PTSD and Sleep Apnea

Most sleep disturbances result from obstructive sleep apnea and posttraumatic stress disorder. While things like anxiety and hyperarousal can make it difficult to fall asleep, sound sensitivity can cause sleep disturbances. Sleep disorders usually start to creep in if you're suffering from traumatic memories due to a traumatic event.

Traumatic events experienced by war veterans and even sexual assault survivors typically come with depression. Sleeping a lot or longer than usual is one of the sure signs of sleep disorders you'll notice in these people. Since PTSD is a common mental health condition among veterans, some research studies suggest that handling sleep apnea through CPAP treatment (continuous positive airway pressure) can significantly help reduce anxiety disorders, nightmares, and other PTSD symptoms. However, for this to be successful, consistent treatment is a necessity. 

A study by the Journal of Clinical Sleep Medicine found the symptoms of post traumatic stress disorder and obstructive sleep apnea rampant among young veterans. From these deductions, it's pretty clear there's a link between PTSD and the sleep disorder; sleep apnea. Disturbed sleep and general sleep problems may cause irregular sleep patterns due to the relationship between these two conditions. So, how do they relate to one another? Read on to find out.

What are these Two Conditions

Aside from war and sexual assault, physical abuse, natural disaster, and other events are also major PTSD triggers. Because of the horrid images, flashbacks, and nightmares such events come along with, the victims are more likely to develop mental disorders like sleep apnea. So, to get a broader understanding of how these two conditions correlate, it's imperative to understand what they are.

What is Post Traumatic Stress Disorder PTSD

As already mentioned, posttraumatic stress disorder is a mental disorder common among those who've experienced traumatic events like violence. According to the National institute of mental health, about 7% of the US population is affected by PTSD.

The onset of PTSD is usually around the first six months or even as early as immediately after the traumatic event. More importantly, it doesn't necessarily mean you'll experience PTSD after going through some trauma. However, most people in this category display traumatic symptoms for a while. 

Such occurrences are normal reactions to the traumatic event a person has experienced. On the other hand, some individuals gradually recover and come to terms with whatever has happened. Proper therapy and medication like central nervous system depressants can help improve symptoms associated with PTSD within a few .

Though there's more researchrequired in this area of mental health, emerging studies by the NHS indicate an estimate of 1 PTSD-affected person in every three individuals with a traumatic experience. Unfortunately, it isn't clear why some develop PTSD while others don't.

Signs and Symptoms of PTSD

As one of the major psychiatric disorders, PTSD has a wider array of symptoms, making it relatively noticeable. People with PTSD may experience the following; 

  • Difficulties avoiding reminders and flashbacks about certain traumatic events. This is typically through people, thoughts, places, and feelings. Other triggers include situations or activities similar to the event. In such a situation, they may feel detached, numb, or even empty.

  • Re-living the traumatic experience. Through flashbacks, vivid nightmares, or memories, they may be reliving the traumatic event repeatedly, which may make them intensely emotional or even react physically. PTSD patients hit with reliving a traumatic event tend to experience; Heart palpitations, sweating, panic attacks, and anxiety.

  • People with PTSD tend to be overly alert. The alertness may affect their overall sleep health due to irritability and sleep difficulty. Also, these people may constantly be on the lookout for danger and have a reduced concentration span.

  • Having mood changes—characterized by mood disorders—and negative thoughts. The negative thoughts usually make them feel numb, angry, and guilty or have perceptions that "the world isn't safe" or "they are bad."

Note that a certified medical practitioner can only diagnose PTSD if the patient displays signs and Symptoms in the four areas mentioned above. Also, the affected person must have experienced the symptoms for at least a month. 

Another reason for the diagnosis is if the affected person is experiencing difficulties carrying out their day-to-day work, relationship, and even study. Dissociative experiences are also frequent among these people. For instance, they may give descriptions like "it felt as if I wasn't there" and " time stood still, and everything just calmed down."

What is Sleep Apnea

Most individuals suffering from sleep apnea usually have obstructive sleep apnea OSA. OSA lies among major sleep disorders affecting veterans. And it primarily occurs when the affected person stops breathing because of upper airway blockage in the nasal cavity. That's why it's commonly identified as sleep disordered breathing. Snoring is a major sign indicating that you have OSA.

Sleep Apnea Treatment

The good news is there are treatments for OSA. Generally, there are three treatment options to choose from. One of them is thrusting your jaw forward with a mouthpiece known as a mandibular repositioning device when you sleep. 

Another option is using a special machine to keep your nasal airway open as you sleep. The treatment process is commonly known as CPAP therapy, plus it's the primary recommended treatment for OSA. Unfortunately, several studies point out PTSD patients have lower positive airway pressure adherence. Because of lower CPAP adherence, PTSD patients require some assistance when initiating the treatment process. It may include optimizing compliance with advanced device modes like bilevel therapy and proper mask selection.

Surgery is also another option depending on the severity of your condition. OSA Surgical procedure can help stiffen or shrink obstructing tissues, enlarge the tonsils or remove excess cell tissues. In cases of mild to moderate symptoms severity, then the mouthpiece should suffice. Aside from surgery, other options are allergy treatment and weight loss. The main goal of these surgical procedures and methods of treating sleep apnea is to widen the nasal airway.

Risk Factors of Sleep Apnea

Though anyone can develop OSA, some factors can put you at high risk, as follows;

  • People with active smoking status are more likely to develop OSA than non-smokers

  • Larger tonsils

  • Family history may also be a determining factor, especially if the members experience obstructive sleep apnea.

