Can anxiety cause sleep apnea?

Sleep apnea is a common sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep. These breathing disturbances cause loud snoring and daytime sleepiness, and can lead to potentially serious health complications if left untreated.

Anxiety is a mental health condition characterized by excessive and persistent worry, nervousness, and tension. Anxiety can range from mild to severe and cause both psychological and physical symptoms.

There has been growing interest around the relationship between anxiety and sleep apnea. While anxiety is not a direct cause of sleep apnea, the two conditions appear to have a bidirectional relationship. Anxiety may worsen sleep apnea in some individuals, while sleep apnea may also trigger or exacerbate anxiety in others. Exploring this relationship is important to improve treatment and quality of life for people living with both conditions.

What is sleep apnea?

Sleep apnea occurs when a person’s breathing is disrupted during sleep. There are three main types of sleep apnea:

– Obstructive sleep apnea (OSA): The most common type, caused by blockage of the airway. This occurs when the soft tissue in the back of the throat collapses during sleep.

– Central sleep apnea: Caused by a problem with the brain’s signaling to the muscles that control breathing. Breathing stops temporarily during sleep because of lack of effort rather than blockage.

– Complex sleep apnea: A combination of both obstructive and central sleep apnea.

Sleep apnea causes oxygen levels to drop and carbon dioxide levels to rise during sleep. This stimulates the brain to pull the person out of deep sleep so that normal breathing can resume. This may happen hundreds of times per night, often so briefly that the person is unaware of these micro-arousals. However, they prevent the person from getting restorative deep sleep.

Common signs and symptoms of sleep apnea include:

– Loud snoring
– Episodes of breathing cessation during sleep witnessed by a partner
– Gasping or choking during sleep
– Excessive daytime sleepiness, lack of energy
– Morning headaches
– Difficulty concentrating, memory problems
– Mood disorders such as depression

Untreated sleep apnea increases the risk for serious health complications including high blood pressure, heart disease, stroke, obesity, and diabetes. Fortunately, sleep apnea can be effectively treated in most cases through lifestyle changes, mouthpieces, breathing devices (CPAP), or surgery.

What is anxiety?

Anxiety is broadly defined as feelings of worry, unease, fear, nervousness, and tension. While mild anxiety can be a normal response to stress, severe or chronic anxiety is considered an anxiety disorder. There are several types of anxiety disorders:

– Generalized anxiety disorder: Excessive worry about everyday issues that is difficult to control
– Social anxiety disorder: Intense fear of social situations and interactions
– Panic disorder: Repeated panic attacks and fear about having another attack
– Phobias: Extreme fear about a specific object or situation
– Separation anxiety: Fear about being away from home or attachment figures
– Illness anxiety: Worry about having or developing a serious undiagnosed medical condition

Anxiety causes both psychological and physical symptoms. Common symptoms include:

– Feeling restless, on-edge, fatigued
– Irritability
– Muscle tension
– Racing thoughts
– Sleep disturbances
– Trouble concentrating
– Nausea
– Difficulty breathing
– Increased heart rate
– Chest pain

Anxiety disorders are among the most common mental health conditions. They affect over 40 million adults in the United States each year. Anxiety can interfere with work, school, and relationships. Treatment options include therapy, medication, holistic health, and lifestyle changes.

Can anxiety directly cause sleep apnea?

Anxiety cannot directly cause obstructive or central sleep apnea, the two main types of sleep disordered breathing. This is because the root causes of OSA and CSA originate from physical or neurological conditions, rather than emotional states.

However, research indicates that in some cases, anxiety may indirectly worsen the symptoms and severity of sleep apnea. Let’s explore how this may occur.

How anxiety may indirectly worsen sleep apnea:

1. Exacerbating breathing problems

One way anxiety could indirectly exacerbate sleep apnea is by worsening breathing difficulties, particularly in obstructive sleep apnea.

OSA occurs due to collapse of throat muscles during sleep. Anxiety causes physical tension and shallow breathing. This can further tighten the airway and contribute to airway obstruction and apneas.

2. Interrupting sleep

Sleep disruption is a hallmark of both anxiety and sleep apnea. But they may interact to form a vicious cycle.

Sleep apnea frequently causes poor sleep quality, leading to daytime anxiety and distress. At the same time, anxiety often produces insomnia and restless sleep, which means less restorative deep sleep. With less deep sleep, the airway may become even more prone to collapse, resulting in more interruptions.

3. Impairing daytime functioning

Untreated OSA impairs daytime functioning, causing issues like fatigue, cognitive dysfunction, and mood changes. Anxiety compounds many of these symptoms. The combination often severely limits quality of life and productivity.

4. Triggering anxiety

There is evidence that in some individuals, sleep apnea may trigger new onset anxiety or exacerbate existing anxiety. Possible reasons include:

– Chronic lack of oxygen during sleep apneas may affect areas of the brain involved in regulating emotions.

– Constant sleep disruptions and lack of deep sleep prevent the brain from properly regulating stress hormones.

– Adjustment difficulties from OSA diagnosis and wearing CPAP may provoke anxiety.

So in these ways, the presence of sleep apnea could stir up anxiety, leading to a self-perpetuating cycle.

Can anxiety cause sleep apnea?

