It goes without saying that patients who are not sleeping well often become depressed. No one wants to spend their nights looking at the ceiling, or tossing and turning, trying to find a comfortable position in which to sleep. Patients with sleep apnea often experience depression related to both their symptoms and the severity of their disease. Control of apnea not only leads to improvement in physical health but can improve depression according to a new report.
Obstructive sleep apnea (OSA) leads to frequent arousals, which are characterized by fragmented sleep. Persistent sleep loss can lead to depressive symptoms. Patients may be treated for depression, but if the underlying symptoms are caused by OSA and the apnea is not treated, depressive symptoms can remain. We may be treating someone with antidepressants when what we really should be doing is treating their sleep disorder, which could in turn restore their normal mood.
Patients in an Australian sleep study1 were screened for depression using the Public Health Questionnaire (PHQ-9). This questionnaire is used by primary care providers to screen for depression and used to monitor treatment. Patients were then given a polysomnogram to evaluate for OSA. Once they were compliant on CPAP, they were screened again for improvement in their depression.
Before CPAP use, over 18% of the patients had stated on their questionnaire that they thought they would be better off dead or had thoughts of harming themselves. After treatment, none responded this way. Depressive symptoms were directly correlated with severity of apnea; those with more severe apnea saw the greater change in their depressive symptoms.
Depression is as prevalent in our society as OSA. Many depression sufferers do not respond to treatment, but perhaps the reason is due to the underlying problem of an untreated sleep disorder. Consider screening your patients that have depression for OSA or other sleep disorders, especially if they have sleep complaints.
Sharon M. O’Brien, MPAS, PA-C, is a practicing physician assistant and health coach in Asheville, NC.
- Edwards C, Mukherjee S, Simpson L, et al. Depressive symptoms before and after treatment of obstructive sleep apnea in men and women. J Clin Sleep Med. 2015;11(9):1029-1038; doi: 10.5664/jcsm.5020