Most people intuitively understand that sleep quality impacts mood, stress response, and decision-making. So it stands to reason that persistent pattern of poor sleep—whether from apnea, insomnia, or frequent nighttime awakenings—only worsens these challenges. The longer poor sleep continues, the more likely it is to contribute to depression, anxiety, irritability, impaired judgment, heightened paranoia, and difficulty managing stress or making sound decisions.

Still, there have been enough research studies completed in the last few years to back up this obvious notion to ensure the connection is real and verified.

STUDY #1:  “Improved depressive symptoms, and emotional regulation and reactivity, in individuals with obstructive sleep apnea after short- and long-term CPAP therapy use”

(Sleep Med. . 2023 Nov:111:13-20.  doi: 10.1016/j.sleep.2023.08.024. Epub 2023 Sep 1.)

OBJECTIVE: This study investigated whether treating OSA with continuous positive airway pressure (CPAP) would lead to improvements in (a) depressive symptoms and (b) emotional regulation and reactivity (i.e., how well individuals control and express emotions, and how strongly they react emotionally).

PARTICIPANTS: Patients diagnosed with OSA were designated into two groups: (1) a CPAP-treatment group or (2) a 4-month wait-list control group (who started CPAP after the waiting period).

RESULT: After 4 months, both groups showed improvements in depressive symptoms, emotional regulation/reactivity, and subjective sleepiness—but only the CPAP-group’s within-group changes reached statistical significance. At 12 months (for the CPAP group) the improvements were maintained (i.e., sustained benefit). The study supports the idea that treating OSA with CPAP can lead to improved mood (reduced depressive symptoms) as well as improved emotional functioning (better regulation of emotion, reduced reactivity).

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STUDY #2: “Effectiveness and feasibility of continuous positive airway pressure in patients with stroke and sleep apnea: a meta-analysis of randomized trials”

(Published Online: September 1, 2023. Journal of Clinical Sleep Medicine)

OBJECTIVE: The researchers sought to determine whether treatment of Obstructive Sleep Apnea (OSA) with Continuous Positive Airway Pressure (CPAP) in patients who had experienced a stroke or transient ischemic attack (TIA) is both feasible (i.e., patients are able to use it, adhere to it) and effective in improving neurological outcomes.

PARTICIPANTS:  Patients who had a stroke or TIA and were diagnosed with sleep-apnea.

RESULT:  There was evidence that CPAP treatment in this context may benefit neurological outcomes (in patients with stroke/TIA and OSA). The study suggests improvements in neurological function in treated patients. It underlines the importance of screening for OSA in stroke/TIA survivors (if not already done) and considering CPAP therapy as part of the recovery/rehabilitation framework.

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STUDY #3: “Efficacy of CPAP duration and adherence for cognitive improvement in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials”

(Sleep Breath. . 2023 Jun;27(3):973-982.  doi: 10.1007/s11325-022-02687-y.)

OBJECTIVE: The authors aimed to assess, via meta-analysis of RCTs, whether CPAP improves cognitive outcomes in OSA patients, and specifically whether treatment duration and adherence matter.

PARTICIPANTS;  They identified 16 randomized controlled trials, involving a total of 1,529 participants with OSA

RESULT:  For the executive function test, among those with good adherence (≥4 h/night), CPAP produced a nearly significant improvement. Interestingly, in the subgroup of short-term CPAP treatment (< 8 weeks), there was a significant improvement in executive function, compared to control. The results suggest that cognitive improvement is possible, but it may depend strongly on how well the patient uses CPAP and for how long — and the improvements are modest over the long term.

Poor Sleep = Poor Decisions

So based on the above studies, it’s plain to see that cognitive ability and mood are both impaired by untreated sleep apnea. In fact, untreated OSA can seriously impair decision-making because it disrupts sleep quality, oxygen supply, and brain function in regions responsible for judgment, attention, and executive control. During apnea episodes, oxygen levels repeatedly drop, stressing the prefrontal cortex — the brain area that manages planning, problem-solving, and decision-making.

What are some examples of how consistent poor sleep affects you in the real world?

• Reduced mental flexibility: When conditions change at work, at home, at school or in relationships, the person will have a harder time adapting and readjusting to the new circumstances.
• Poor working memory: When asked to make decisions in all facets of life, good working memory comes into play to recall life lessons, key facts, social nuances, and personality anomalies. Decisions made without these considerations can impair the results for yourself and others.
• Slower processing speed: When the circumstances are urgent and quick decisions are required, the person may delay longer than necessary or make decisions based on rushed judgements that may be inaccurate or biased.
• Disrupted Cognitive processing: At work or school, it’s imperative to be alert and mentally sharp, which can result in increase in work performance or higher grades. When sleep is disrupted, a person may experience poor focus and attention, difficulty weighing pros and cons, trouble learning from mistakes, resistance to integrating feedback, and prioritizing tasks in the order of importance.
• Social Issues based on dysregulation and impulsivity:  When dealing with others, co-workers, colleagues, peers, family or partners, poor sleep can contribute to being more emotionally reactive and less able to control impulses (especially related to anger, hurt, perceived rejection, emotional neglect, etc.). It can result in misjudgment of social cues and poor consequences.
• Increased accidents and injuries: With poor cognitive function, comes increased workplace accidents, errors and injuries, especially when operating machinery. There are higher rates of car accidents due to poor decision making and slower reaction time. With increased impulsivity comes the increase of alcohol and drug use, which results in personal and physical hazards. There is also a noted increase in slips, trips and falls (especially in older adults) that can result in injury.
• Increased risk of depression and anxiety:  People with untreated OSA are 2–3 times more likely to experience major depression because of lower levels of serotonin and dopamine. The persistent fatigue can result in hopelessness, low motivation, and social withdrawal. Frequent awakenings trigger surges of adrenaline and stress hormones, that increase feelings of anxiety and paranoia. Many people with untreated OSA describe feeling “foggy,” detached, or overwhelmed — symptoms that mimic burnout or mild depression. These symptoms only get worse over time, unless treated.
• Increased risk of serious mental illness:  Studies link untreated OSA to greater risk of bipolar disorder relapse, worsening PTSD symptoms, cognitive decline and early dementia due to chronic oxygen deprivation.

