PTSD and sleep apnea: How they are related

Post-traumatic stress disorder (PTSD) and sleep apnea have been linked by a number of clinical studies. Some research even suggests that consistent treatment of sleep apnea with CPAP can help ease PTSD symptoms like nightmares and anxiety among military veterans.¹

For starters, what exactly is PTSD? The U.S. National Institute of Mental Health (NIMH) defines it as a condition that develops “after a terrifying ordeal that involved physical harm or the threat of physical harm” (and which isn’t limited to the victim of that trauma, but sometimes also affects loved ones or witnesses to the event).² Most commonly associated with war veterans, PTSD can also result from other traumatic incidents like criminal assault, kidnapping, child abuse, plane crashes, natural disasters or terrorist events.

It’s long been accepted that PTSD generally affects sleep. That same NIMH overview cites difficulty sleeping as a symptom of PTSD, and recommends that doctors help counsel PTSD sufferers with tips for better sleep (as well as diet and exercise habits, which, as we’ve learned, are also closely linked to sleep health).

A study published in the European Journal of Psychotrauma supports that conclusion, describing a “perpetual circle” when “sleep disturbances increase the risk for PTSD and vice versa.”³

How are PTSD and sleep apnea connected?

So, we know that sleep problems are frequently linked to post-traumatic stress disorder. But what’s the specific connection between PTSD and sleep apnea?

As we pointed out in our blog post exploring the connection between anxiety and sleep apnea, a 2015 study in the Clinical Psychology Review considered the presence of sleep apnea to be a risk factor for PTSD.

“Insomnia and excessive daytime sleepiness even within a month after a traumatic event are important predictors for the development of PTSD,” the report claims. “One specific sleep disorder – sleep apnea – may even intensify symptoms of PTSD, including sleeplessness and nightmares.”

PTSD and sleep apnea share other connections. “In a sample of 78 individuals seeking treatment for posttraumatic sleep disturbances … 95% of those tested (50% of the subjects) experienced diminished airflow during sleep” which is suggestive of sleep-disordered breathing (SDB), according to the authors of a 2012 study published in the Journal of Clinical Sleep Medicine.¹

That same study found that, among 44 “consecutive crime victims with PTSD reporting nightmares and insomnia,” 91% also had sleep-disordered breathing (SDB). (Sleep apnea is a common form of SDB.)

“Untreated OSA appears to be associated with worse outcomes among patients with PTSD,” the authors continued. “Likewise, CPAP therapy has been shown to improve symptoms of depression among patients with concomitant PTSD.”

The report also referenced an earlier study concluding that “patients who were adherent with CPAP reported a 75% improvement in PTSD symptoms compared with a 43% worsening in PTSD symptoms among patients who were non-adherent.”

“Although the literature addressing the impact of CPAP adherence on PTSD is limited,” the report added, “it suggests improved outcomes.”