Why Sleep Apnea Treatment Is Important
Like PTSD, OSA is not something to be taken lightly. When left untreated, it can lead to serious health issues like high blood pressure, weight gain, heart disease, memory problems, and can even cause a stroke. These factors put even more stress on the body, worsening the chronic stress most PTSD patients already experience.
Veterans whose sleep apnea developed as a result of their PTSD can seek help from the VA disability for sleep apnea treatment. The most common way to treat sleep apnea, and what has been found most successful in reducing PTSD-related sleep disorders, is with the use of a CPAP machine.
The good news is sleep apnea treatment is readily available. If youre unable to adjust to a CPAP machine, you can explore alternatives to CPAP that may still provide the symptom relief for both PTSD and sleep apnea.
References:
1. Colvonen, Peter J et al. Obstructive Sleep Apnea and Posttraumatic Stress Disorder among OEF/OIF/OND Veterans. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine vol. 11,5 513-8. 15 May. 2015, doi:10.5664/jcsm.4692
Do I Need A Nexus Letter For Sleep Apnea Secondary To Ptsd
Yes, you should get a Nexus Letter to help service connect Sleep Apnea secondary to PTSD.
Veterans who become members of the VA Claims Insider Elite program get access to a network of independent medical providers who can write a Nexus Letter for Sleep Apnea Secondary to PTSD, usually with weight gain and/or obesity as an interim link for service connection.
Our advice is to be weary of private providers charging $2,000 or more for a Nexus Letter for Sleep Apnea secondary to PTSDespecially those who suggest the two conditions are medically connectedthey arent.
Can You Cure Ptsd And Sleep Apnea
Sleep apnea and PTSD are two complicated conditions.
Finding the right treatment means pursuing help from a professional who can tailor the treatment plan you need to your situation. Unfortunately, there are some issues with PTSD and sleep apnea.
Adherence to CPAP therapy is less common than most doctors would like because sleeping with a mask on can be an uncomfortable experience.
Individuals with PTSD may struggle to keep their masks on when suffering from discomfort, nightmares, and feelings of claustrophobia which can arise during sleep.
A small study of veterans found that among people without PTSD, 70% did adhere to CPAP therapy. However, less than 50% showed ongoing adherence.
The good news is that those who do follow through with the correct treatment can see significant benefits. The more you use your CPAP therapy, the more the positive impact increases. Specifically, CPAP can reduce the frequency of nightmares by up to 50% and can significantly lower feelings of distress and daytime sleepiness.
Although both sleep apnea and PTSD are worrying conditions, its important to note that treatment options are available to help anyone overcome these problems with time. The key to success is following the guidance provided by your doctor.
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Other Symptoms Of Sleep Apnea Include:
- Excessive sleepiness and fatigue
- Mood swings
- Weight gain
Risk factors for sleep apnea include age and obesity. The disorder also is more common in men.
Treatment could include wearing a Continuous Positive Airway Pressure machine at night to ensure adequate oxygen flow. And doctors frequently recommend a better, more calming sleep routine, like regular bedtime and avoiding stimulants before bed.
If a doctor determines that weight is the cause of the disorder, treatment can involve losing weight.
If left untreated, sleep apnea can result in more severe health issues, including the risk of heart attack or stroke.
How Va Diagnoses Sleep Apnea In Veterans
The first step we like to suggest is to get a medical opinion from your doctor when it comes to proving a sleep apnea claim. You will need medical evidence that shows what type of sleep apnea you have , how severe it is and if you can show how it was caused by your service in the military then even better.
VA will rate your disability based on the type of disorder you have and the severity of your sleep apnea symptoms. VA ratings are assigned based on the symptoms, not the condition itself.
For example, veterans who develop sleep apnea or PTSD must demonstrate how their symptoms are affecting their daily living and ability to work a diagnosis is not enough for benefits.
