Sleep Apnea and Overall Well-Being
Posted On Oct 14, 2016
According to the National Healthy Sleep Awareness Project (http://www.sleepeducation.org/healthysleep), there are about 25 million Americans diagnosed with sleep apnea, obstructive sleep apnea (OSA) being the most common. The most noteworthy symptoms of OSA include snoring, gasping for air throughout the night, dry mouth, sore throat, and sleepiness throughout the day. Throughout my clinical work, I realized that many individuals present with classic OSA symptoms and require a referral to a pulmonologist for further assessment. Therefore, I make it a point to always inquire about sleep apnea regardless of the client’s “presenting problem.” About 95% of the time, my initial impressions are correct and a diagnosis of OSA is confirmed through a sleep study (e.g., Polysomnography).
A common treatment for OSA is Continuous Positive Airway Pressure (CPAP) therapy. However, for a multitude of reasons, many individuals either do not comply with treatment (e.g., use CPAP for 4-5 hours throughout the night) or cannot simply tolerate the CPAP. When OSA is untreated, it can lead to a host of problems. Much is known about the long-term adverse health consequences, including risk for hypertension, chronic fatigue, stroke, heart disease, and even diabetes. However, much less attention has been given to the risk of emotional health consequences. The following comments are just some of the experiences from my clients who do not use or are unable to tolerate CPAP:
- I can’t concentrate; maybe I have ADHD
- I don’t have any enthusiasm
- My memory is shot
- I don’t have a sex drive
- It’s like I’m in a fog
- I’m so irritable
- I can’t tolerate stress
- Anything is too much for me
- I’m easily overwhelmed
- I’m angry
- It's like my brain is "stuck"
- My spouse has to sleep in a different room because of my gasping and loud snoring.
Such comments are not a rarity; in fact, when I worked at the VA Hospital, I heard these complaints on a fairly regularly basis. It isn’t any different in private practice either. Untreated or poorly controlled OSA is a serious problem. It progressively impacts emotional, psychological, and cognitive functioning. Here is some of the evidence:
- OSA can lead to symptoms of depression, regardless of weight, age, sex, or race (as reported by CDC, 2012). Individuals diagnosed with OSA and Major Depression see a significant reduction of mood symptoms as they increase CPAP compliance (American Academy of Sleep Medicine, 2015).
- OSA is associated with increased interpersonal difficulties, stemming from increased anger and irritability due to cumulative effects of poor sleep quality (Reishstein, et al., 2006).
- OSA can complicate PTSD treatment in the veteran population. Veterans are more likely to experience greater difficulty with overall anxiety reduction, and nightmares in particular, even when undergoing mental health treatment (Krakow, et al., 2004).
- OSA impacts the consolidation of declarative memory (Guo, Igue, Malhotra, Stickgold, & Djonlagic, 2013). In other words, OSA may not necessarily impact initial learning, but it does significantly reduce retention of learned material.
As you can see, OSA is not merely just a sleep disorder. It places individuals at much risk for further suffering in all domains of life (physical, emotional, cognitive, and social). Take sleep apnea very serious. Controlling OSA can literally save your life….