Can Sleep Apnea Cause Schizophrenia?

While sleep difficulties are not part of the diagnostic criteria for schizophrenia, many with the condition report having problems with sleep.

Common sleep problems reported include:

• sleeping too much (hypersomnia)
• not getting enough sleep (insomnia)
• unusual sleep patterns

It’s not clear whether sleep apnea causes schizophrenia or schizophrenia causes sleep apnea. But research shows they are related in some way.

Some people with schizophrenia reported that sleep disturbances such as insomnia were an indication that an episode of psychosis was expected.

In a 2015 study of adolescents with schizophrenia and a high chance of psychosis, those who reported sleep disturbances also reported that their positive symptoms — such as psychosis — were worse after 12 months.

Additionally, treatment for schizophrenia often includes atypical antipsychotic medication.

A side effect of antipsychotics includes weight gain, either from increased appetite or decreased metabolism. Being overweight or obese is a common cause of sleep apnea, according to the National Heart, Lung, and Blood Institute.

Research from 2017 found that those with schizophrenia who also had sleep apnea had a higher body mass index (BMI) than those who did not.

Sleep apnea is a condition that involves repeatedly stopping breathing and then resuming breathing during sleep. This prevents your body from getting enough oxygen to your brain, which can lead to brain damage in the long term.

A 2014 study found that people with sleep apnea who had never received treatment had a low amount of white matter in their brains. The study also discussed how people with sleep apnea often report mild cognitive (memory and concentration) issues.

Sleep apnea may also cause atrophy — loss of cells — in the brain, which may also contribute to cognitive issues. A 2016 study found that people with untreated sleep apnea showed atrophy in the cerebral cortex, the part of the brain responsible for emotion, thinking, memory, and concentration.

People with sleep apnea often have an increased chance of dementia due to changes in the brain.

A 2021 study found that the brain damage seen in people with Alzheimer’s, a form of dementia, is similar to that seen in people with sleep apnea.

But this brain damage is reversible with treatment. People in the 2014 study showed an improvement in white matter and significant improvements in memory and concentration after 12 months of treatment with continuous airway pressure (CPAP).

Sleep apnea may seem like a purely physical condition. But it’s often found in many people with mental health conditions.

A 2017 study found a direct link between having sleep apnea and an increased chance of having a mental health condition. Untreated sleep apnea increased the odds of having the following conditions:

• depression
• anxiety
• severe psychological distress
• suicidal ideation

In the study, people with sleep apnea were also noted to be more likely to use mental health services but also more likely to report more dissatisfaction with their treatment.

Schizophrenia is one of those conditions associated with sleep apnea. A 2016 review found that about 15% of people with sleep apnea also had some form of schizophrenia.

There are several known contributing factors to sleep apnea. Some of these can also be found more often in people with schizophrenia. These include:

• Obesity: Some medications that treat schizophrenia also cause weight gain, which is a common cause of sleep apnea.
• Smoking: A 2019 review found that people with schizophrenia had the highest rates of smoking and dependence on nicotine. This is thought to be because smoking tobacco decreases the severity of some psychiatric symptoms.
• Being male: A 2012 study discussed how schizophrenia is more common in males than females and how the disease presents differently in each gender.
• Use of sedatives or tranquilizers: These medications aren’t typically used as a first-line treatment for schizophrenia, but a 2015 review suggests that some people with schizophrenia find them useful for some symptoms or other mental health conditions they may have.

There’s currently no treatment for both schizophrenia and sleep apnea. But there are ways to help manage both symptoms.

• Healthy lifestyle changes: Maintaining a healthy weight, getting regular exercise, limiting alcohol, and quitting smoking are some changes that may help manage symptoms of sleep apnea.
• Breathing device: Breathing devices such as CPAPs or BPAPs (bilevel positive airway pressure) are common treatments for sleep apnea. After 12 months of treatment with a CPAP, people with schizophrenia showed improvements in memory, attention, and concentration. A 2019 study found that treatment with CPAP resulted in increased mental status and fewer symptoms of psychosis overall.
• Switching medications: Some atypical antipsychotics used for schizophrenia can cause weight gain, which can increase your chance of sleep apnea.

If you have schizophrenia and are experiencing sleep problems such as sleep apnea, consider talking with a healthcare or mental health professional about your treatment options. They can work with you to determine the best treatment options for you and your symptoms.

Schizophrenia has been directly linked with sleep problems.

Many people living with schizophrenia report experiencing sleep difficulties such as sleep apnea. Others report that their sleep problems worsen their schizophrenia symptoms.

While there’s no existing treatment for both conditions, there are ways you can manage your symptoms. Adopting a healthy lifestyle, using a breathing device (such as a CPAP), and managing your schizophrenia medications are ways you can help.

If you live with schizophrenia and your sleep problems are interfering with your daily life, consider reaching out to a healthcare or mental health professional for support.