Poor sleep can affect how you think and feel. Feeling grumpy after a night of tossing and turning is one example.

While the short-term effects of poor sleep on your mood can be glaring, repeated nights of nonrestorative sleep can have a much broader impact on your mental health.

If you live with an anxiety disorder, you may wonder if your sleep apnea contributes to your anxiety in any way. If you don’t have a known anxiety disorder, you might wonder if your sleep apnea can trigger one.

Here, we’ll discuss the relationship between sleep apnea and anxiety while covering the specific ways that sleep apnea often worsens anxiety.

How Sleep Apnea and Anxiety Can Be Connected

Anxiety and sleep apnea can feed off each other in an ongoing cycle. Poor sleep from sleep apnea can trigger or worsen anxiety, while anxiety can worsen the insomnia that often occurs with sleep apnea.

Being sleep-deprived makes it harder to control your emotions, which can make feelings of anxiety or sadness more likely.

People with obstructive sleep apnea (OSA) have high rates of anxiety, depression, and other mental health disorders. If you have sleep apnea, your risk for anxiety is three times higher than that of the general population.

You might also feel more anxious day to day, even if your symptoms don’t meet the criteria for an anxiety disorder diagnosis.

How Poor Sleep Triggers or Worsens Anxiety

Sleep apnea changes the way your brain works in a few ways that open the door for anxiety. Interestingly, mild OSA is more likely to be related to anxiety symptoms than severe OSA. Still, you should be aware of the following ways that even mild sleep apnea can trigger or worsen anxiety symptoms.

Sleep Disruptions and Stress Activation

OSA can wake you up five to 30 times per hour or more. Fragmented sleep is often poor-quality sleep because you don’t reach the deep, restorative phases of sleep that allow your brain to rest.

This is true even if you don’t remember waking up. It’s possible to be unaware of repeated sleep disruptions from sleep apnea and still get poor-quality sleep.

Nonrestorative sleep and frequent sleep disruption are strongly linked with mental health conditions, including anxiety. Poor sleep activates the autonomic sympathetic nervous system, which is the part of your nervous system associated with the fight-or-flight response. When this system is activated, stress hormones like cortisol increase, and your brain and body feel like they’re in danger.

Those stress hormones affect your mood and thinking processes to increase anxiety.

Oxygen Deprivation

Repeated breathing interruptions associated with OSA mean your brain doesn’t get the oxygen it needs to function well. Chronic (long-term) intermittent hypoxia (periods of your brain not receiving adequate oxygen) increases inflammation inside your brain. Doctors believe this inflammation can trigger or worsen symptoms of anxiety.

Daytime Symptoms

Several common daytime symptoms of sleep apnea may trigger or worsen anxiety. Anxiety can also feed into common OSA symptoms like irritability and trouble concentrating, making them more severe than they would be otherwise.

Morning symptoms of sleep apnea, including morning headaches and daytime fatigue, are also strongly associated with anxiety and depression.

For example, you may feel extra worried or anxious if your performance declines at school or work, or if you have memory problems.

Poor sleep can also increase risk-taking behaviors and affect your judgment, which may lead to decisions that cause you to feel anxiety or regret in hindsight.

Can Treating Sleep Apnea Improve Anxiety Symptoms?

The good news is that OSA-related anxiety is manageable through direct mental health treatment and through treatment of the underlying sleep apnea. Your doctor or sleep specialist will work closely with you to manage anxiety and sleep apnea at the same time. They may recommend one or more of the following strategies.

Continuous Positive Airway Pressure

Continuous positive airway pressure (CPAP) is the main sleep apnea treatment that uses a CPAP machine to keep your airway open at night so you can breathe and sleep better.

CPAP can improve your sleep quality, reduce daytime sleepiness, and lower the risk of cardiovascular complications of OSA. Research suggests that CPAP therapy also typically improves psychological conditions associated with sleep apnea, including anxiety.

Cognitive Behavioral Therapy

It’s important to recognize that anxiety or panic disorders may make it harder to adhere to CPAP therapy. For this reason, your doctor may recommend cognitive behavioral therapy (CBT) alongside CPAP and other sleep apnea treatments.

CBT is a type of talk therapy that teaches you to become aware of the thought patterns that contribute to mental health challenges. It also teaches you to respond to these thought patterns in a constructive and adaptable way.

You work closely with a licensed therapist or psychologist who understands how anxiety and other disorders affect the way you function.

Studies suggest that CBT can improve a person’s adherence to CPAP therapy for sleep apnea. CBT can reduce panic attacks and sudden feelings of panic, which can make it difficult to sleep through the night with a CPAP machine.

In general, CBT also teaches you coping skills to help you shift anxiety-related thinking patterns.

There is even a type of CBT that focuses primarily on insomnia and is considered the primary therapy for insomnia.

Sleep Hygiene

Alongside evidence-based sleep apnea treatments, improving your sleep hygiene might make it easier to fall asleep at night while also improving anxiety. Sleep hygiene won’t cure OSA, but it does set the stage for better sleep quality once OSA is well managed.

You can improve your sleep hygiene by following these tips:

• Avoiding caffeine in the afternoon and evening
• Keeping a consistent sleep schedule (same bedtime every night)
• Reducing noise and light in your sleeping area
• Using your bed for sleep only
• Avoiding screen time before bed (including your phone and television)

Stress Reduction

Relaxation- and mindfulness-based stress reduction techniques may make it easier to sleep while also reducing anxiety symptoms. Techniques like deep breathing exercises, meditation, or yoga can help reduce stress, anxiety, and insomnia.

Your doctor may encourage you to exercise more often and adopt other healthy lifestyle changes that reduce sleep disturbances and associated anxiety.

What To Know About Anxiety Medications

Selective serotonin reuptake inhibitors and other medications may help with anxiety management, but some anxiety medications can worsen sleep apnea risk factors. It’s important to work closely with your doctor to determine which treatments help anxiety and OSA and which cause problems.

Talk to Your Doctor

If you feel like your sleep apnea is causing or worsening feelings of stress, depression, or anxiety, get in touch with your doctor or sleep medicine specialist.

Your doctor can prescribe or make adjustments to your sleep apnea treatment to improve your quality of sleep and reduce the stress hormones and brain inflammation that make anxiety worse.

Your doctor may refer you to a psychiatrist, licensed therapist, or other mental health specialist who can treat your anxiety independently of OSA.

Tell your doctor if you have any increasing anxiety symptoms, including sudden feelings of panic, restlessness, tension, or an increased heart rate.

Join the Conversation

On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.

What anxiety symptoms have you noticed after being diagnosed with sleep apnea? Let others know in the comments below.