upset man holding his hand in his hands leaning against a wallSince the Quarantine started, many people are feeling the effects of isolation, both physically and mentally.
While it has been proven that people with Obstructive Sleep Apnea have higher rates of depression, little is known about rates of OSA in patients with a major depressive disorder.  When someone is depressed, having suicidal thoughts, or their depression treatment just isn’t working, physicians may want to consider a sleep study.  (Maybe use at-home sleep test for right now because of COVID?)
Many symptoms of depression and OSA overlap, causing an under-diagnosis of both issues.  OSA patients can present with major depressive symptoms, but it is highly recommended that the physician should determine the underlying cause of depression, rather than just diagnosing the patient as depressed.  Both Depression and OSA are rapidly growing problems.   Patients with OSA present with sleep problems, anxiety, and depressive symptoms.  Depressive patients can also present with the same symptoms.

Typically, a patient who is diagnosed with depression will start on a series of different medications to see which one is the best fit for their body chemistry.  If the patient does not improve after antidepressant therapy, they should be screened for OSA to rule it out.
One option to rule it out would be presenting patients with a questionnaire as a starting point, similar to the screenings that I do with my TMD and OSA patients in my office.
Examples of questions may include any of the following:

  • Have you lost interest in activities that you normally enjoy?
  • Do you feel hopeless?
  • Are you constantly tired/fatigued?
  • Do you have trouble sleeping? Staying asleep and falling asleep?
  • Are you having trouble focusing or concentrating?
  • Do small tasks seem unmanageable?
  • Is your appetite affected? Are you eating more or less?
  • Do you feel nervous or anxious?
  • Have you thought about hurting yourself?

Depression and OSA have major associated comorbidities, and therefore patients should be tested for both.  We cannot ignore other possibilities such as Endocrine malfunctions, Hypothyroidism, Coronary artery disease or cancer, or even reactions to medications, but for the sake of this article, we want to make sure to integrate treatment for OSA if the treatment for depression is not showing signs of improvement.
Once the quarantine started, people all over the world have experienced something that they probably thought they never would.  Being in quarantine is not an easy situation to handle.  Our bodies and minds are used to social interaction, and with that being removed for our daily lives, many people are finding that they cannot function as they normally would.

Exercise, healthy eating habits, and sufficient sleep are the 3 most important things that people can maintain during the quarantine.  This may be easier said than done, as many of us rely on establishments like gyms for exercise.  Some of us don’t cook, and suddenly we had to fend for ourselves.  It’s not always easy to make changes to your daily routine (especially the older we get) so this has certainly been a challenging time for all of us.
If you are feeling like you may have depression, take a moment to think about when it started.  In addition, if any of the below symptoms apply to you, a sleep study may be what you need instead of antidepressants.

Should your sleep study show signs of OSA, there are several different treatment options.  The first thing that the doctor will usually tell you is to lose weight, but that may not always apply.  Some patients may already have a low BMI.   While CPAP therapy has long been considered the “gold standard”, many patients benefit from treatment with an intraoral appliance which is customized and fitted to each individual patient, and then adjusted on a periodic basis throughout the duration of the treatment plan.
For more information on OSA, or if you think you are a candidate for a sleep study, please view our website for more information.

  1. McCall WV, Benca RM, Rumble ME, Case DP, Rosenquist PB, Krystal AD. Prevalence of obstructive sleep apnea in suicidal patients with major depressive disorder.Journal of Psychiatric Research, 2019; 116: 147. doi:10.1016/j.jpsychires.2019.06.015
  1. Medical College of Georgia at Augusta University. (2019, July 23). Obstructive sleep apnea may be one reason depression treatment doesn’t work. ScienceDaily. Retrieved May 21, 2020 from 
  1. Jehan S, Auguste E, Pandi-Perumal SR, et al. Depression, Obstructive Sleep Apnea and Psychosocial Health. Sleep Med Disord. 2017;1(3):00012.
  1. McCall WV, Harding D, O’Donovan C. Correlates of depressive symptoms in patients with obstructive sleep apnea. J Clin Sleep Med. 2006;2(4):424‐426.
  1. Harris M, Glozier N, Ratnavadivel R, Grunstein RR. Obstructive sleep apnea and depression. Sleep Med Rev. 2009;13(6):437‐444. doi:10.1016/j.smrv.2009.04.001
  1. Stubbs B, Vancampfort D, Veronese N, et al. The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia: A systematic review and meta-analysis. J Affect Disord. 2016;197:259‐267. doi:10.1016/j.jad.2016.02.060
  1. Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263‐276.