Sleep apnea can have some surprising symptoms, including nightmares. Many people with sleep apnea report having worse dreams than people who don’t have sleep apnea.

Fortunately, there are ways to treat sleep apnea and get a more peaceful night’s sleep.

How Does Sleep Apnea Cause Nightmares?

Sleep apnea doesn’t directly cause disturbing dreams. Instead, it makes you more likely to have bad dreams because of how sleep apnea affects your sleep cycle.

REM Sleep

When you go to bed, you don’t experience the same type of sleep for the entire night. There are two kinds of sleep: rapid eye movement (REM) and non-REM sleep.

You spend most of your sleep time in non-REM, or deep, sleep. During non-REM sleep, your body repairs itself and builds up your immune system. Your breathing is regular and less frequent, and your heartbeat slows.

But about a quarter of sleep time is spent in REM sleep. During REM sleep, the brain “wakes up” and produces emotions and memories. These emotions and memories become dreams. To keep you from acting on your dreams, much of your body is temporarily paralyzed during REM sleep.

Sleep Apnea Events During REM Sleep

During REM sleep, your body temporarily keeps you from moving so you don’t act out your dreams. At the same time, your tongue, soft palate, and throat can lose muscle tone. This makes it more likely that a sleep apnea event will occur during REM sleep.

Sleep apnea events during REM sleep tend to last longer than events that occur during non-REM sleep. Some people even have a subtype of sleep apnea called REM-predominant sleep apnea, when all or most of the breathing obstructions happen during REM sleep.

Women and people under the age of 60 are more likely to have REM-predominant sleep apnea, according to a study published in the journal Nature and Science of Sleep.

Sleep apnea events during REM sleep can break up your REM sleep and affect your dreams, making them more vivid and disturbing.

People with sleep apnea may actually be less likely to remember their dreams. However, when they do remember them, those dreams are more likely to be nightmares.

A study of 33 people with sleep apnea found that when participants woke up after an apnea event, they were more likely to report stressful or negative dreams.

Not being able to breathe during an apnea event may affect your dreams. Some people report vivid dreams about choking, drowning, or being buried alive. This may happen because the brain is not getting enough oxygen.

Other Causes of Nightmares

Your frequent nightmares may not be linked to sleep apnea events during REM sleep. Other possible causes include stress, mental health conditions, and medication side effects.

Stress

The symptoms of sleep apnea can cause stress. In turn, that stress can influence your dreams and cause nightmares. This can become a vicious cycle, with worsening sleep from bad dreams causing more stress, which in turn worsens your nightmares.

Mental Health Conditions

People with sleep apnea are more likely to have mental health conditions, such as mood disorders, anxiety disorders, psychotic disorders, and post-traumatic stress disorder (PTSD), than people who don’t have sleep apnea.

It’s unclear whether these disorders are caused by sleep apnea, but poor sleep can make them worse. These mental health conditions can make nightmares more likely.

Medication Side Effects

Medications used to treat psychiatric disorders, like antidepressants and antipsychotics, can also make nightmares more likely.

Other medications, like semaglutide (sold as Ozempic for diabetes and Wegovy for weight loss) and beta-blockers for high blood pressure, increase your nightmare risk. Even the sleep aid melatonin has nightmares as a side effect.

However, not everybody who uses these common medications will have nightmares.

Treating Sleep Apnea

Treating your sleep apnea can help you get better sleep and potentially prevent nightmares. One of the most common ways to treat sleep apnea is by using a continuous positive airway pressure (CPAP) machine, which keeps the airway from becoming blocked.

In one study of CPAP users, nightmares went away in 91 percent of people who kept using their CPAP machines, compared with 36 percent of people who didn’t use them regularly.

Other treatment options for sleep apnea include oral appliances, which keep your jaw in a position where your airway is always open. Lifestyle changes, like losing weight and changing sleep position, can also ease sleep apnea and improve your sleep quality.

Cutting back on alcohol or avoiding it may help reduce sleep apnea events. Alcohol relaxes the muscles around the airway and causes nasal congestion, making it harder to breathe. Don’t drink right before you go to bed.

Other Ways To Prevent Nightmares

Simple changes in routine can help reduce your chances of bad dreams, whether you have sleep apnea or not.

Relax Before Bed

An hour before you go to sleep, have some quiet time. Take a shower or a bath, brush your teeth, and engage in a quiet activity in your bedroom like reading or listening to a guided meditation. Turn off your TV, tablet, and phone.

Keep To Your Sleep Schedule

Your body knows when you’re ready to go to bed and when you’re ready to wake up. When you don’t disturb your internal clock and go to bed at a consistent time, you’re less likely to have nightmares.

Choose Calming Content Before Bed

If you’re using a screen before bed, or even if you’re reading or listening, limit your content to what’s cheery and relaxing. Stay away from news, horror, true crime, and other disturbing topics.

Avoid Caffeine Before Bed

Coffee and soda will keep you up at night, but if you do manage to fall asleep, you’re more likely to have nightmares.

Join the Conversation

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

Have you had nightmares with sleep apnea? Have you found anything that helps you sleep more peacefully? Let others know in the comments below.