Sleep Apnea: A stealthy cause of depression

More and more of my patients seem to know about sleep apnea-a breath-stopping type of snoring. But I bet most people will be surprised to hear that research has linked sleep apnea to depression. If you think about it, though, it makes sense that being sleep deprived could affect your body's chemistry and moods. Here's what a colleague of mine, psychiatrist Dr. Michael Miller, has to say about the connection between sleep apnea and depression.

It seems like a minor problem, even an amusing one: A bedmate complains about his or her partner's snoring. Laughs follow when someone imitates the racket that regularly intrudes on sleep. But the problem may not be so funny. In many cases, it can literally be depressing.

As many as one-fifth of people with depression may suffer from a sleep-related breathing disorder called sleep apnea. People with depression are about five times as likely as people without depression to have a sleep-related breathing disorder.

Let's take a look at what this problem is and why it might be an important one to pay attention to.

What is Sleep Apnea?

Apnea means "without breathing." No matter what the cause - an obstruction (such as large tonsils) or faulty signaling from the part of the brain that controls breathing - people with apnea stop breathing for 30 seconds or less. This is temporarily suffocating. Oxygen levels drop and carbon dioxide builds up. The sleeper wakes up, gasping loudly for air until blood oxygen levels return to normal.

At its worst, this cycle may repeat itself hundreds of times each night. Yet the sleeper may be completely unaware. Anyone listening is likely to dismiss the problem as merely annoying snoring.

 People with the condition:

·    Get very sleepy during the day

·    Have many more traffic accidents than people without the condition

·    Have a higher risk for stroke, heart attack and heart failure because of the extra strain that lack of oxygen places on the heart

The Apnea-Depression Connection

Obstructive sleep apnea also appears to increase the risk for depression. One research team found that among 1,400 randomly-selected people, those with even a mild sleep-related breathing disorder were 60% more likely than unaffected people to be depressed.

There is also some evidence that a breathing disorder can make an existing depression worse. If a person's depression isn't responding to treatment, it could be that sleep apnea is an aggravating factor. The reverse is also true: Treating obstructive sleep apnea can help to improve depressed mood and reduce depressive symptoms in some people.

If you're depressed-whether or not you have any symptoms of sleep apnea-be sure to talk to your doctor about getting treatment.

How To Treat Sleep Apnea

If you are diagnosed with sleep apnea, your doctor may recommend the most studied treatment for obstructive sleep apnea. It's called "continuous positive airway pressure" or CPAP. The air pressure makes your airway less likely to collapse. Between 60% and 80% of people benefit from using a CPAP device-a special mask over your mouth and nose while you sleep. Most people need time to adjust to the device and coaching to learn how to use it comfortably.

Certain lifestyle changes may also help relieve sleep apnea. Being depressed, however, can affect your motivation and energy to make these changes.

Here are some things to consider doing before you invest in a CPAP machine:

·    Being overweight makes the mechanics of breathing more difficult, so losing weight - if you can do it - is a good idea.

·    If you get more exercise and follow a healthy diet, you will not only feel better, but your body will work better in many ways, including breathing during sleep.

·    Sleeping on your side instead of your back may take pressure off the air passages.

·    Since alcohol, sedatives, and muscle relaxants can aggravate the underlying mechanical problem, it may help to avoid or limit your use of these substances.

Another option is a dental device that fits in the mouth to reposition the lower jaw and tongue. Sometimes it will successfully prop the airway open. Such devices are easier to use than CPAP, but are less helpful if you have severe sleep apnea.

If none of these approaches is effective, you may consider surgery to correct the source of the blockage. If tissue at the back of the mouth and throat has loosened or grown too large, a surgeon may be able to remove excess tissue and clear the airway. Or adjusting the upper or lower jaw may improve air flow.

Surgery does offer the possibility of a cure, but it is not a sure cure. Some patients improve, but many don't. Older patients heal slowly and may encounter more complications, such as infections and difficulty swallowing. In some cases, symptoms get worse. A decision about surgery should only be made after reviewing all possible options with a sleep specialist.

Tell us about your experience with sleep apnea or other sleep disorders. Have you noticed a connection between poor sleep and depression?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Sleep
Need better sleep? Learn how to get it with Improving Sleep: A Guide to a Good Night's Rest. This special report from Harvard Medical School describes the factors that can disturb sleep, the latest in sleep research, and, most importantly, what you can do to get a good night's sleep. It also includes in-depth information on sleep disorders, including restless legs syndrome, narcolepsy, and sleep apnea.






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