How Does Central Sleep Apnea Affect Mental Health?

woman yawning in bed

Peter Dazeley / Getty Images

Sleep plays a critical role in our brain function and mental health. When your sleep is disrupted, whether it be from a crying child, a thunderstorm, alcohol use, or a medical condition, you are bound to feel negative effects. Poor sleep can lead to exhaustion, low energy, and poor lifestyle choices. It can also be a contributing factor to the development of a mental health or substance use disorder.

The correlation between sleep and mental health is even more prevalent in people with chronic sleep conditions, especially people with sleep apnea who face an increased risk of experiencing anxiety, depression, and serious psychological distress, among other mental health conditions.

While sleep apnea is common, with an estimated 22 million Americans suffering from it, central sleep apnea is quite rare.

Learn how central sleep apnea occurs, why it’s so closely tied to mental health, and how to build a treatment plan for a comorbid sleep and mental health disorder.

The Cause of Central Sleep Apnea

In central sleep apnea, the brain stops sending signals to the respiratory muscles, causing air flow to temporarily stop. This can last for ten seconds or longer and is often caused by health conditions such as congestive heart failure, obesity, and stroke. In patients with heart failure, central sleep apnea is highly prevalent and can promote disease progression and increase the risk of mortality.

Central sleep apnea can also be caused by medications like morphine, oxycodone, or codeine. It’s common in patients who take opioids for pain management. In a study of 560 chronic opioid users, the prevalence of central sleep apnea was 24%.

The condition also occurs in high-altitude settings. When you rise above 2,000 m, you become more susceptible to the condition and if you rise above 5,000 m you are likely going to experience central sleep apnea. Increasing your cerebral blood flow in this instance could help reduce the severity of central sleep apnea.

How Central Sleep Apnea Affects Sleep Quality

“In central sleep apnea, there is no obstruction. The brain simply does not initiate the breath,” says Alex Dimitriu, MD, founder of Menlo Park Psychiatry & Sleep Medicine. “The body essentially feels choked during such episodes, and it wakes up to reopen the airway. Oftentimes, people do not remember these small awakenings, or they just wake up, roll over, and fall back to sleep.”

You Wake Up Frequently During the Night

Even if you follow all the recommended steps to get a good night’s rest, you may still wake up feeling exhausted due to these frequent disruptions and this can have a negative impact on your day—and your mental health. Insufficient sleep, which can be caused by sleep disruptions, is tied to a number of different mental health concerns and can lead to risk-taking behavior, deficiencies in reasoning, irritability, negative moods, deterioration in decision-making, as well as anxiety, and depression.

Daytime Sleepiness

People with central sleep apnea may experience symptoms such as excessive daytime sleepiness, morning headaches, non-restorative sleep, difficulty concentrating, or mood changes. You may not know you have sleep apnea, but if you wake up from a full night’s sleep feeling unrested on a regular basis then chances are you’re battling a chronic sleep condition—and it’s important to let your doctor know so you can address the underlying problem before it hinders your overall health and well-being.

Because sleep apnea occurs while you’re sleeping, sufferers don’t often recognize the symptoms, but their sleep partners might.

If you or your partner suspect that you’re experiencing sleep apnea in any form, you’ll want to get a sleep study performed. Undiagnosed sleep apnea can cause serious and potentially fatal consequences.

The Association Between Sleep Apnea and Mental Illness

Sleep apnea is closely tied to psychiatric pathology. Among patients with psychiatric disorders, the risk for sleep apnea is high—often because psychotropic medications can have sedating side effects.

Among those diagnosed with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD), there’s an increased prevalence of obstructive sleep apnea (OSA). There’s also a higher prevalence of psychiatric comorbid disorders in veteran populations with sleep apnea. 

Alex Dimitriu, MD

Sleep disturbance is common in many psych conditions, but it’s unclear whether the disturbed sleep is the outcome or cause of many mental health issues.

— Alex Dimitriu, MD

Though the most common form of sleep apnea seen in those with mental illness is obstructive sleep apnea, central sleep apnea disorders can also occur simultaneously. Insomnia and sleep-related breathing disorders (SRBDs), such as central sleep apnea, are often seen in patients with substance use disorders, for instance. If the sleep condition is caused by the opioid drug, then central sleep apnea can be reversed upon discontinuation of the medication.