  • Sex. After menopause, there is an increased chance for women to develop OSA. Men, on the other hand, are thrice as likely as premenopausal ladies to develop OSA. 

  • Advanced age. As you age, the chances of developing OSA also increase. And at the age of 60s and 70s, it appears to level off.

  • Diabetes may also increase the possibility of developing OSA.

  • Obesity

Signs and Symptoms of Obstructive Sleep Apnea OSA

Like PTSD, sleep apnea warning signs are many and can help you determine whether or not you're a victim of the condition. 

Since OSA is known to limit oxygen flow to the brain, it may result in poor sleep health. That's why many people often complain of daytime sleepiness. Also, due to a lack of proper oxygen flow to the body, you may experience a lack of clarity upon waking up in the morning or daytime drowsiness. People with sleep partners who have OSA may notice the following; 

  • Snorting
  • Gasping
  • Loud snoring
  • Chocking
  • Interrupted breathing while sleeping

Your doctor can detect some of the symptoms during health maintenance routine screening. Other symptoms OSA patients may experience include; 

  • Forgetfulness and memory gaps
  • Morning headaches
  • Drowsiness
  • Intensifying depression
  • Children may experience hyperactivity
  • Poor performance at your job or school
  • Loss of sexual interest
  • Feelings of irritability
  • Constantly waking up at night

Untreated OSA may cause you trouble sleeping which can potentially affect your sleep health negatively. More importantly, if you're a driver, you should seek immediate medical attention when you suspect you have OSA. This is because many fatal car crashes result from obstructive sleep apnea.

How PTSD and Sleep Apnea Relate

Patients with posttraumatic stress disorder and obstructive sleep apnea packaged in one bundle tend to experience severe PTSD symptoms. Notably, this usually arises from the sleep disorder sleep apnea. In fact, according to the sleep foundation, Around 12%-90% of people with post traumatic stress disorder experience sleep apnea. In a different study, approximately 70% of Vietnam war veterans with PTSD had sleep apnea. 

As previously mentioned, war veterans are the more affected population. An article in the journal of clinical sleep medicine shows that individuals with PTSD are more likely to develop sleep apnea. 

Since the severity of the link between these two has been established, more research indicates that PTSD symptom severity can intensify sleep apnea. The reason behind this is multiple factors aggravating PTSD can equally amplify sleep apnea. Some signs include insomnia, daytime sleepiness, and prolonged sleep deprivation. Other common symptoms of sleep apnea and PTSD are; 

  • Increase suicidal thoughts and risks
  • High risk of dying early
  • Severe depression
  • Poor sleep quality and overall lifestyle

Unfortunately, though there's a link between these two conditions, the mechanism connecting the two isn't known yet. According to some theories, it may be likely due to complex interplay shared with neuroendocrine pathways and sleep fragmentation. 

Note that during rem (rapid eye movement), sleep is when sleep apnea is usually at its worse. Also, during REM sleep, the muscles remain paralyzed to prevent the affected person from enacting vivid dreams. This kind of paralysis may exacerbate sleep apnea's risk factors by also restricting nasal airway muscles. The undeniable truth is that the complex relationship between these two conditions requires more research. But effective sleep apnea treatment may assist in alleviating PTSD symptoms.

Symptoms Complications Between Obstructive Sleep Apnea and PTSD

Considering how they relate, there are instances where one condition may seem to aggravate the symptoms of the other. Based on emerging scientific research, sleep apnea may spell doom to your normal rem sleep. 

If you have post-traumatic stress disorder, it can make the PTSD symptoms much worse. Signs include; intensified nightmares and chronic stress, among others. According to some theories, there's a high possibility of waking up in mild obstructive events. Increased chances of hypervigilance of PTSD mainly fuel this. Usually, the consequences are sleep interruption and sleep fragmentation. 

Surprisingly, sleep apnea effects on PTSD may be far-reaching to the level of suicidal ideation. A jcsm 2018 study observed a direct relation between OSA symptoms and heightened suicidal ideation, primarily in PTSD patients. Such discoveries have led to the creation of the National Suicide Prevention Lifeline number; 988. This is to help PTSD patients from enacting their suicidal thoughts.

Secondary Service and Sleep Apnea and PTSD

Due to the increased PTSD cases and sleep apnea symptoms among military veterans, the US government has established multiple programs to run their civilian veterans affairs. For instance, to help those with mental health problems like combat related PTSD through therapy. 

Another standout program is the VA disability program. Both young and elderly war veterans are entitled to these benefits as long as they are suffering from the mentioned conditions. As a veteran, you must demonstrate the following to establish a direct service connection;

  • Injury, illness, and, or an in-service event
  • If you have an existing diagnosed condition.
  • If your diagnosed condition shares a link with the in-service

Generally, if the VA is satisfied that the conditions mentioned above are met, then PTSD and sleep apnea are automatically granted service connection. Another service connection path veterans may opt for as a viable alternative is the secondary Service connection.

A secondary Service connection usually results from an already established service-connected condition. Plus, there must be a link between a veteran's service-connected disability and medical nexus opinion. Overall, veterans can establish secondary service connections if they develop sleep apnea if, initially, they have PTSD.

Final Thoughts

If sleep apnea goes untreated, it may impact your sleep negatively. Some people with PTSD may experience amplified sleep fragmentation commonly identified by frequent awakenings, increased cortisol release, and nightmares. Treatment-wise, sleep apnea and PTSD require different approaches. 

If you suffer from the two, you should see your doctor or therapist to devise the best treatment plan. However, it'll take time to try multiple strategies before arriving at the right treatment plan. Notably, sticking to a particularly effective treatment plan of your choice long-term can yield profound positive results.

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