Could your sleep apnoea be connected to PTSD? (And 7 ways to get a better night’s sleep)

Could your sleep apnoea be connected to PTSD?

It’s probably no surprise that Post Traumatic Stress Disorder can wreak havoc with your sleeping patterns. Hyperarousal and anxiety can make it harder to fall asleep, while sensitivity to the slightest sound can cause you to wake up frequently during the night. Some people suffer from nightmares, while depression can cause others to sleep more than usual. But did you know that PTSD and C-PTSD are both also linked to sleep apnoea?

What is sleep apnoea?

Sleep apnoea (also called Obstructive Sleep Apnoea , OSA or apnea) is when your breathing stops and starts during the night. You might snore excessively and wake up gasping or choking. Poor sleep quality can result in tiredness, mood swings and headaches during the day.

Research shows that sleep apnoea and PTSD/C-PTSD are commonly found together (this is known as comorbidity). Although there’s no clear evidence that sleep apnoea causes PTSD or C-PTSD or vice versa, there’s evidence that one can be a risk factor for the other and potentially make symptoms worse. According to one study of people with PTSD:

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

Untreated sleep apnoea can lead to heart and liver problems, high blood pressure and diabetes. Mild sleep apnoea doesn’t always need treatment, but in more serious cases, doctors may recommend the use of a night-time gum shield to open your airways while you sleep, or a CPAP machine, which pumps air through a mask over your mouth or nose while you sleep.

How Fear, Sleep Apnoea and PTSD are linked in the brain

“Good sleep benefits individuals with PTSD and plays an extremely important role in reducing the fear associated with traumatic memories. Studies show that sleep, especially REM sleep, helps facilitate fear extinction — a process where your brain forgets the association of a neutral trigger with a fear response. Just as your brain learns to consolidate and remember events during REM sleep, it also works to reduce the fear associated with certain memories.

Both fear extinction and nightmares occur during REM sleep. When a person with PTSD wakes up from a nightmare, it disturbs their REM sleep and interrupts this important fear extinction process. If the individual also has sleep apnea, their tendency to experience disturbed sleep is even more likely. In fact, for some individuals with OSA, the majority of their apneas occur during REM.

Some researchers believe the connection between PTSD and sleep apnea stems from the brain. Individuals with PTSD have lower growth hormone (GH) levels than those without PTSD, and reduced GH secretion is associated with more awakenings during the night. Chronic stress, like that experienced by those with PTSD, can also lead to frequent awakenings.”

Treating sleep apnoea and PTSD

Research shows that when someone has both sleep apnoea and PTSD or anxiety, treating one condition could help improve both.

The CPAP machine, which is used to treat sleep apnoea has shown to reduce many PTSD & C-PTSD symptoms. In CPAP therapy, ‘individuals sleep with a mask that connects via a hose to a CPAP machine on their bedside table. CPAP therapy enables the person’s airways to stay open during sleep, reducing apnea episodes during the night.

Fortunately, the evidence suggests that for individuals with sleep apnea and PTSD, consistent CPAP therapy can not only relieve symptoms of sleep apnea, but also those of PTSD, including anxiety, depression, nightmares, and quality of life. Unfortunately, the reverse is also true: untreated OSA is associated with poorer outcomes for PTSD.’

One study of individuals with PTSD and OSA found that ‘those who followed their CPAP therapy experienced a 75% improvement in PTSD symptoms.

Studies show the more frequently a person uses their CPAP therapy, the more their PTSD symptoms improve. CPAP therapy has an even stronger positive effect among those with severe PTSD, as opposed to mild to moderate symptoms.

Specifically, CPAP therapy can significantly reduce the frequency of nightmares — by as much as 50 percent — and the distress they cause for individuals with PTSD. CPAP therapy also relieves the daytime sleepiness symptoms of PTSD, improving quality of life.’

When to get help

Some researchers recommend  that all PTSD patients should be screened clinically for symptoms of OSA and receive CPAP treatment whenever possible to improve PTSD symptoms. If you suffer from PTSD or C-PTSD and are concerned you may also have sleep apnoea, consider seeing a doctor if:

  • Your sleep partner complains of loud snoring or mentions that your breathing pauses during your sleep.
  • You wake up gasping or choking during the night.
  • You still feel tired after a full night’s sleep.
  • You have trouble staying awake at school or work, or when you’re driving.

Find out more about PTSD or C-PTSD treatments here. Please remember, these aren’t meant to be medical recommendations, but they’re tactics that have worked for others and might work for you, too. Be sure to work with a professional to find the best methods for you.

 

 

  • Lettieri, C. J., & Williams, S. G. (2017). The PTSD-OSA Paradox: They Are Commonly Associated and They Worsen Outcomes, but Treatment Nonadherence Is Common and the Therapeutic Effect Limited. What Are Clinicians To Do?. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine13(1), 5–6. https://doi.org/10.5664/jcsm.6370
  • NHS
  • Gilbert, K. S., Kark, S. M., Gehrman, P., & Bogdanova, Y. (2015). Sleep disturbances, TBI and PTSD: Implications for treatment and recovery. Clinical psychology review40, 195–212. https://doi.org/10.1016/j.cpr.2015.05.008
  • Sleep Foundation
  • Anxiety and sleep apnea: The sleep/health connection
  • Sleep Problems When You Have PTSD
  • Exercising for Better Sleep
  • The Connection Between Sleep Apnea and PTSD

  • Tamanna S, Parker JD, Lyons J, Ullah MI. The effect of continuous positive air pressure (CPAP) on nightmares in patients with posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA). J Clin Sleep Med 2014;10(6):631-636.

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