People with sleep apnea often experience depression. Some studies say that perhaps two-thirds of people with sleep apnea have symptoms of depression. One study found that 14% of people with depression had undiagnosed sleep apnea, even after excluding all those deemed high risk for sleep apnea. The question is: can treating sleep apnea help people who have depression?
Science says that, yes, treating sleep apnea generally leads to good results for people with depression.
However, as in all studies with CPAP, adherence remains a significant factor. Several studies that noted no improvement in depression with CPAP didn’t actually monitor CPAP use. It is likely that CPAP non-adherence diminished the apparent effectiveness of the treatment, making it seem as if the treatment was not effective.
CPAP Adherence Matters
When studies look at the impact of CPAP and pay attention to adherence, they find that adherence makes a big difference. A 2021 study shows just how big that difference can be.
This study looked at 108 people with sleep apnea and depression, and anxiety.
Overall, the study showed a decrease in depression with CPAP treatment. However, people with high CPAP compliance (an average of more than four hours a night) saw their depression decreased by 13%. However, those with low CPAP compliance saw their depression increase by 4%. This was not a statistically significant increase, but enough to show that CPAP doesn’t help depression unless used for most of the night.
Can Oral Appliance Therapy Help?
The next question is whether oral appliances can help reduce depression symptoms. If they can, they will be a viable alternative when people can’t adapt to CPAP or don’t like it. This could be quite a few people. One study found that, even though CPAP was effective at improving mood and quality of life, only 41% of people preferred it over no treatment.
Science also supports the effectiveness of oral appliances.
One 2014 review showed that both CPAP and oral appliances provided significant relief of sleep apnea symptoms, including depression. Participants used CPAP for most studies, 19, which partly contributed to the wide disparity in results among CPAP treatments experiments. Oral appliances were used in 5 studies (two used both) and were more uniform in their results. Studies ranged from a mere 23 participants to a rather large 391 participants and in length from 1 week to 24 weeks.
A 2017 review followed these results but included more studies. In this review, researchers looked specifically at studies using the 36-item short-form health survey (SF-36), which evaluated psychological and physical components of quality of life. This review showed that both treatment options improved both aspects of quality of life. There was more improvement in the psychological components for oral appliance therapy than in the physical component of quality of life. However, researchers concluded that there was no significant difference between the treatments regarding their overall effectiveness for improving quality of life.
Therefore, people who find they can’t or don’t want to adapt to CPAP will likely get good results with oral appliance therapy.
Is Sleep Apnea behind Your Depression?
Many people who suspect or have been diagnosed with depression likely have sleep apnea as the primary or contributing cause. Many common symptoms of depression, such as daytime sleepiness, lack of energy, and loss of interest, are associated with sleep apnea. As a result, people who have been diagnosed with depression should talk to their doctor about sleep apnea and consider a sleep test to determine whether it’s a factor.
It’s imperative for people to talk to their doctor if their current depression treatment is not working for them. Although many of these studies have limitations (such as short duration or small sample size), science supports the effectiveness of sleep apnea treatment for improving depression symptoms.
At the Advanced Dental Sleep Treatment Center, we focus on matching people with the proper sleep apnea treatment for them. We can get you a sleep test if you haven’t been diagnosed with sleep apnea. We can then help you consider treatment options and decide whether CPAP or oral appliance therapy will likely yield better results for you.
If you think sleep apnea may be contributing to your depression, please call (402) 493-4175 for an appointment with an Omaha sleep dentist to talk about treatment options.