Can Sleep Apnea Cause Anxiety?

Anxiety can sometimes make sleep apnea worse—and vice versa. Sleep apnea is a common medical condition that causes your breathing to stop intermittently during sleep. The most common type is obstructive sleep apnea (OSA), in which the upper airway gets blocked during the night. 

Around 22 million people in the U.S. have sleep apnea. Untreated sleep apnea can lead to serious medical complications and even sudden death. An estimated 38,000 people die each year from heart disease complicated by sleep apnea.

This article discusses how sleep apnea and anxiety are connected, including symptoms, treatment, and how to talk to your doctor.

What Is Anxiety?

Anxiety is an emotion characterized by worrying thoughts and tension. It can also involve physical changes, such as an increased heart rate or high blood pressure. 

Symptoms

Occasional anxiety is typical and expected. However, when someone experiences chronic or excessive anxiety, they may have an anxiety disorder.

Someone may have generalized anxiety disorder (GAD), for example, if they experience excessive anxiety or worry most days for at least six months. Their anxiety can cause problems in relationships, work, school, and other aspects of daily living.

According to the "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition" (DSM-5), symptoms of GAD include:

• Feelings of restlessness or tension
• Excessive sweating
• Dizziness
• Fatigue
• Irritability
• Muscle tension
• Difficulty concentrating
• Intrusive or uncontrollable worries
• Sleep problems, including difficulty falling or staying asleep, as well as low sleep quality

Other anxiety disorders include panic disorder (recurring panic attacks) and phobia-related disorders (extreme fear of specific things or situations).

How Anxiety Affects Sleep

Sleep problems and anxiety can be intricately connected. 

Insomnia (difficulty falling asleep or staying asleep), chronic sleep deprivation, and poor quality sleep can worsen anxiety. In turn, stress and anxiety can make it hard to fall or stay asleep and to get restful sleep regularly. 

For example, someone with anxiety might toss and turn at night because of their patterns of overthinking or intrusive worries. The next day, they may be less able to cope with daily stressors because their physical, mental, and emotional functioning is compromised after a night of poor sleep.

The Anxiety and Depression Association of America (ADAA) points out that nearly all psychiatric problems involve some kind of disruption in sleep. People with chronic insomnia are also at a higher risk of developing sleep-related disorders, such as sleep apnea.

Sleep Apnea

Sleep apnea is a condition that causes breathing to stop or become shallow during the night. These pauses in breathing, called “apneas,” often last 10 seconds or more and can occur 30 or more times per hour in severe cases.

Symptoms

The most common signs and symptoms of sleep apnea include:

• Loud, frequent snoring
• Gasping or choking during sleep
• Excessive daytime sleepiness
• Difficulty concentrating
• Headaches and dry mouth in the morning
• Sexual dysfunction

If untreated, sleep apnea can lead to several possible medical complications and other problems, including:

• Decreased performance in work or school
• Increased risk of accidents, such as car crashes, due to daytime sleepiness
• Heart disease
• Heart failure (the heart is unable to pump enough blood for the body's needs)
• Stroke (a blockage of blood flow or bleeding in the brain)
• Diabetes (the body does not make or use insulin well, resulting in high blood sugar)
• High blood pressure
• Asthma (a chronic disease of the lungs with constricted and inflamed airways)
• Atrial fibrillation (irregular heart rhythm)

How Sleep Apnea Is Connected to Anxiety

A growing body of evidence suggests that sleep apnea and anxiety are connected. It’s likely that each condition exacerbates the other: Disturbed sleep due to sleep apnea can increase daytime stress and fatigue. Anxiety can also trigger and worsen sleep apnea by making it harder to fall asleep at night.

Some research suggests that sleep apnea and anxiety are often co-occurring conditions. One 2014 study revealed that people with OSA were more likely to have symptoms of anxiety. Severe OSA was linked to an even higher likelihood of anxiety symptoms. People with sleep apnea were also likelier to have both anxiety and depression than just one or the other.

A 2019 study echoed these results, revealing that the incidence of anxiety disorders and depression was higher in people with sleep apnea than in people without it. This was especially true among female patients.

Treatment

The only definitive way to be diagnosed with sleep apnea is through a sleep study, also known as polysomnography. After a referral from your doctor, a sleep specialist uses a sleep study to measure your oxygen levels, brain waves, heart rate and rhythms, and leg movements for about six hours overnight.

With this data, a specialist can determine the severity of your sleep apnea based on your apnea-hypopnea index (AHI)—the number of times you stop breathing for 10 seconds or more per hour. 

The first choice of treatment for sleep apnea is positive airway pressure (PAP) therapy, which requires sleeping with a small mask over your nose or over your nose and mouth.

Usually, this involves being fitted for a continuous positive airway pressure (CPAP) device, which blows pressurized air into your lungs as you sleep to keep your airways open and prevent apneas. 

If you have both sleep apnea and anxiety, it’s important to seek treatment for both conditions. Treatment for anxiety can include:

• Mental health therapy, such as cognitive behavioral therapy
• Prescribed medications
• Mindfulness techniques, such as meditation

To address sleep problems, including sleep anxiety, it can also be helpful to practice good sleep habits. Healthy sleep habits include:

• Establishing a consistent bedtime routine
• Keeping your bedroom comfortable, dark, and uncluttered
• Turning off your phone, tablet, and other devices an hour before bedtime
• Using white noise to fall asleep
• Limiting caffeine intake before bedtime 
• Staying physically active during the day

When to Talk to Your Doctor

If you have symptoms of sleep apnea, anxiety, or both, talk to your doctor about getting a referral for a specialist. Consider talking to your doctor if you have any of the following signs or symptoms:

• Dread or anxiety about falling or staying asleep
• Excessive daytime sleepiness
• Excessive snoring
• Irritability or mood swings 
• Not feeling rested even after a full night of sleep
• Trouble staying awake or concentrating during the day
• Intrusive thoughts or worries, especially before you go to sleep
• Nightmares or night terrors

Summary

Sleep apnea is a condition that causes your breathing to stop or become shallow intermittently while you sleep. Sleep apnea symptoms include gasping or choking for air, snoring, daytime sleepiness and fatigue, irritability, difficulty concentrating, and trouble staying awake during the day.

Many people with sleep apnea also have anxiety, which can make their symptoms worse. In turn, many people with anxiety have trouble falling and staying asleep. 

The first choice of treatment for sleep apnea is usually positive airway pressure (PAP) therapy, which involves blowing compressed air into the lungs through a mask or nose tubes during sleep. This usually requires a continuous positive airway pressure (CPAP) device at night.

Treatment for anxiety can include talk therapy, medication, and relaxation techniques. People with both sleep apnea and anxiety should also practice good sleep habits, such as establishing a consistent bedtime routine, sleeping in a dark room, getting physical activity during the day, and turning off all devices an hour before bedtime. 

A Word From Verywell

Both sleep apnea and anxiety can disrupt your sleep patterns, cause distress, and make it hard to focus during the day. Talk to your doctor about getting treatment for sleep apnea, anxiety, or both in order to start getting a better night of rest.