Suicidal thoughts and behaviors are also associated with sleep disturbances, especially in populations suffering from comorbid mental health disorders.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

How to Treat Central Sleep Apnea

If you want to improve your nighttime breathing, Dr. Dimitriu suggests avoiding alcohol, maintaining a healthy weight, and managing your allergies, if you have them. 

You can also try sleeping on your side or using breathing strips, but depending on the severity of your condition, you may need professional treatment, which is why it’s important to visit your doctor. For a central sleep apnea diagnosis, you may be referred to an ear, throat, or nose doctor, as well as a cardiologist.

Unlike obstructive sleep apnea, central sleep apnea isn’t caused by an upper airway obstruction; it’s caused by a neurological issue. The brain, for whatever reason, is failing to send signals to the body and this can be dangerous and deadly.

Some of the most common treatments for central sleep apnea include:

  • Continuous positive airway pressure (CPAP) therapy
  • Adaptive servo-ventilation (ASV) device
  • Bilevel positive airway pressure (BPAP) device
  • Medication such as acetazolamide or theophylline
  • Remedē system, which is implanted under the skin and helps regulate breathing

Opioids predispose you to central sleep apnea, so if you’re on chronic opioid therapy and experiencing central sleep apnea or another form of sleep-disordered breathing, you may need to consider alternative medication or work with your doctor to treat the sleep disorder. 

A Word From Verywell

“Sleep is the most essential restorative activity for the brain. It helps store memories, process emotions, and try creative new ideas,” says Dr. Dimitriu. “Sleep helps maintain our moods, energy level and motivation, and it improves impulse control, which can help lower anxiety.”

If you’re not sleeping well or feeling tired throughout your day, you’ll want to consult with your doctor. Simple lifestyle changes may help, but if you’re suffering from a sleep disorder then you’ll need a medical treatment plan

In addition to working with a medical doctor to treat your sleep disorder, you’ll want to work with a mental health professional to address your mental health issues. Treatment for your sleep disorder may improve your mood and mental health, but it won’t help treat any underlying mental health conditions.

15 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kaufmann CN, Susukida R, Depp CA. Sleep apnea, psychopathology, and mental health careSleep Health. 2017;3(4):244-249.

  2. American Sleep Apnea Association. Sleep Apnea Information for Clinicians.

  3. Garcia-Touchard A, Somers VK, Olson LJ, Caples SM. Central sleep apneaChest. 2008;133(6):1495-1504.

  4. Javaheri S, Patel S. Opioids cause central and complex sleep apnea in humans and reversal with discontinuation: a plea for detoxificationJ Clin Sleep Med. 2017;13(6):829-833.

  5. Correa D, Farney RJ, Chung F, Prasad A, Lam D, Wong J. Chronic opioid use and central sleep apnea: a review of the prevalence, mechanisms, and perioperative considerationsAnesth Analg. 2015;120(6):1273-1285.

  6. Burgess KR, Lucas SJE, Burgess KME, et al. Increasing cerebral blood flow reduces the severity of central sleep apnea at high altitudeJ Appl Physiol (1985). 2018;124(5):1341-1348.

  7. Chattu VK, Manzar MdD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The global problem of insufficient sleep and its serious public health implicationsHealthcare (Basel). 2018;7(1):1.

  8. Braitman DV. Screening for sleep apnea in psychiatryAmerican Journal of Psychiatry Residents’ Journal. 2018;13(5):5-7.

  9. Gupta Madhulika A., Simpson Fiona C. Obstructive sleep apnea and psychiatric disorders: a systematic reviewJournal of Clinical Sleep Medicine. 11(02):165-175.

  10. Sharafkhaneh A, Giray N, Richardson P, Young T, Hirshkowitz M. Association of psychiatric disorders and sleep apnea in a large cohortSleep. 2005;28(11):1405-1411.

  11. Chakravorty S, Vandrey R, He S, Stein MD. Sleep management among patients with substance use disordersMed Clin North Am. 2018;102(4):733-743.

  12. Sleep, suicide behaviors, and the protective role of sleep medicineSleep Medicine. 2020;66:264-270.

  13. Aurora RN, Chowdhuri S, Ramar K, et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analysesSleep. 2012;35(1):17-40.

  14. FDA. Remedē® system – p160039.

  15. Van Ryswyk E, Antic NA. Opioids and sleep-disordered breathingChest. 2016;150(4):934-944.

By Sarah Sheppard
Sarah Sheppard is a writer, editor, ghostwriter, writing instructor, and advocate for mental health, women's issues, and more.