DID YOU KNOW?? … Lack of sleep can be as dangerous as alcohol when it comes to accidents and injuries. Whether it’s behind the wheel or on the job, staying well-rested is one of the most effective — and most overlooked — safety measures.

Good News = CPAP Therapy Helps

As the above studies show (and many more studies we did not include), it’s clear that Continuous Positive Airway Pressure (CPAP) therapy restores oxygen flow and stabilizes sleep, thus with consistent adherence, it will improve attention, working memory, and executive function – helping patients make clearer, more rational decisions.

CPAP is the gold standard treatment for OSA, because it works with your body to keep the airway open during sleep, therefore maintaining normal oxygen levels which restores the functions of your prefrontal cortex and hippocampus. (These areas of the brain are directly related to mental health and cognitive function.)

And with consistent CPAP usage, even on the short term, patients will see a significant reverse of all the effects of poor sleep in the real world including:

• Executive function: better planning, problem-solving, and decision-making
• Memory: both short-term and working memory improve with consistent use
• Attention and concentration: fewer lapses, better focus
• Processing speed: faster reaction times and improved mental clarity
• Mood booster: reduces irritability, emotional reactivity, and relationship strain
• Increase mental resilience: better coping with stress and feeling more alert, motivated, and socially engaged
• Decreased risk of serious illness: protect against cognitive decline, dementia, depression, anxiety, and other mental illnesses

Steps to a Better Night’s Sleep

Before you can get a prescription for CPAP therapy, there are several steps to getting started, especially if you want insurance coverage. 

1. Recognize your symptoms: Keep a sleep diary for a few weeks and take notice of any of the following symptoms: loud snoring, daytime sleepiness, fatigue, morning headaches, difficulty concentrating.
2. Make an appointment with a doctor (preferably a sleep specialist or sleep physician): You may need to start with your primary care doctor to get a referral to a sleep physician, but a doctor specializing in sleep medicine will be more likely to accurately assess your risk and determine which type of sleep testing you should undergo.
3. Schedule a Sleep Study (Polysomnography): A sleep study is necessary, even if you have all the symptoms and risk factors, because it will not only confirm diagnosis but also determine severity and specific treatment settings based on your readings and is often required for insurance coverage.
4. Receive a CPAP Prescription: Only a licensed health care provider can prescribe a CPAP treatment plan and your insurance provider will require prescription details based on your sleep study results. The prescription will detail the device type, pressure settings, titration results and mask type recommendations. 
5. Take your prescription to a Sleep-Related DME (durable medical equipment) Provider: At Everything CPAP, we accompany our patients CPAP journey to successful treatment from receipt of your prescription …. to insurance approval … to long-term and ongoing support.  We assist our patients with the following services:
   1. We will submit required documentation to your insurance provider and conduct an appeal on your behalf, if necessary. We will comply with your insurance provider’s terms for approval including adhering to their trial period of usage and provide ongoing reporting to prove evidence of usage. 
   1. We provide training on CPAP devices, masks and accessories and educate patients on use, cleaning and maintenance.
   1. We provide our free and unconditional Mask Fit Guarantee with over 200 mask options, proper fitting by our staff at our initial visit as well as ongoing support for our patients.
   1. We provide ongoing support and regular follow-ups to ensure comfort and successful adherence. At 4 weeks, three months, six months and then annually, we go over any issues, complaints, or questions and make needed adjustments to the mask or pressure settings.
   1. We provide maintenance and replacement with 30-day or 90-day resupply program for CPAP supplies (mask, tubing, filters, etc.) and machine replacement every 5 years.
6. CPAP Adherence drives Treatment Success: The standard benchmark definition of adherence is ≥4 hours per night on 70% of nights.  Without consistent use, the benefits are minimal or nonexistent so address any issues early on.  Proper setup, mask fitting, and troubleshooting are essential to achieve early success — which in turn encourages adherence. And educate yourself on the benefits because patients who understand why CPAP matters, how to use it, and what to expect are more likely to comply.

In conclusion, Better Sleep = Better Health

At Everything CPAP, we understand how serious the problem of untreated sleep apnea can be for your health. It is our goal to make sure we do everything we can to help you have a great experience from the first time you come in and every time after … for years to come. 

Everything CPAP serves the people of the greater southwest Idaho region with a comprehensive approach to sleep apnea care through the integration of education, instruction, clinical research, excellence in follow up, and a personalized approach to treatment. The owners and employees of Everything CPAP are dedicated to the improvement and extension of our patient’s lives through personalized care, use of state-of-the-art equipment, constant innovation, and clinical research.