Sleep apnea is a common sleep disorder in which breathing periodically stops and restarts during sleep. It has also been linked to mood disorders, especially depression. People with sleep apnea are almost twice as likely to also have bipolar disorder than the general population. Sleep apnea and bipolar disorder can be tied together in how mood is affected.
There are three kinds of sleep apnea.
-Obstructive sleep apnea is caused by an obstructed airway. The tongue collapses against the soft palate, which collapses against the back of the throat, blocking off the airway. This can happen 5 to 30 times per hour.
-Central sleep apnea is caused by the brain failing to properly signal the muscles that control breathing.
-Complex sleep apnea is a combination of the two.
Physical symptoms of sleep apnea include:
- Loud snoring
- Witnessed pauses in breathing
- Gasping for air during sleep
- Shortness of breath on waking
- Restless sleep
- Dry mouth
- Morning headaches
- Daytime sleepiness
Sleep apnea can also affect mood in several areas:
- Problems with executive function
- Poor concentration
- Impaired vigilance
Each of these can complicate or exacerbate symptoms of mood disorders. Each of the symptoms of sleep apnea affecting mood are also symptoms of bipolar disorder. This can complicate treatment. If sleep apnea is undiagnosed in a patient with bipolar disorder, it could explain why symptoms are not getting better despite treatment. Likewise, someone with sleep apnea might not receive an accurate diagnosis of bipolar disorder.
It has been estimated that up to 50% of individuals with bipolar I disorder are at a higher risk for sleep apnea. Obstructive sleep apnea is the most common form of sleep apnea found in people with bipolar disorder.
Many people with bipolar disorder have multiple risk factors for developing obstructive sleep apnea. These include:
- Excess weight- people with bipolar disorder experience obesity at a higher rate than the general population.
- Use of alcohol- more than half of people with bipolar disorder also have substance use problems.
- Smoking- people who smoke are three times more likely to experience sleep apnea than those who don’t. Smoking is also common in people with bipolar disorder
- Medications that cause problems with weight gain, decreased arousability during sleep and upper airway muscle dysfunction
Additional risk factors for developing obstructive sleep apnea include:
- Larger neck circumference
- Naturally narrowed throat including enlarged tonsils
- Being male
- Family history of sleep apnea
- Nasal congestion
If you or a loved one are concerned that you might have sleep apnea, you should contact your doctor immediately. There are treatments available. Make sure you mention all medical problems including bipolar disorder as well as any medications you may be taking.
Image credit: Bill Bates