Veterans Disability Info Blog

Is Depression Secondary to Sleep Apnea?

The topic of whether veterans can receive VA disability benefits for depression secondary to sleep apnea has gained significant attention in recent years. Scientific research suggests a potential link between obstructive sleep apnea (OSA) and depression. The oxygen deprivation, chronic daytime sleepiness, and impact on daily functioning caused by sleep apnea ultimately increase the risk of developing depression.

Veterans with a sleep apnea VA rating should be aware of this connection to maximize their VA disability rating. Obtaining secondary service connection is less straightforward than getting a PTSD VA rating. Many veterans are able to secure VA benefits for depression secondary to service-connected OSA with the help of a VA disability lawyer.

For more details about filing VA Claims for Depression and working with a disabled veteran lawyer, read our free eBook, VA Disability Ratings for Depression: An Essential Guide for U.S. Veterans.

How is Obstructive Sleep Apnea Related to Military Service?

Sleep apnea affects millions of people worldwide. Amongst the population affected by sleep apnea, military veterans are disproportionately affected. Studies show that 34% to 47% of military veterans meet high-risk criteria for obstructive sleep apnea, compared to just 12% of the U.S. population as a whole.

Serving in the armed forces often involves demanding physical activities, constant alertness, irregular schedules, and high-stress levels. The combination of these experiences can disrupt normal sleep patterns and increase the risk for sleep disorders, including obstructive sleep apnea.

Another contributing factor lies in the lifestyle changes that occur during and after military service. Veterans often experience significant changes in eating patterns, physical activity levels, and environmental factors. These changes can directly contribute to weight gain, a well-documented risk factor for sleep apnea. The stress and demands of military service can also result in unhealthy coping mechanisms like smoking and excessive alcohol consumption, both of which increase the risk of sleep apnea.

Additionally, exposure to military-related air pollutants may play a role in developing sleep apnea among veterans. Military operations often involve exposure to different types of hazardous chemicals, fuels, and other pollutants that may contribute to the onset or exacerbation of sleep apnea in veterans.

Sleep apnea is a condition that involves shallow breathing or frequent breathing pauses during sleep, ultimately leading to disrupted sleep and decreased blood oxygen levels. Obstructive sleep apnea symptoms can vary but commonly include:

  • Morning headaches
  • Loud snoring, gasping, or choking during sleep
  • Irritability
  • Fatigue
  • Difficulty concentrating
  • Changes in appetite and sleep patterns

Continuous positive airway pressure (CPAP) therapy is the most effective sleep apnea treatment. Lifestyle changes, including regular exercise, weight management, and avoiding alcohol and tobacco consumption, can also help alleviate symptoms.

Left untreated, sleep apnea can impact overall health and quality of life, increasing a patient’s risk of stroke, cardiovascular disease, and mental health disorders.

Can Obstructive Sleep Apnea Cause Depression?

Sleep is a physiological necessity in humans. Sleep deprivation is a causative factor for a range of adverse physical and mental conditions, including major depressive disorder (MDD).

Depression is a multifaceted disorder and can significantly impact an individual’s quality of life. Symptoms of major depressive disorder include:

  • Persistent feelings of sadness
  • Irritability
  • Loss of interest in previously enjoyed activities
  • Changes in appetite and sleep patterns
  • Fatigue
  • Difficulty concentrating
  • Thoughts of death or suicide

Recent research has unveiled a potential link between obstructive sleep apnea and depression. Research reports that over 46% of people with obstructive sleep apnea report depressive symptoms. Several studies have found that people with sleep apnea have a higher risk of developing depression compared to those without the condition. A study in the journal Chest discovered that even when controlling for various demographic and health factors, the presence of sleep apnea was still significantly associated with depression.

How does sleep apnea cause depression? One theory suggests that the intermittent pauses in breathing and the resulting low blood oxygen levels during sleep can lead to brain damage over time. These disturbances in oxygen supply to the brain can impact the regulation and production of neurotransmitters, like serotonin, which play a major role in mood stability. Consequently, the imbalance of neurotransmitters due to sleep apnea can lead to the development of depressive symptoms.

Furthermore, the chronic daytime sleepiness experienced by individuals with sleep apnea can also indirectly lead to depression. Sleep apnea disrupts the normal sleep architecture, preventing individuals from obtaining restful and restorative sleep. As a result, they often feel tired and foggy throughout the day, which can interfere with their daily functioning, work performance, and overall quality of life. Prolonged sleep deprivation can exacerbate depressive symptoms and increase the risk of developing depression.

It is also important to note that depression and sleep apnea share certain risk factors, like obesity and smoking. This overlap in risk factors further strengthens the association between the two conditions.