The most common way to diagnose sleep apnea is with a polysomnogram test, which measures things like your breathing, heart rate and oxygen levels. If you have central sleep apnea, then your doctor may also order a test called a home titration study. This test measures how well you respond to treatment for central sleep apnea.
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Why Osa Is Problematic For Those With Ptsd
Obstructive Sleep Apnea leads to sleep deprivation and poor sleep quality which can worsen PTSD and PTSD symptoms. Even if someone does not recognize they are waking up in the middle of the night, they can still be suffering from OSA.
Good sleep is an important part of PTSD treatment and recovery. When Obstructive Sleep Apnea presents itself in someone who is suffering from PTSD, it reduces fear extinction. REM sleep is the part of sleep where our brains consolidate memories and where fear extinction takes place. It is important that those suffering from PTSD receive treatment for OSA if necessary.
Sleep Cycle Center has treatment options outside of noisy CPAP machines. If you or someone you know thinks they have sleep apnea, we encourage you to take our Sleep Apnea Screener. It is 92% accurate and can be completed in minutes.
Sleep Apnea Treatment May Improve Ptsd Symptoms
If you have both sleep apnea andposttraumatic stress disorder, CPAP therapy may help improve your symptoms. As weve mentioned, PTSD symptoms may be more severe for people with untreated sleep apnea. However, some studies have found thatsleep apnea treatment improves PTSD symptoms. For instance, one small study from 2014 looked at 69 veteran patients with both sleep apnea and PTSD. The patients were treated for their sleep apnea with continuous positive airway pressure therapy. The researchers found that those using CPAP therapy had a significantly lower risk for nightmares. On average, the participants had nearly half the number of nightmares per week than before beginning sleep apnea treatment.
Unfortunately, CPAP therapy adherence is frequently low for people with PTSD. Therefore, its important to work with a mens health management team to find customized solutions that work for you. One important way our providers can help you with CPAP therapy is finding the right mask for you. We are here to help you find the most comfortable mask to help you feel better about using your CPAP device. In other cases, we may explore other sleep apnea treatment options. For example, we can look at positional therapy options if your sleep apnea is related to sleeping on your back. Our team is here to find customized treatment solutions so you can address your health and start feeling better.
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How Ptsd Affects Sleep
Individuals with PTSD frequently have trouble falling asleep and awaken easily, often waking up many times throughout the night. Many people with PTSD also have nightmares. These issues result in disrupted, non-refreshing sleep.
Those with chronic pain, substance abuse, traumatic brain injury, depression, or other medical problems face an additional barrier to getting quality sleep. Certain sleep medications also interfere with REM sleep, which is the sleep stage during which we dream and an important sleep stage for dealing with traumatic memories.
The most common sleep problems in PTSD can be summed up in three categories:
Treating PTSD-related sleep problems, as well as co-existing disorders such as depression, is an important part of resolving overall PTSD symptoms.
The Overlap Among Sleep Fragmentation Insomnia And Nightmares
Sanja Jelic, MD is board-certified in pulmonary disease, sleep medicine, critical care medicine, and internal medicine. She is an assistant professor and attending physician at Columbia University College of Physicians and Surgeons in New York, NY.
Veterans and other people with post-traumatic stress disorder may wonder about the potential relationship to difficulties breathing in sleep that occur with obstructive sleep apnea. What sleep problems might trauma cause? Can sleep fragmentation from untreated sleep apnea worsen PTSD symptoms?
Consider the research supporting this association, the concerning symptoms and long-term health consequences of both conditions, and how treatment of sleep apnea may improve PTSD.
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Study Finds High Risk Of Sleep Apnea In Young Veterans With Ptsd
DARIEN, IL A new study of young U.S. veterans shows that the probability of having a high risk of obstructive sleep apnea increased with increasing severity of post-traumatic stress disorder symptoms.
The study involved 195 Iraq and Afghanistan veterans who visited a VA outpatient PTSD clinic for evaluation. Results show that 69.2 percent of participants had a high risk for sleep apnea, and this risk increased with PTSD symptom severity. Every clinically significant increase in PTSD symptom severity was associated with a 40 percent increase in the probability of screening as high risk for sleep apnea.
