Lifting Depression with CPAP
Are you depressed, or do you just feel depressed because of untreated sleep apnea?
What does depression have to do with sleep apnea? A new research study suggests that if you have sleep apnea and you feel depressed, treatment of your apnea with CPAP (Continuous Positive Airway Pressure) might relieve the depression.
Although we don't know how apnea might cause symptoms of depression, or just how CPAP treatment can relieve those symptoms, we have long suspected there is a link. Writing with T. Scott Johnson, MD., we pointed out in Phantom of the Night (1994) that some of the symptoms of depression are commonly seen in people with sleep apnea, and that in many people, these symptoms resolve with CPAP treatment. We included depression as one of the symptoms of apnea in our quiz intended to help people identify apnea. And, based on personal experience and the clinical experience of pyschologists and physicians, I wrote about the importance of being aware that some of the symptoms of sleep apnea could be confused with those of depression; and the importance of having a mental health professional involved in diagnosing and treating apnea, as well as the benefits of CPAP for mood as well as fatigue.
Gila Lindsley, PhD, a psychologist with extensive experience in the diagnosis and treatment of sleep disorders, suggests that people with untreated apnea don't function well and thus experience stress, which in turn can cause a "reactive" depression. Treating the apnea can thus treat the apnea-induced depression.
But "knowing" something from observation or experience is not proving it--so it is good to find a scientific study that strongly supports the idea that CPAP therapy relieves the symptoms of depression--or more precisely, that people with depression and apnea are less depressed if they use CPAP to treat the apnea.
The authors of this new study, Daniel J Schwartz and Gillian Karatinos, are physicians at the Sleep Center at University Community Hospital in Tampa, Florida. They found that a large percentage of the patients coming to them for evaluation of possible apnea had been prescribed antidepressant medications, and many patients showed mild to severe depression on a standard screening test.
In order to see if treating the apnea might relieve the symptoms of depression, they studied a group of patients who had moderate to severe apnea and who responded well to CPAP therapy--the treatment worked for them. The authors evaluated depression using a standard questionnaire before treatment, several weeks after CPAP treatment began, and a year or so later. Only the patients who continued to use CPAP for several hours a night were included in the study results.
The evaluation of depression was based on patient responses to a standard questionnaire instrument, the Beck Depression Inventory (BDI). This test asks patients to score their responses to seven topics that correlate with depression. The topics include: feelings of sadness; pessimism about the future; being overly self-critical; feelings of failure; inability to feel pleasure; suicidal ideation. The patient's scores for each topic are added together for a global score on depression. Schwartz and Karatinos found that the depression scores were lowered for apnea patients treated with CPAP, both in the short term and over a year.
Schwartz and Karatinos are careful to note what is not known or proven. We really don't know if CPAP treatment causes the improvement in depression ratings; there is an association. We don't know if the measured symptoms are caused by "depression" or by sleep apnea. We don't know how apnea might cause the symptoms nor how the treatment might relieve them. But there is a measureable improvement in depression when the apnea is treated.
Take away: If people with symptoms of depression and who have sleep apnea use CPAP, they are likely to have a reduced level of depression. This is a good reason for people living with sleep apnea to use their CPAP treatment faithfully.
Depression can be a serious problem, whatever the cause, but it can be treated. Neither depression nor apnea should be ignored. If people living with apnea continue to feel depressed despite CPAP treatment, they should have their apnea treatment checked and consult a mental health professional.
References
Schwartz, DJ; Karatinos G. "For individuals with obstructive sleep apnea, institution of cpap therapy is associated with an amelioration of symptoms of depression which is sustained long term." Journal of Clinical Sleep Medicine, Vol.3, No 6, 2007.
Jerry Halberstadt, Sleep apnea can cause depression (1994)
http://www.healthyresources.com/sleep/apnea/articles/depress.html
Quiz to identify sleep apnea syndrome
http://www.healthyresources.com/sleep/apnea/phantom/orders/quiz.html
T. Scott Johnson MD, William Broughton, MD, and Jerry Halberstadt; with contributions by B. Gail Demko, D.M.D. Sleep Apnea--the Phantom of the Night 2003 http://www.healthyresources.com/sleep/apnea/phantom/
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Comments
sleep apnoea
Hi all my name is Dave.I have recently been diagnosed with severe sleep apnoea (I stop breathing btween 80-100 times per hour) the CPAP machine is driving me to suicide. Having just read the blog I hope that there is light at the end of the tunnel. Can anyone tell me if theres a cure!
There is help!
Dave, your short note raises a number of possibilities. Are you depressed? Do you truly have obstructive sleep apnea, and if so is the treatment effective? Are you just very frustrated with the CPAP and mask? There are ways to deal with each of these. Both depression and sleep apnea can be treated and managed effectively. Apnea is a chronic condition and while it may not be "cured" it can be managed so as to eliminate the symptoms. Because apnea can have such drastic effects on us if it is not treated, we need to balance the slight discomfort and nuisance of the CPAP against the many benefits of treatment.
If you are truly considering suicide, consult with a mental health professional at once. Do not delay. You can be helped.
If you are not feeling relief for your apnea symptoms, and/or the CPAP treatment is bothersome and a nuisance, again there are ways to manage. There are many issues that can come up with diagnosis and treatment, and we have tried to cover them in some detail in the book, Sleep Apnea--the Phantom of the Night. Many of the problems are trivial to fix, the book will help you engage in a dialog with your sleep specialist to find a way to assure that your treatment works for you.
There are some problems which are a bit dfficult to manage; these include open mouth during sleep, which is discussed in the book, and so-called "complex sleep apnea." Some people open their mouth during sleep (this is not under voluntary control but the result of muscle relaxation during sleep) and this may allow some of the air pressure to blow off, lessening the control of apnea. Perhaps a full face mask would help. Complex sleep apnea is a newly discovered problem that may only emerge when CPAP is used. Carbon dioxide or CO2 levels are used by the body to help regulate breathing. The increased ventilation from CPAP carries off too much CO2, leading to an imbalance in CO2--there is so little that the body slows or stops breathing, causing "central" apneas. Your sleep specialist should be consulted to see if either of these problems is affecting you and for an appropriate treatment. Look for a detailed report on complex sleep apnea in the newsletter, in the near future.
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