PTSD and Sleep Apnea: How Do They Connect?

Post-traumatic stress disorder (PTSD) can cause sleep disturbance, resulting in daytime fatigue and low moods. 

Often associated with military veterans, PTSD is a mental health disorder which can affect anyone involved or witness to a traumatic event. Nightmares, flashbacks and often feeling on edge are some of the symptoms of the disorder.

Sleep apnea is another disorder that disrupts sleep. This is a disorder which also sees you awake through the night, awakened by pauses in your breathing -- resulting in sleep deprivation and daytime fatigue. 

Recent studies indicate a link between sleep apnea and post-traumatic stress disorder. They suggest that where the disorders co-occur, they can worsen the symptoms for both disorders.

What Is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is the most common form of sleep apnea. Someone with OSA experiences an obstruction of the upper airways when they sleep. The reduction in blood oxygen levels resulting from the subsequent breathing difficulties prompts the brain to awake the body for air.

In severe cases of OSA, someone may experience over 30 such arousals from their sleep every hour. Sleep deprivation increases the risk from serious health issues such as heart disease, stroke and diabetes if left untreated. 

Symptoms of OSA include:

  • frequent night-time awakenings
  • daytime fatigue
  • snoring
  • morning headaches
  • dry mouth
  • mood swings
  • poor concentration

As some of the symptoms occur as you sleep, it is often a partner who first spots the symptoms of OSA. However, once diagnosed it is a treatable condition.

The Link Between Sleep Apnea and PTSD

Both obstructive sleep apnea and PTSD can lead to significant sleep disturbance. Therefore, studies have looked at a potential link between the two. While around 20% of people may have OSA, which remains undiagnosed in the large majority of cases, this figure can be seen to jump significantly in those with post-traumatic stress disorder.

One of the contributing factors for OSA is age, with older people more at risk of developing the disorder. However, in younger Iraq and Afghanistan military veterans, 69% tested positive for OSA according to one study. The takeaway from the study was that post-traumatic stress disorder increased the risk from sleep apnea.

What the studies also found was the presence of untreated OSA could worsen the symptoms and outcomes of post-traumatic stress disorder. Good sleep is an important tool in managing the nightmares and fears associated with the disorder. When someone suffering with PTSD awakes from a nightmare it is usually during the REM phase of their sleep. This is key, as the REM phase has been shown to help with fear extinction.

If you also have OSA, the frequent awakenings caused by breathing cessations can also interrupt the REM phase of sleep, further impacting on the fear extinction this phase of sleep benefits. This is the process by which the brain forgets the link between a trigger and the fear response it provokes. Indeed, the studies point to sleep apnea increasing the severity of depression and suicidal thoughts and reducing the overall quality of life.

Someone whose sleep is disturbed due to post-traumatic stress may further their sleep deprivation if they also have OSA. Any condition which increases the chance of sleep disturbance could worsen their OSA symptoms, particularly if their OSA remains undiagnosed

Can One Disorder Cause the Other?

While the evidence from the studies suggests that sleep apnea worsens the symptoms of post-traumatic stress disorder and vice-versa, there is no evidence that one disorder causes the other.

The connection between the two disorders is quite complex. The studies certainly suggest there is a connection one of correlation not causation. 

What the research does seem to indicate is that having severe PTSD can lead to more severe OSA symptoms and having a more severe degree of OSA can increase the severity of your PTSD symptoms. 

The continual disturbed sleep resulting from undiagnosed OSA can affect someone’s recovery from PTSD. On the other hand, with each clinically significant increase in a veteran’s post-traumatic stress disorder symptoms their risk from OSA was seen to increase by 40%. 

Lifestyle Changes Can Help Both Disorders

Both disorders can be treated, making diagnosis key, and as both disorders lead to sleep deprivation, improving sleep hygiene is one of the first port of calls. This involves developing a bedtime routine where you go to bed and get up at the same time each day.

Ensuring a comfortable bedroom environment, reducing alcohol consumption and avoiding heavy meals in the hours before bed, as well as shutting down electronic devices early also can help you sleep. 

Developing a relaxing nighttime routine which may include meditation or reading, can also help relieve stress, helping you fall asleep quicker and stay asleep longer.

PTSD Benefits From Medication and Talk Therapy

However, both disorders will also need to be treated separately. As well as lifestyle changes and self-care considerations, PTSD once diagnosed can be treated using medication and talk therapy. Psychotherapy, such as cognitive behavioral therapy, may also be considered as part of the treatment plan.

Sleep Apnea May Require CPAP Therapy

As treating OSA can also help reduce the severity of your post-traumatic stress disorder symptoms, receiving treatment could help improve both disorders. Although lifestyle factors play a role in treating OSA as obesity is a major contributing factor, CPAP therapy is one of the leading treatments.

CPAP stands for continuous positive airway pressure therapy. It involves a device which delivers pressurized air through a mask you wear when sleeping. 

The pressurized air prevents the airways from blocking, maintaining an uninterrupted flow of air to the lungs and eliminating the frequent nigh-time awakenings. 

Using CPAP has been seen to improve PTSD symptoms by 75%, whereas those who don’t adhere to CPAP saw their symptoms worsen by 43%.

Because treating OSA could improve PTSD symptoms, it is important to consult a physician if you display any symptoms of sleep apnea.