While anxiety may aggravate sleep apnea in some cases, there is no evidence that anxiety directly causes or produces sleep apnea on its own. The root causes of OSA and CSA originate from non-anxiety related factors.

Root causes of obstructive sleep apnea (OSA):

– Anatomical abnormalities like enlarged tonsils, tongue, or uvula
– Obesity and excess weight around the neck
– Structural nasal obstructions or deviated septum
– Large neck circumference in men
– Menopause hormonal changes in women
– Natural aging process decreasing muscle tone
– Alcohol, sedatives causing excessive muscle relaxation

Root causes of central sleep apnea (CSA):

– Heart disorders like atrial fibrillation or heart failure
– Opioid pain medications
– Stroke or neurological disorder
– High altitude causing periodic breathing
– Brain tumor or other brain structural disorder

While anxiety may not directly initiate sleep apnea, it’s possible it could contribute to worsening of the underlying causes in some individual cases. For example, anxiety could potentially exacerbate heart problems like arrhythmias, or promote unhealthy lifestyle habits like alcohol use, indirectly leading to higher OSA risk. However, the primary mechanisms remain distinct.

Treatment considerations when anxiety and sleep apnea co-occur

When anxiety disorder and sleep apnea co-occur, it presents unique challenges for evaluation and treatment. Some key considerations include:

– Conduct thorough screening for both conditions, as symptoms overlap. Use sleep studies and anxiety questionnaires.

– Determine whether anxiety or OSA developed first, as this may impact treatment approach.

– Treat sleep apnea first with CPAP, oral devices, surgery. This often improves anxiety.

– Adjust CPAP pressure, mask fit to minimize anxiety side effects. Consider behavioral therapy.

– Add anxiety treatment like CBT, medications if needed, after OSA treatment.

– Adopt healthy sleep habits, stress management, exercise, and nutrition.

– Take a coordinated, multidisciplinary approach to care. Communication across providers is key.

– Be aware that residual anxiety may persist even after sleep apnea therapy, requiring ongoing mental health support.

– Monitor for co-occurring mood disorders like depression which may develop.

Overall, there is no evidence that anxiety alone directly causes sleep apnea. However, it may worsen the condition in some people. Awareness of the bidirectionality between anxiety and OSA can lead to better screening, treatment, and quality of life. A holistic approach addressing both conditions is ideal.

The effects of anxiety and sleep apnea on the body and mind

Both anxiety and sleep apnea can negatively impact physical and mental health in overlapping ways. Here is an overview of some of the effects:

Physical effects:

– Fatigue and low energy
– Headaches
– Cognitive impairments like poor memory and concentration
– High blood pressure
– Increased inflammation
– Impaired immunity
– Heart problems like arrhythmias, heart disease
– Metabolic disorders like obesity, diabetes

Mental health effects:

– Depression
– Irritability and mood swings
– Stress
– Difficulty coping with daily responsibilities
– Reduced motivation
– Problems with relationships and social withdrawal

These negative effects are often significantly amplified when anxiety and sleep apnea occur together. The combination can profoundly disrupt cognitive abilities, emotional health, cardiovascular function, weight control, and quality of life.

Getting adequate treatment for both conditions is crucial. This includes therapy, medications, CPAP, and lifestyle changes. With proper treatment, many patients see dramatic improvements in physical and mental well-being.

Tips for improving anxiety and sleep quality

Here are some proactive tips to help minimize anxiety and improve sleep:

– Adopt a regular sleep-wake cycle with consistent bedtime.
– Limit daytime napping to 30 minutes.
– Avoid screens and digital stimulation before bedtime.
– Create an optimal sleep environment that is cool, quiet and comfortable.
– Reduce evening consumption of stimulants like caffeine, alcohol, nicotine.
– Practice relaxing activities before bed like light reading, guided imagery, deep breathing, meditation.
– Take a warm bath 1-2 hours before sleep.
– Keep a pen and pad next to your bed to write down anxious thoughts.
– Reduce fluid intake 2-3 hours before bed to limit nighttime awakenings.
– Participate in moderate daily exercise to reduce stress hormones.
– Talk to a therapist or counselor for cognitive-behavioral therapy.
– Discuss anti-anxiety medications or sleep aids with your doctor.
– Use white noise or ambient sounds to dampen noise disturbances.
– Ensure your bedroom is dark and wear eyeshades if needed.

Combining healthy sleep habits with medical treatment and therapy can help break the cycle of anxiety and OSA. Ensure any underlying disorders are properly addressed as well. With time, both conditions can be successfully managed.


While anxiety does not directly cause sleep apnea, the two conditions appear to have a bidirectional relationship that may worsen symptoms. Anxiety could promote factors like airway collapse, sleep disruption, and arousal issues that exacerbate OSA. Meanwhile, the presence of sleep apnea may also provoke anxiety in some patients.

Treating both disorders concurrently is often needed for optimal outcomes. Maintaining open communication across providers is essential. With proper management, many patients see significant improvements in sleep quality, daytime functioning, mental health, and overall wellness. Adopting healthy sleep habits and relaxation techniques helps as well.

In summary, anxiety and sleep apnea interact in complex ways that are important for patients and providers to understand. A holistic, integrative treatment approach can successfully minimize the burden of these co-occurring conditions. Patients can achieve restful sleep, reduced anxiety, enhanced cognition and a greater quality of life.

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