How Fixing Sleep Can Help Your Depression

How Fixing Your Sleep Can Help Your Depression

Dr. Meghna Dassani

Depression is becoming more common. In a 2017 study, more than 1 in 14 Americans over the age of 12, and 1 in 8 Americans between the age of 12 and 17, had a diagnosis of depression. The rates are climbing quickly. Is human brain chemistry suddenly changing, or is there something else contributing to our growing issues with mental illness?

Sleep and Depression

If you’ve ever completed a depression screening, you probably answered questions about sleep. It’s widely known that depression seems to cause sleep disturbances. People with depression often report insomnia, exhaustion during the day, and daytime sleepiness. When a previously energetic person becomes listless and sleepy, we often assume that they have become depressed.

Depression may cause sleep issues. But could sleep issues also lead to depression? If you’ve ever experienced a night of bad sleep, you were probably in a terrible mood for the next day. After several sleepless nights, your work suffers and sleep becomes the most important thing in your life. What happens to people who aren’t getting sufficient sleep over a long period of time? When a person has a condition like obstructive sleep apnea (OSA) the onset is often gradual. Their sleep slowly gets worse, causing them to gain weight. The weight gain makes the OSA worse. Over time, these people become increasingly sleep-deprived. Could this mimic depression?

What is OSA?

In obstructive sleep apnea, the airway becomes blocked when you are sleeping. The blockage deprives the lungs of air and the brain of oxygen. This causes a ‘microarousal.’ You wake up just for a short time, gulp down air, and fall back asleep. You won’t remember the microarousals in the morning, but the constantly interrupted sleep takes a toll on the brain and the body. Your stress hormones go up, your cardiovascular system is under constant stress, and your body can’t get the kind of sleep it needs to consolidate memories, heal itself, and rest. Over time, untreated sleep apnea can lead to chronic pain, poor performance at work, mental fogginess, and an impaired ability to relate to friends and family. Yet, many people don’t realize there’s a treatable cause for their symptoms. Is there any reason so many of them begin to spiral into depression?

It’s an invisible disease.

In a 2019 study, researchers looked at people with major depression and suicidal tendencies who were not suspected of having obstructive sleep apnea. These patients didn’t fit the typical OSA profile: they weren’t older, they weren’t obese, and no one had reported issues with snoring. The researchers had all of the patients complete a sleep study. 14% of the patients had OSA, and they turned out to be the patients whose depression had failed to respond to drug treatments.

In other studies, patients who suffered from depression and OSA were prescribed CPAP (continuous positive airway pressure) devices. Researchers found that as amount and quality of sleep improved, the patients’ depression symptoms gradually resolved as well. In one sleep study, 73% of patients referred for sleep apnea treatment had clinically significant depression. After 3 months on the CPAP, only 4% still had symptoms of depression. It appears that the chronic pain, inflammation, and exhaustion of untreated obstructive sleep apnea caused depression in these patients.

While the science of the link between OSA and depression is becoming increasingly clear, clinical practice has not yet caught up with research. Most PCPs know to check iron levels, thyroid levels, and vitamin D levels before diagnosing depression in their patients. However, unless a patient reports snoring or is obese, they may not think to order a sleep study as well.

Is sleep issue treating your mental health?

If you suffer from depression, especially depression that seems to resist drug treatments, it’s time to see if sleep issues are contributing to your mental health issues. There are a couple of ways to be screened for OSA so that you can receive treatment.

Your Psychologist or Psychiatrist. At your next appointment, ask for a referral to a sleep doctor.

At your next appointment, ask for a referral to a sleep doctor. Your Dentist. Many dentists screen for OSA at regular appointments. OSA often causes damage to the teeth or inflammation of the throat, so dentists are in a great position to screen for the disease. And since you see your dentist every 6 months, you may see them sooner than any other specialists.

Many dentists screen for OSA at regular appointments. OSA often causes damage to the teeth or inflammation of the throat, so dentists are in a great position to screen for the disease. And since you see your dentist every 6 months, you may see them sooner than any other specialists. Your Primary Care Provider. Describe your symptoms and ask for a referral to a sleep lab. You can even print some of the articles from the source list to bring along if you want to explain why you’re interested in investigating the possibility of OSA. Since untreated OSA can lead to obesity, diabetes and heart disease, your PCP will probably have experience getting patients diagnosed and treated.

What are my treatment options?

For most healthy adults, the first-line treatment for OSA is a CPAP machine. These machines are worn all night and provide a continuous airflow that can move past the blockage and reach the lungs. If worn regularly, a CPAP can resolve many of the effects of sleep apnea. However, some people, especially those with asthma or allergies, may have trouble tolerating the CPAP. For them, there are other options available.

If you can’t stand the CPAP, you may be a good candidate for a dental appliance. These custom appliances are custom fitted. They reposition your tongue and jaw while you sleep in order to keep your airway open. Unlike a CPAP they don’t dry out your airways or exacerbate sinus infections. If your attempts to use a CPAP have been unsuccessful, talk to your PCP about a referral to a dentist who treats sleep issues.

Finally, for some people, surgery may be the best option for removing the obstruction and promoting better breathing. If your PCP suspects you may need surgery, you’ll receive a referral to an ear, nose, and throat specialist. In fact, surgery to remove the tonsils and adenoids is the first-line treatment for children with OSA.

As our understanding of the connection between the brain and the body grows, we’re beginning to realize that many ‘mental illnesses’ are caused by underlying physical conditions. For many adults with depression, undiagnosed sleep apnea could be causing or exacerbating the condition. If you, or a loved one, have depression that includes sleep-related symptoms, see your PCP for a sleep apnea screening. It could turn your life around.

Resources for further help:

The Stop-Bang Screening Tool is a quick online quiz to help you determine if you’re at risk for OSA.

These articles may be helpful for demonstrating the connection between OSA and depression to your PCP:

McCall WV, Benca RM, Rumble ME, et al.: Prevalence of obstructive sleep apnea in suicidal patients with major depressive disorder. J Psychiatr Res 2019; 116:147–150 accessed at https://www.sciencedirect.com/science/article/abs/pii/S0022395619302018?via%3Dihub

Shoib S, Malik JA, Masoodi S. Depression as a Manifestation of Obstructive Sleep Apnea. J Neurosci Rural Pract. 2017;8(3):346–351. doi:10.4103/jnrp.jnrp_462_16 accessed at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488552/