Are Sleep Apnea & Anxiety Connected?

If you have sleep apnea, chances are you know that the pauses in breathing during sleep can cause some serious, long-term effects on your physical health and quality of life. But what about your mental health — can sleep apnea cause distress, stress or even anxiety disorders? 

Whether you or a partner struggle with sleep apnea, you’re already worried about what it does to someone’s body. Unfortunately, it may also be causing problems for the mind. There are many reasons to believe that there's a link between sleep apnea and anxiety, and that this connection can have serious health consequences. 

To understand the connection between these conditions, it’s important to understand how sleep apnea actually happens. So before we dive into the cause-effect relationship between your sleep breathing and your waking anxiety, let’s cover some basics about this nighttime condition.

Sleep apnea, also called obstructive sleep apnea or obstructive sleep apnea syndrome, is a disorder characterized by the collapse of a person’s airway during sleep. This collapse can be partial or complete, but when it happens, you’re unable to breathe. The resulting choking sensation causes oxygen deprivation, which in turn causes loss of sleep.

Apnea has many potential causes and risk factors, and a variety of habits, medical conditions, disorders and diseases can increase your risk. It’s important to understand that these conditions do not necessarily cause apnea — they’re simply associated with greater risk. 

At the most basic level, apnea is a condition that is caused by anatomical abnormalities, which can be caused by risk factors such as:

• Jaw position

• Obesity

• Pregnancy

• Smoking

• Alcohol consumption

• Using sedatives

• Tonsil obstruction

• Diabetes

• Hypothyroidism

• Down syndrome

• Congestive heart failure 

And while sleep apnea has many causes, it has one certain outcome that we’re here to discuss: It can increase your risk of anxiety and anxiety disorders.

This has been shown in a few ways, but it’s helpful if we look at some specific studies. For instance, one 2008 study looked at cortisol levels (stress hormone levels) in obese patients and found that they were slightly higher in the patients with sleep apnea. They likewise found that cortisol levels declined when a CPAP machine was used to treat apnea.

A 2015 review noted numerous studies that showed higher levels of reported anxiety in patients with sleep apnea. Those levels were noted particularly in women, alongside fatigue and depression symptoms that negatively affected quality of life. 

In a separate 2015 study, researchers looked at a decade of data on the relationship between sleep apnea and panic disorders in the Taiwanese population.

Nearly 9,000 apnea patients and nearly 35,000 controls were included in this data. They found that people with apnea were significantly predisposed to develop panic attacks and panic disorder, though they acknowledged that the collected data was vulnerable to certain collection flaws.

Perhaps the most telling results come from a 2021 study that looked at obstructive sleep apnea syndrome and stress. That study looked at about 100 people, roughly half with untreated sleep apnea and half without issues.

They found that sleep apnea patients had elevated stress, anxiety symptoms and depressive symptoms, and went so far as to call anxiety a symptom of apnea, though they couldn’t explain an underlying mechanism for the anxiety. 

The authors also stated clearly that the anxiety they observed fell short of the criteria for an “anxiety disorder.” In other words, apnea may cause anxiety and stress, but it did not, in their opinion, seem to trigger an anxiety disorder.

Most of these studies fell short of acknowledging a cause, in part because the relationship between anxiety and sleep apnea is poorly understood.

It’s unclear, for instance, why cortisol levels might be higher in people with obstructive sleep apnea, except that these higher hormone levels are potentially the result of an unconscious stress response to the sudden choking sensation — which we can all agree would be enough to stress anyone out in the middle of the night. 

Anxiety is responsible for a multitude of physical and emotional symptoms. Everything from your digestive system to your muscles can be affected by anxiety, and it can cause everything from fatigue and difficulty concentrating to irritability, nausea, diarrhea, hot flashes, trembling and more.

Anxiety can even cause sleep disturbances — a generic and inclusive term for things including sleep disorders like insomnia, sleep debt, poor sleep quality, restlessness and other behaviors that reduce your ability to get a good night’s rest.

