As people grow older, changes in sleep become very common. Many adults notice that they wake up more often at night, feel tired during the day, or struggle to get deep, refreshing sleep.
While these changes are often seen as a normal part of aging, researchers are finding that certain sleep problems may have much more serious effects on health than previously thought.
One of these problems is obstructive sleep apnea, a condition that affects breathing during sleep and may quietly harm mental health over time.
A large new study from researchers at the Ottawa Hospital Research Institute and the University of Ottawa suggests that adults who are at high risk of obstructive sleep apnea are much more likely to experience poor mental health.
The study followed people aged 45 to 85 across Canada and found that those with a high risk of sleep apnea had about a 40 percent higher chance of having mental health problems, both at the start of the study and several years later.
Mental health problems such as depression and anxiety are already a major challenge worldwide. They are among the leading causes of disability and reduced quality of life.
People living with mental health conditions are more likely to face other difficulties, including heart disease, diabetes, unemployment, social isolation, and repeated hospital visits. On a global scale, mental health disorders are estimated to cost the world economy around one trillion dollars each year due to lost productivity.
Obstructive sleep apnea is a condition where the airway repeatedly narrows or closes during sleep. When this happens, breathing briefly stops or becomes very shallow. These events can occur dozens of times each night, often without the person being aware of them.
Each pause in breathing lowers oxygen levels in the blood and forces the body to briefly wake up to restart breathing. Over time, this leads to broken sleep, ongoing stress on the nervous system, and repeated drops in oxygen that can affect many organs, including the brain.
Scientists believe that untreated sleep apnea may contribute to mental health problems in several ways. Poor sleep quality can interfere with mood regulation, memory, and emotional control. Low oxygen levels can stress brain cells and trigger inflammation.
At the same time, mental health conditions themselves may worsen sleep apnea by affecting muscle tone, breathing control, and the balance of stress hormones. Until now, however, large long-term studies examining this connection have been limited.
To better understand this relationship, researchers used data from the Canadian Longitudinal Study on Aging, one of the largest aging studies in the world.
The study included more than 30,000 adults between the ages of 45 and 85 at the start, with nearly 28,000 participants followed up after about three years. Participants answered detailed questionnaires about their sleep, mental health, medical history, and daily functioning.
The researchers identified people at high risk of sleep apnea based on common signs such as loud snoring, feeling very sleepy during the day, pauses in breathing noticed by others during sleep, and having high blood pressure. Mental health problems were measured using a combination of symptom questionnaires, self-reported doctor diagnoses, and antidepressant use.
The results were striking. Nearly one quarter of participants were considered at high risk of sleep apnea at the start of the study, and this number increased slightly at follow-up. About one third of participants met the study’s definition of poor mental health at baseline.
After carefully adjusting for many other factors that could affect mental health, such as age, lifestyle, and physical health conditions, the researchers found that people at high risk of sleep apnea were significantly more likely to experience poor mental health. This higher risk remained stable over time.
Even more concerning, among participants who did not have mental health problems at the beginning of the study, those with a high risk of sleep apnea were more likely to develop mental health problems by the follow-up period. This suggests that sleep apnea may not only worsen existing mental health issues but could also contribute to new ones over time.
Additional analyses showed similar patterns when looking at specific mental health diagnoses such as anxiety disorders, mood disorders, and clinical depression.
The findings point to several possible biological pathways linking sleep apnea to mental distress, including low oxygen levels, repeated sleep disruption, inflammation, and the added burden of heart and metabolic diseases that often accompany sleep apnea.
Overall, this study highlights the importance of paying closer attention to sleep health as part of mental health care, especially for middle-aged and older adults.
The findings suggest that screening for depression and anxiety should become routine when people show signs of sleep apnea. At the same time, identifying and treating sleep apnea may help protect mental well-being and prevent future problems.
From a broader perspective, the study strengthens the idea that mental health and physical health are deeply connected. Sleep apnea has often been viewed mainly as a breathing or heart-related condition, but this research shows it may also have a significant impact on emotional and psychological health.
While the study cannot prove that sleep apnea directly causes mental illness, the consistent and long-lasting associations across time strongly suggest that untreated sleep apnea is an important and underrecognized risk factor.
Further research will be needed to determine whether treating sleep apnea can reduce the risk of developing mental health conditions or improve outcomes for those already affected. However, the findings provide strong support for more integrated care approaches that consider sleep, mental health, and physical health together rather than in isolation.
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The study is published in JAMA Network Open.
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