Both post-traumatic stress disorder (PTSD) and sleep apnea can cause sleep disturbance — but could having one condition make the other worse?
Startling awake in the middle of the night can set you up for fatigue and low mood during the day.
When you live with post-traumatic stress disorder (PTSD), these disturbances might feel commonplace. Nightmares and swirling thoughts can sometimes make sleep feel out of reach.
Lurching out of bed in the middle of the night, however, might not solely be the result of PTSD. Sleep apnea, a type of disordered breathing, can also contribute to your restless nights.
A growing body of evidence suggests PTSD and sleep apnea might play off one another, potentially making symptoms of both conditions worse.
The exact reason for this is not yet well understood. However, it’s speculated that certain lifestyle changes some people make to cope with PTSD could increase the risk of sleep apnea — or that sleep apnea may be more readily noticed among patients living with PTSD.
There’s currently no evidence to suggest that PTSD causes sleep apnea, or that sleep apnea causes PTSD.
When these conditions co-occur, however, they seem to share a complex connection.
Complications from symptoms
PTSD and sleep apnea appear to intensify some symptoms of one another.
Experts theorize that sleep apnea may disrupt your normal rapid eye movement (REM) phase of sleep, which can make PTSD symptoms, like nightmares, worse.
At the same time, the hypervigilance of PTSD may increase the chances you’ll wake up during mild obstructive events, which could ultimately lead to greater sleep fragmentation, or interruption of sleep.
The effects of sleep apnea on PTSD may even be as far-reaching as suicidal ideation.
A 2018 study suggests that the severity of sleep apnea may be directly related to an increased chance of suicidal ideation in people living with PTSD.
PTSD is a condition that commonly occurs after exposure to a traumatic event.
Symptoms tend to fall into four categories, outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), which include:
- Intrusion. You may experience flashbacks or intrusive memories after a reminder of a traumatic event. Persistent memories and recurring dreams are also common intrusion symptoms.
- Avoidance. This can include going to great lengths to avoid people, situations, thoughts, and objects that remind you of a traumatic event.
- Reactivity or arousal. You may notice changes in your behavior and attitude. You might feel irritable, be prone to emotional outbursts, or indulge in self-destructive behavior.
- Cognitive or mood. In addition to feeling a lack of joyful emotions, you may develop an increasingly unhelpful worldview or experience feelings of detachment, as well as experience difficulty remembering details about the traumatic event.
Obstructive sleep apnea occurs when your upper airway becomes blocked during sleep, reducing — or completely stopping — your airflow.
Since this occurs while you’re sleeping, it can be difficult to notice signs of sleep apnea. For example, you may wake up without knowing why.
Many times, it’s a partner who notices your symptoms of sleep apnea in the middle of the night, such as:
- gasping sounds
- loud, frequent episodes of snoring
- shallow breaths
- pauses in breathing
- waking up frequently
During the waking hours, sleep apnea warning signs can include:
- sexual dysfunction
- difficulty concentrating
- excessive fatigue or daytime sleepiness
- dry mouth when waking
- headaches in the morning
- slower motor, verbal, or visual function
By nature, PTSD is often associated with sleep disorders, which are listed as one of the common side effects of living with PTSD.
Sleep apnea isn’t the only type of sleep disorder associated with PTSD, though.
PTSD and sleep apnea are not the same condition, and treating each of these disorders on their own may help improve symptoms in both.
Treating PTSD is typically multifaceted and often depends on your individual symptoms, their severity, and the traumatic event you experienced.
PTSD treatment plans often consist of a combination of:
- self-care and lifestyle changes
Psychotherapy is considered a first-line approach for PTSD, including:
- cognitive behavioral therapy (CBT)
- cognitive processing therapy (CPT)
- cognitive therapy (CT)
- dialectical behavior therapy (DBT)
- reconsolidation of traumatic memories (RTM)
- Eye Movement Desensitization and Reprocessing (EMDR)
Psychedelic therapy is also making strides as an alternative therapy for treating PTSD. Though this option isn‘t yet legal or widely available in the United States, it may become more accessible in the coming decades.
Treating sleep apnea
The treatment of sleep apnea commonly takes a more universal approach with what’s known as continuous positive airway pressure (CPAP).
While you sleep, the CPAP machine helps maintain a consistent level of pressure in your airways, preventing them from collapsing.
It requires you to wear a mask that covers your nose, a mask over your nose only, or prongs that fit inside your nose.
Data from a 2019 review indicates that CPAP may not only help prevent sleep apnea, but also diminish the severity of some PTSD symptoms.
The only downside to CPAP treatment is that it has a low adherence rate, and according to a 2017 review, living with PTSD may make you even less likely to stick with CPAP treatment.
If you’re living with PTSD and experience sleep fragmentation, or your partner picks up on irregular breathing patterns in the middle of the night, you may also be living with sleep apnea.
Though the exact relationship between these two conditions is unclear, living with one may impact the severity of symptoms in the other.
PTSD and sleep apnea often require different treatment approaches. Talking with your doctor or therapist about a creating a treatment plan to address these dual conditions can be a good starting place.
It may take time to find the right treatment plan, and you may need to try multiple strategies.
Even though symptoms may improve as one disorder is managed, there’s no evidence that indicates you can cure PTSD through sleep apnea treatment, or vice versa.
As with most long-term health conditions, sticking with your treatment program may give you the best chance of seeing a positive outcome.