Depression and sleep problems: Where sleep apnea fits in

Depression and sleep problems are health conditions that are frequently connected — not just by conventional wisdom, but by increasing clinical evidence. And, although that conversation mostly focuses on depression and sleep problems like insomnia more than, say, obstructive sleep apnea (OSA) — the focus of this blog — it’s still worthwhile to point out all the ways in which sleep problems can contribute to the negative effects of depression.

As the National Sleep Foundation (NSF) puts it, “depression may cause sleep problems and sleep problems may cause or contribute to depressive disorders,” noting that symptoms of depression seem to come before sleep problems just as frequently as the other way around. In other words, it’s generally understood that depression and sleep (or lack thereof) share a complicated relationship. What isn’t clear is the nature of that relationship. Does one cause the other?

The topic has sprung up again in clinical research circles with the findings in November that sleep therapy may significantly ease the problems of depression. The preliminary study, which has yet to be published in the scientific literature, was featured in the National Institutes of Health’s Medline Plus newsletter, which stated that “treating persistent insomnia at the same time as depression could double the chances that the mood disorder will disappear.”

“If the figures continue to hold up, the advance will be the most significant in the treatment of depression since the introduction of Prozac in 1987,” writes Benedict Carey in a New York Times article describing the study’s results.

“It makes good common sense clinically,” the article quotes Dr. Nada L. Stotland, a renowned professor of psychiatry. “If you have… depression, you’re often awake all night, it’s extremely lonely, it’s dark, you’re aware every moment that the world around you is sleeping, every concern you have is magnified.”

Depression and sleep apnea: Is there a connection?

Insomnia is the sleep problem most commonly associated with depression — about 90 percent of patients with depression complain about sleep quality, according to this 2005 study¹ — but it’s not the only one.

Depression has also been connected with other sleep problems like restless leg syndrome (RLS): “Approximately 40% of people with RLS complain of symptoms that would indicate depression if assessed without knowledge or consideration of a sleep disorder,” according to the Fall 2006 edition of the Restless Legs Syndrome Foundation newsletter.

There’s also growing evidence of a direct relationship between depression and sleep apnea. The NSF points to this 2003 study showing “people with depression were found to be five times more likely to suffer from sleep-disordered breathing (OSA is the most common form of sleep disordered breathing).”²

There’s a bright side to this story. According to this 2007 study published in the Journal of Clinical Sleep Medicine, treating sleep apnea with continuous positive airway pressure (CPAP) led to a “statistically significant, sustained improvement” in the symptoms of depression.³

A 2010 study published in the journal Sleep Medicine agrees, concluding that “CPAP treatment may result in a significant improvement of residual depressive symptoms due to the improvement of daytime sleepiness in these patients.”⁴

The takeaway? If you’ve found yourself suffering from the effects of depression and sleep apnea, sleep therapy may help alleviate the problems of both, and bring you closer to experiencing a healthier, more energetic lifestyle. Talk to your doctor about whether taking a sleep test may be a good option for you.