But you didn’t come here to learn about all the symptoms of anxiety or conditions like insomnia — you came to find out if anxiety can cause obstructive sleep apnea. And the answer is pretty squarely “no.”

We were unable to find any evidence — even the most modest assertion — that anxiety can cause or exacerbate sleep apnea. In fact, most of the resources that we were able to find that did mention sleep apnea and anxiety did so only to say that no, anxiety can’t cause you to develop sleep apnea.

Because anxiety does not cause sleep apnea, there are no studies looking at whether treating anxiety disorders improves the symptoms of sleep apnea. We’re not saying anxiety treatment has no benefits — it has plenty — but when it comes to your sleep apnea, there’s very little that therapy or medication can do. 

In fact, one 2015 paper went so far as to say anxiety treatment can actually have negative effects on sleep apnea. They argued that limited studies suggest that certain antipsychotic medications, including benzodiazepines (which are used in the treatment of anxiety), could exacerbate the problems of sleep apnea.

Because these medications affect your central nervous system, they could cause undesirable relaxation of certain muscles and sensory signals that would otherwise function normally and prevent sleep apnea.

This is far from conclusive — even the review’s own authors said that further study is needed for a better understanding of how antipsychotic medications can impact sleep apnea. But from their findings, it looks like the medication you use to treat anxiety could very well be worse for your sleep apnea than the anxiety itself.

If you have obstructive sleep apnea, most experts still recommend continuous positive airway pressure machines (commonly called CPAP machines) as the first-line treatment.

Other treatments for sleep apnea — including weight loss, reduced alcohol consumption and smoking cessation — may be effective depending on your unique circumstances, but that’s part of a conversation that you should have with a healthcare professional about your individual circumstances. 

If you do have sleep apnea and anxiety, you may want to avoid certain medications for the treatment of anxiety, like sedatives, which could potentially contribute to the problem.

Whether or not you have sleep apnea, anxiety is best treated with medication, lifestyle changes and therapy in a combination tailored to your unique needs. Some of these recommended treatments may overlap with sleep apnea treatment — a better diet, more exercise, and fewer unhealthy habits may improve both your anxiety and sleep apnea.

Meanwhile, anxiety has several proven treatments that do not seem to have risks for people with sleep apnea. 

Medication

Medication for anxiety is a little more complicated, especially when certain medications can increase risks for sleep apnea. Generally, the medical community believes that the greatest potential benefits come from using selective serotonin reuptake inhibitors (SSRIs) in an off-label capacity. 

These medications help your brain balance its levels of serotonin, which can reduce mood swings and other potential symptoms of psychiatric issues. Fewer mood swings mean less severe reactions, which means your anxiety salsa goes from hot to mild. 

Therapy

Cognitive behavioral therapy is among the most popular recommended therapies for mood disorders, including anxiety disorders, because, with practice, it allows the patient to master the emotional and mental symptoms of anxiety. 

CBT helps you learn to spot anxious thoughts, reject them when they’re irrational and avoid the anxiety spiral that typically comes from those ways of thinking. Alongside medication and lifestyle changes — or even on its own — it can be incredibly effective.

One thing we failed to mention here is the awkward dichotomy between anxiety and sleep apnea.

Both sleep apnea and anxiety can ruin your sleep, the former by constricting your airway and causing health problems and the latter by causing insomnia and other stress-induced sleep disturbances. It’s a big problem if you have trouble falling asleep, only to do so and immediately struggle to breathe. 

If you’ve had this problem yourself, it’s time to do something about it. Apnea, anxiety and lack of sleep can also increase your risks of other health issues — everything from cardiovascular disease to high blood pressure. Getting help is crucial to your health — without treatment, both of these conditions will worsen and can negatively affect your health. 

If you’re looking for support, our mental health resources and online therapy platform are great places to take the next step in anxiety treatment. As for sleep apnea, a healthcare professional can help you set realistic, achievable goals and modify your sleep behaviors in the necessary ways to correct (and possibly eliminate) that problem. 

Both sleep apnea and anxiety are treatable problems that don’t have to run you down, leave you tired or affect your quality of life. Treatment is available — and it’s nothing to lose sleep over.