diabetes and obesity. However, the associations with OSA doesnt end there the relationship between OSA and mental illness is well established and can further complicate both the diagnosis and treatment of these two diseases.
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Is Sleep Apnea Related To Depression
Sleep apnea is associated with many serious conditions, including depression. Millions of people suffer from this life-threatening condition, which may be linked with untreated sleep apnea. Although the sleep apnea depression link is complex, its thought that people with depression may be more likely to suffer from obstructive sleep apnea , the most common form of sleep-disordered breathing.
It can be challenging to get a proper diagnosis since sleep apnea and depression share common symptoms like fatigue, lack of energy, difficulty concentrating, memory loss, sexual dysfunction and loss of interest in hobbies or activities. Depression may cause sleep apnea symptoms to surface and sleep apnea could also contribute to or worsen depressive symptoms. Because each person is different, some people might notice symptoms of depression before they notice that theyre having symptoms specific to sleep apnea like loud snoring or nighttime gasping and choking. If you are having any of these symptoms, talk to your doctor right away and ask to be screened for sleep apnea.
This blog post contains general information about medical conditions and potential treatments. It is not medical advice. If you have any medical questions, please consult your doctor.
What Did The Research Find
The study, which was conducted at the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University and published in The Journal of Psychiatric Research, examined the rate of undiagnosed obstructive sleep apnea by studying 125 people who suffered from depression. The researchers tested the participants of the study by means of a sleep study and found that almost 14 percent of them had obstructive sleep apnea. Of the 125 participants, 52 had treatment resistant depression, eight of whom also had obstructive sleep apnea.
According to the research team behind the study, underlying conditions like hypothyroidism, cancer and carotid artery disease, are often the cause of treatment resistant depression. This means that in many cases, individuals with depression undergo extensive testing to try and determine the cause of their depression treatment failure. While this can be useful, the researchers suggest that it could be helpful to begin with a sleep test because people with obstructive sleep apnea do not typically respond well to antidepressant medications. For this reason, it is worth testing for sleep apnea and addressing the issue if necessary.
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The Infinite Loop Between Sleep Apnea And Anxiety
Do you have anxiety because of sleep apnea and sleeplessness, or are you experiencing sleep apnea and lack of sleep because of your anxiety? This is a chicken-or-the-egg type of question.
During a sleep apnea episode, the brain receives a sort of a panic signal, which jolts the body awake to resume breathing. The sudden wake up prevents you from receiving uninterrupted sleep and reaching all of the sleep stages, getting your body into what is known as sleep debt. Sleep debt makes it more difficult for your brain to cope with stress.
Also, when sleep is disrupted consistently, it can alter brain activity as well as the neurochemicals which affect your thinking pattern and mood. The hindered sleep prevents the healing or recovery of your body from day-to-day stresses. In other words, if your brain were a computer processor, being in sleep debt would be like having a bunch of apps running in your head, and none work as well or as fast as they should because there are too many open.
Over time, that stress will increase your heart and blood pressure rates and will lead to additional physiological health issues. The more stress you feel because of sleeplessness, the more likely you are to have a panic attack.