Sleep Apnea and Low Mood: How Treatment May Lift Depression Symptoms

Treating sleep apnea may ease depression symptoms for some people. Pooled results from many randomized trials (fair tests where chance decides who gets the treatment) show that CPAP leads to a small but real improvement in low mood. The benefit is larger for people who start out with more depression symptoms and for those who use CPAP more than four hours a night.¹²³ Sleep apnea treatment can support depression care, but it does not replace it.

How are sleep apnea and depression connected?

Obstructive sleep apnea (OSA) is a condition in which the airway in the throat narrows or closes many times during sleep. Each pause in breathing briefly disturbs sleep. People with sleep apnea are more likely than others to have depression.¹

Some signs of the two conditions also look alike: tiredness, low energy, poor focus, irritability, and losing interest in things. This overlap matters. A person treated only for depression may still feel worn down if untreated sleep apnea keeps breaking up their sleep. A person treated only for sleep apnea may still need help for depression.

Does CPAP help depression?

CPAP (continuous positive airway pressure) is the most common treatment for sleep apnea. A small bedside machine gently blows air through a mask to keep the airway open during sleep. Several research reviews have looked at whether CPAP improves mood:

• 2023 review — Across 17 randomized trials with 1,931 people (nearly 2,000), CPAP improved depression symptoms compared with control treatments. The effect was small, and results were similar from trial to trial.¹
• 2020 review — A review of 9 randomized trials with 1,052 people also found that CPAP improved depression symptoms.³
• 2019 analysis — An analysis of 20 randomized trials with 4,255 people confirmed a modest benefit.⁴

In plain terms, on average, CPAP may lift mood a little. For some people, though, the change can be bigger.

Who is most likely to feel better?

• People with more depression symptoms to start with — A 2014 review found CPAP helped far more in the two trials of people who already had depression than in trials of people who did not.² The large SAVE trial found the same pattern. The benefit was greater in people who already had depression symptoms.⁴
• People who use CPAP most of the night — When people used CPAP more than four hours a night, their mood improved more clearly.³ Like any treatment, CPAP can only help when it is used.

What did the SAVE trial show?

The SAVE trial enrolled 2,410 adults who had moderate to severe sleep apnea and heart or blood vessel disease. They were randomly assigned to CPAP plus usual care or to usual care alone, and followed for almost four years.

People using CPAP had about 20% lower odds of having significant depression symptoms. This benefit did not seem to come only from feeling less sleepy.⁴ CPAP did not reduce anxiety symptoms in this trial or in the related review.⁴

Can an oral appliance help mood?

An oral appliance (also called a mandibular advancement device) is a custom mouthpiece that holds the lower jaw forward during sleep. The research on mood is mixed. A 2014 review found a small improvement in depression symptoms with these devices.² A larger 2023 review found no clear effect.¹

Oral appliances are still a useful sleep apnea treatment for some people. But the evidence for a mood benefit is less certain than for CPAP.

Can treating sleep apnea replace depression treatment?

No. Researchers have said that CPAP and oral appliances may be useful parts of care for people with both sleep apnea and depression. How they compare with standard depression treatments, such as therapy or medicine, is not known.²

Keep working with your primary care doctor, therapist, or psychiatrist. Treating sleep apnea is one more tool, not a substitute.

When should you get a sleep evaluation?

Consider asking about a sleep evaluation if you have low mood or depression and you also:

• Snore or gasp — You snore loudly, or someone has seen you stop breathing or gasp in your sleep.
• Wake up tired — You wake up unrefreshed or with headaches.
• Feel sleepy by day — You feel sleepy during the day despite enough time in bed.
• Still feel low — Your depression symptoms have not improved as much as hoped with treatment.

At Universal Sleep Solutions we offer home and in-lab sleep testing to find out whether sleep apnea is part of the picture. If it is, we set up CPAP or BiPAP and follow up to help you get comfortable and use it most nights. If CPAP does not work for you, we can refer you for an oral appliance or evaluate you for Inspire. We also offer cognitive behavioral therapy for insomnia (CBT-I) for people who struggle to fall or stay asleep.

If you ever have thoughts of harming yourself, seek help right away. In the U.S., you can call or text 988 to reach the Suicide and Crisis Lifeline, or call 911.