The implication is that veterans who come to PTSD treatment, even younger veterans, should be screened for obstructive sleep apnea so that they have the opportunity to be diagnosed and treated, said co-principal investigator Sonya Norman, PhD, researcher at the San Diego VA, director of the PTSD Consultation Program at the National Center for PTSD, and an associate professor of psychiatry at the University of California San Diego School of Medicine. This is critical information because sleep apnea is a risk factor for a long list of health problems such as hypertension, cardiovascular disease and diabetes, and psychological problems including depression, worsening PTSD and anxiety.
The study was led by Norman and co-principal investigator Abigail Angkaw, PhD. The lead author of the study is Peter Colvonen, PhD.
Could Your Sleep Apnoea Be Connected To Ptsd
Its probably no surprise that Post Traumatic Stress Disorder can wreak havoc with your sleeping patterns. Hyperarousal and anxiety can make it harder to fall asleep, while sensitivity to the slightest sound can cause you to wake up frequently during the night. Some people suffer from nightmares, while depression can cause others to sleep more than usual. But did you know that PTSD and C-PTSD are both also linked to sleep apnoea?
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Obstructive Sleep Apnea May Worsen Ptsd Symptoms
Also, untreated obstructive sleep apnea may make PTSD symptoms worse. According to the Sleep Foundation, people with bothPTSD and obstructive sleep apnea typically have more severe symptoms. For instance, people with both conditions are more likely to experience severe depression, have a higher suicide risk, increased risk for substance abuse, and decreased quality of life. In addition, for people under 70 years old, people who suffer from both PTSD and OSA have a higher risk for experiencing an early death.
Interestingly, the more severe a persons obstructive sleep apnea symptoms, typically the more severe the PTSD symptoms. The same is also true: severe PTSD sufferers with OSA also usually have more severe sleep apnea symptoms.
One potential explanation for the link between OSA and PTSD is that sleep apnea can disrupt sleep and cause sleep deprivation. Sleep deprivation then can make PTSD symptoms worse and recovery harder. Low sleep quality and sleep fragmentation from obstructive sleep apnea can negatively affect mood, which can impact PTSD symptoms.
In addition, some believe REM sleep may also play a role in the connection between PTSD and sleep apnea. REM sleep may support fear extinction, which can help reduce fear associated with certain triggers. Because OSA can negatively impact REM sleep, some experts also believe that this may be why people with PTSD and untreated sleep apnea typically experience more severe PTSD symptoms.
How To Establish Service Connection For Va Sleep Apnea Secondary To Ptsd
In accordance with 38 CFR § 3.310 disabilities that are proximately due to, or aggravated by, or the result of a service-connected disease or injury shall be service connected.
When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition.
Service connection on a secondary basis requires a showing of causation.
A showing of causation requires that the secondary disability claim be shown to be proximately due to or aggravated by another service-connected disability.
There are three evidentiary elements that must be satisfied for secondary conditions to PTSD to prove service connection under the law:
- A medical diagnosis of the secondary disability condition youre attempting to link to PTSD AND
- A current service-connected primary disability AND
- Medical nexus evidence establishing a connection between the service-connected PTSD and Sleep Apnea
The FIRST part can be satisfied with any existing medical evidence in service treatment records, VA medical records, or any private medical records.
The SECOND part can be satisfied with a veterans existing service-connected disability rated at 0 percent or higher, which in this case, is PTSD.
The THIRD part, and often the missing link needed to establish secondary service connection, can be satisfied with a credible Medical Nexus Letter from a qualified medical provider.
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Adherence To Cpap Therapy
Adherence to CPAP therapy is less common than doctors would like, simply because sleeping with the mask on can feel uncomfortable. Individuals with PTSD are significantly less likely to use CPAP therapy consistently, often due to masking discomfort, nightmares, and claustrophobia. Nightmares in particular are associated with higher resistance to CPAP therapy. Individuals with PTSD use CPAP therapy for a shorter amount of time only 3.5 hours on average and on fewer nights overall.
