PTSD and sleep apnea are life-threatening disorders that often feed into each other. How and why this occurs, and the connection between each condition, was not well-known in the past. As we gain more acceptance of mental health challenges that people face every day, more light is being shed on these often comorbid conditions, too. The link between PTSD and sleep apnea is getting clearer. Here’s what you need to know.
What is sleep apnea?
Sleep apnea is a widely undiagnosed type of sleep disordered breathing that affects an estimated 25 million people in the U.S. There are three types of sleep apnea.
- Obstructive sleep apnea: In this most common form of sleep apnea, breathing stops when the tissues of the throat relax down and back, obstructing the airway
- Central sleep apnea: The central nervous system “forgets” to send the signal to breathe
- Complex sleep apnea: The airway first becomes blocked, but the brain “forgets” to send the signal to breathe
People who suffer from sleep apnea may wake up with a headache and a groggy feeling. They may be irritated and unable to concentrate during the day. This can be especially challenging for the estimated 80% of people who are not diagnosed and just believe they are poor sleepers.
What is PTSD?
Post-traumatic stress disorder (PTSD) is a complex condition that places a person’s body back in the same state of previously experienced trauma. This emotional and mental stress persists well after the traumatic event. Although PTSD gets more press as it applies to men in combat, turns out that women are more likely to develop PTSD when placed in combat situations similar to men.
Most people are familiar with PTSD as a result of warfare or combat, but there are other situations that can lead to PTSD. These include:
- Physical trauma (accidents or abuse)
- Witnessing a traumatic event
- Surviving a natural disaster
- Past trauma that was repressed
- Sexual abuse
People who suffer from PTSD may experience symptoms that include:
- Increased anxiety
- Irritability or agitation
- Emotional detachment
What has been less often considered is the connection between sleep apnea and post-traumatic stress disorder, but this is changing.
How are PTSD and sleep apnea related?
Sleep apnea secondary to PTSD is becoming clearer with every piece of research that is revealed.
In a 2015 study of veterans of the wars in Iraq and Afghanistan, almost 70% of study participants screened at a higher risk for obstructive sleep apnea. This was after controlling for age and lifestyle habits. Because in this study risk was not at all related to weight or body-mass index, researchers concluded that PTSD was the primary factor in developing sleep apnea.
Another study in 2018 found that 76% of veterans with PTSD also had obstructive sleep apnea. This is again controlling for other factors that might influence the development of PTSD.
Other studies indicate:
- Lower CPAP adherence among PTSD/sleep apnea patients
- Comorbid PTSD and sleep apnea mean a lower quality of life among veterans
The studies above focus on veterans, as they remain the population most likely to develop PTSD. But it is important to remember that the traumatic event need not be combat or warfare for this difficult condition to occur. The brain does not differentiate combat in a war zone versus combat in a violent neighborhood. Both can result in PTSD for witnesses or victims.
PTSD and sleep apnea occur because of the way the brain processes trauma. A common feature of PTSD is anxiety, and people with sleep apnea are almost 18 times more likely to have anxiety. The features of anxiety – rapid breathing, shortness of breath, cortisol stress response – resemble the body’s stress response that occurs during trauma.
Poor sleep increases anxiety, which may trigger PTSD, which can in turn continue the cycle of poor sleep. As with sleep apnea and depression, another common symptom of PTSD, the relationship is bidirectional, with each condition – PTSD and sleep apnea – feeding the other.
In many ways, PTSD is the body trying to protect itself, and sleep apnea comes along for the ride. Many combat veterans and victims of trauma are almost afraid to sleep due to chronic nightmares and flashbacks. This cycle can feed into sleep apnea as the brain lays down every night on high alert.
How to manage PTSD and sleep apnea
The first crucial part of managing these two conditions is to recognize if you are in a high-risk population and to get yourself evaluated for both conditions. High-risk populations include:
- People who live in a violent neighborhood or city (especially children)
- Survivors of trauma or natural disasters
- Victims of physical or sexual abuse
Unlike screening for sleep apnea in patients without PTSD, age, weight, and other usual risk factors do not often apply to those with PTSD. Patients with PTSD in otherwise excellent health were just as likely to suffer from sleep disordered breathing.
When seeking treatment, it is important to treat both conditions. Treating sleep apnea while ignoring PTSD is like putting a bandage on a third-degree burn. For many people with PTSD, cognitive behavior therapy and stress-reducing exercise like yoga and meditation can help with the mental and emotional aspects of this disorder.
While undergoing care for PTSD, your sleep apnea dentist or doctor can help with the physical symptoms of sleep apnea. They may recommend a CPAP or BiPAP machine to help with breathing, but sometimes people with PTSD cannot sleep with a mask on their face. In these cases, sleep apnea dental devices are one CPAP alternative that can be effective.
AZ Dentist is your sleep apnea dentist with convenient locations and hours all across the Phoenix area. With experience and compassionate care, let us help you get a better night’s sleep. Get in touch today.