Separating a Sleep Apnea Diagnosis from a Depression Diagnosis

Sleep apnea and depression share some symptoms, but their underlying mechanisms are distinct. An accurate diagnosis for each condition is crucial for veterans seeking VA benefits for depression secondary to sleep apnea.

Doctors employ various diagnostic criteria and assessment tools to differentiate between sleep apnea and depression. To determine a diagnosis of sleep apnea, doctors must assess the patient’s medical history, focusing on sleep patterns, breathing difficulties, and associated symptoms such as gasping for air or loud snoring during sleep. Doctors also consider the patient’s body mass index (BMI) because obesity is a known risk factor for sleep apnea. Other indicators include a family history of sleep apnea and the presence of conditions such as hypertension or diabetes.

Once a doctor suspects sleep apnea based on the patient’s history, they may suggest a sleep study known as polysomnography. This test records various physiological measurements during sleep, such as brain activity, eye movements, muscle tone, and oxygen levels. It helps doctors determine the severity and type of sleep apnea present – obstructive sleep apnea, central sleep apnea (CSA), or a combination of OSA and CSA. Sometimes, patients may undergo a home sleep test, involving portable monitoring devices to collect key sleep-related data.

In contrast, diagnosing depression involves assessing a patient’s mental health and emotional well-being. Doctors utilize recognized diagnostic criteria defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to analyze symptoms and diagnose accurately. These criteria involve evaluating the presence and severity of symptoms, their duration, and their impact on daily functioning.

Doctors may use various evaluation tools like questionnaires or interviews to gather information about the patient’s symptoms and experiences. One commonly used tool is the Hamilton Depression Rating Scale (HDRS), which rates the severity of depression based on various criteria such as mood, guilt, suicidal thoughts, and appetite changes. The Patient Health Questionnaire-9 (PHQ-9) is another widely used tool for screening and diagnosing depression.

Differentiating between sleep apnea and depression can be challenging due to their overlapping symptoms. Both conditions can lead to fatigue, changes in sleep patterns, and mood disturbances. However, doctors can often distinguish between them through careful evaluation and consideration of associated factors.

For instance, doctors are likely to suspect sleep apnea in cases where symptoms primarily occur during sleep. Conversely, if mood disturbances and other emotional symptoms are predominant, depression may be the primary concern. However, it is essential to recognize that individuals with comorbid conditions may experience symptoms of both sleep apnea and depression simultaneously, further complicating the diagnostic process.

Veterans often face difficulty getting two separate diagnoses for the purposes of VA benefits. An experienced disabled veteran lawyer who specializes in VA claims for depression secondary to service-connected conditions like sleep apnea can help ensure that your VA claim shows a diagnosis of depression separate from sleep apnea and a scientific link between the two conditions.

Does The VA Consider Sleep Apnea Secondary to Depression?

Yes. The VA recognizes depression as a secondary condition to sleep apnea. The VA uses the Veterans Affairs Schedule for Rating Disabilities (VASRD) to evaluate mental health conditions. Like a PTSD VA rating, under this schedule, depression is rated based on severity.

To establish a medical nexus between sleep apnea and depression disorder, veterans need to provide medical evidence that supports the connection between the two conditions. This evidence becomes critical to proving that the primary condition (sleep apnea) has caused or worsened the secondary condition (depression) in a significant way. This is where a medical nexus letter becomes crucial.

A medical nexus letter is a document written by a medical professional that explains the relationship between two conditions. This letter serves as vital evidence for the VA when considering a disability claim involving secondary conditions.

In the case of sleep apnea and depression, the medical nexus letter would outline:

  1. The veteran’s diagnosed conditions
  2. How the scientific literature links sleep apnea to depression.
  3. How sleep apnea has contributed to the development or worsening of depression in the specific veteran’s case.

Veterans seeking a medical nexus letter may want to ask their primary care physician, a specialist, or a qualified psychiatrist. Most veterans find doctors who write medical nexus letters through their VA disability lawyer. Others find them through independent medical consulting firms that specialize in providing VA nexus letters for veterans.  It is critical to choose a medical professional with a thorough understanding of sleep apnea, mental health disorders, and the VA claims process.

VA Ratings for Depression Secondary to Sleep Apnea VA Rating

Unlike most claims for a PTSD VA rating, to get a VA rating for depression secondary to a sleep apnea VA rating, veterans will need to obtain a medical nexus letter. You will also need to gather supporting medical records, including diagnostic reports, sleep study results, and any other relevant documentation provided by their healthcare providers.

The VA will carefully review the evidence and medical documentation provided to determine the level of disability and whether it is adequately connected to the veteran’s military service. Veterans can get assistance with preparing these complex claims by contacting a disabled veteran lawyer.

For more details about filing VA Claims for Depression, read our free eBook, VA Disability Ratings for Depression: An Essential Guide for U.S. Veterans.

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