Category Archives: Neurological Disorders

The PTSD and Sleep Apnea Connection

Several recent studies have shown a very high incidence of sleep apnea in anxiety disorders.  These include disorders such as Post Traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder and Panic Disorder as well as Obsessive Compulsive Disorder.  Sleep apnea has been noted most often in PTSD, both in studies on returning veterans as well as in woman who have suffered sexual trauma.

Until recently, it remained hard to explain why people with anxiety disorders had coexisting sleep apnea.  The percentages were too high to be coincidental and how these disorders could trigger sleep apnea made little sense.  In addition, if the sleep apnea were coincidental or secondary, why is it that treating the sleep disorder results in significant improvement in the anxiety disorder?

The answer may lie in the Limbic System.  This is the part of the brain that regulates autonomic and endocrine function, particularly in response to emotional stimuli and physical threats.  The limbic system contains the amygdala, which receives the information.  This is then passed on to the hippocampus, which compares these stimuli to prior memories.  If perceived as foreign and a threat, the fight or flight part of our nervous system, the sympathetic nervous system, is activated.  In addition, stress hormones are released.

We now believe that many of these people have preexisting sleep apnea.  In fact, it may be that sleep apnea sets them up for the anxiety disorders.  The theory is that the presence of increased levels of stress hormones and an activated sympathetic nervous system may impair the ability to deal with life’s stresses, and in the case of PTSD, severe psychological trauma.  In fact, it is during sleep, especially REM sleep, when much of emotional reconciliation with the day’s events occur.  If our sleep is severely fragmented by sleep apnea, our ability to accomplish this is hindered.  This also might explain the severe difficulty people with these disorders have in tolerating treatments such as CPAP for sleep apnea.  Several studies have pointed out the very poor compliance with treatment in returning veterans with PTSD.  Although the airway opens immediately in response to treatment, it may take much longer for the limbic system and its stress response to return to normal.  As a result, these individuals may continue to manifest very light sleep, claustrophobia, and a feeling of shortness of breath for a prolonged period.  In turn, they frequently give up on the therapy.  This is unfortunate because if they stick with it the majority will experience a real improvement in daytime symptoms as well.

Therefore, I have found that the key is to keep working with these patients.  Most importantly, by explaining both the long-term benefits and the expected initial problems, we are able to achieve much better results than has been noted nationally.


Dr. Rosenberg wrote this article for Everyday Health.


Alzheimer’s and the Sleep Cycle

It is well-known that people with Alzheimer’s have difficulty with sleep.  One of the areas the disease attacks is the sleep/wake center of the brain called the suprachiasmatic nucleus.  This results in severe problems with the timing of falling asleep and waking up – thus the link between Alzheimer’s and the sleep cycle. This can become maddening for family members and caregivers trying to cope with nighttime wanderings and people who sleep most of the day.

Interestingly, several recent studies have shown that lack of sleep or poor quality sleep may be a cause of Alzheimer’s.  The culprit is a protein called beta-amyloid.  Beta-amyloid is the substance that forms the destructive plaques that progressively destroy the brains of those with Alzheimer’s.  In the studies, normal subjects were followed at night using sleep diaries as well as a device called an actigraph that can show whether one is asleep or not.  Those people who either slept six and one-half hours or less or spent less than 85% of time in bed asleep were more likely to show elevated levels of beta-amyloid in their brain fluids.  They also tended to show early evidence of plaque formation on brain scans.

So the question is, can lack of sleep contribute to the development of Alzheimer’s?  The jury is still out.  There are those who argue that the early plaque formation and elevated beta-amyloid may be causing the sleep disturbance.  It’s the old chicken and the egg argument.  However, it would seem to me from the studies that it is likely that insufficient and poor quality sleep may be involved in the development of Alzheimer’s.  The resulting message is that once again we see the consequences of poor sleep.  When we don’t get enough sleep, everything from diabetes to heart disease increases.  Now we have evidence that even dementia may be related to poor sleep.  Accordingly, if you can, try to sleep at least seven to eight hours a night.  If you can’t, then seek help.


Dr. Rosenberg wrote this article for Everyday Health


Sleep and Cancer

Most recently, there have been two studies that show a link between Sleep Apnea and Cancer. In a study, performed in Wisconsin, people with severe Sleep Apnea were found
to have a 5 times higher chance of dying from cancer when followed over a 20 year period.

A second study done in Spain revealed that the chance of having any type of cancer was 68% higher in patients with severe Sleep Apnea. Patients were followed over a seven year period. In this particular study, having oxygen saturations lower than 90% for greater than 12% of the night was a major predictor of cancer.

Researchers postulate; that it is the low oxygen levels that may be the common denominator. It is believed, that low oxygen levels promote the growth of blood vessels, which feed these cancerous tumors. This process is referred to as angiogenesis.

Thus, it would appear; that in addition to hypertension, heart disease and stroke, we can now add cancer as another disease that may be caused by Sleep Apnea. Considering that an estimated 20 million people suffer from Sleep Apnea; it is imperative, that we diagnose and treat this disorder.