A study of veterans found that among those without PTSD, 70% adhered to CPAP therapy. Among veterans with PTSD, that adherence rate dropped to less than 50 percent.
Non-adherence to CPAP therapy has serious consequences. One study of individuals with PTSD and OSA found that those who followed their CPAP therapy experienced a 75% improvement in PTSD symptoms. For those who didnt, their symptoms got 43 percent worse.
Studies show the more frequently a person uses their CPAP therapy, the more their PTSD symptoms improve. CPAP therapy has an even stronger positive effect among those with severe PTSD, as opposed to mild to moderate symptoms.
Specifically, CPAP therapy can significantly reduce the frequency of nightmares and the distress they cause for individuals with PTSD. CPAP therapy also relieves the daytime sleepiness symptoms of PTSD, improving quality of life.
Pharmacological Treatment Of Sleep Disturbances In Ptsd
Several types of drugs have been specifically evaluated in PTSD-related sleep disorders . Alpha1-receptor antagonists such as prazosin are best supported by evidence, showing improvement in nightmares as well as insomnia . Both sedating antipsychotics and antidepressants have been found beneficial in the treatment of PTSD, including specific positive effects on sleep quality and nightmares, but need close monitoring of negative effects such as hang-over, metabolic dysregulation, and induction/elevation of restless legs syndrome , PLMD and nightmares . The use of benzodiazepine-receptor agonists is controversial in patients with PTSD, not just because of generally known adverse effects, but specific negative outcomes such as worse therapy outcomes and increased risk of developing PTSD when used directly following trauma . Considering current evidence, pharmacological treatment of insomnia and nightmares in PTSD should be regarded as temporary and additional, rather than alternative, to psychological interventions.
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Prevalence Of Sleep Problems In Veterans With Ptsd
PTSD is unique among mental health disorders in that sleep problems are mentioned twice among its diagnostic criteria in DSM-5: the presence of insomnia qualifying as a symptom of an alteration in arousal and reactivity and the presence of frequent nightmares as an intrusion symptom. Insomnia is reported to occur in 90-100% of Vietnam era Veterans with PTSD . Insomnia was also the most commonly reported PTSD symptom in a survey of Veterans from Afghanistan and Iraq . In the Millennium Cohort Study, 92% of active duty personnel with PTSD, compared to 28% of those without PTSD, reported clinically significant levels of insomnia .
It has been argued that sleep problems, rather than being just symptoms of PTSD, are a hallmark of the disorder . In support of this viewpoint, insomnia occurring in the acute aftermath of a traumatic event is a significant risk factor for the later development of PTSD in civilian and active duty populations. Despite the efficacy of evidence-based treatments for PTSD such as Prolonged Exposure or Cognitive Processing Therapy , the arousal and reactivity cluster symptoms that include sleep difficulties appear to be particularly difficult to resolve even after substantial PTSD improvement .
What Causes Sleep Apnea
Veterans are at an increased risk of developing sleep apnea due to various risk factors like weight gain leading to obesity, hypertension, and/or high blood pressure. Additionally, smoking, substance abuse, and alcohol abuse may contribute to sleep apnea. OSA is also commonly seen as a secondary condition in veterans who have PTSD .
In fact, a recent study found that almost 60% of veterans with PTSD also suffer from sleep apnea. This is because people with PTSD often deal with chronic stress have problems relaxing and getting a full nights sleep. Now, were not saying every veteran with PTSD will develop sleep apnea but its worth being aware!
This is just one example of how having a mental health condition like PTSD can impact your health. If you are a veteran who has been diagnosed with sleep apnea and you also have PTSD, then read on to learn more about VA disability benefits for both.
If you have depression or anxiety, you may also be at higher risk of sleep disordered breathing the good news is that if you can prove a service connected condition then you may qualify for disability compensation.
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