Mental Health and Obstructive Sleep Apnea Challenging misconceptions of sleep in mental health research Sue Anderson, BA (Industrial Relations / Philosophy) Trade Certificate (Printing) Author, Consumer Associate Professor Garun Hamilton MBBS, FRACP, PhD. Consultant Respiratory and Sleep Physician. Director Sleep Medicine Research at Monash Health, Dept of Lung and Sleep Adjunct Clinical Associate Professor, School of Clinical Sciences, Monash University

Obstructive Sleep Apnea Obstructive Sleep Apnoea (OSA) is defined as the cessation of breathing, or reduction in breathing, for a period of time during sleep. This is caused by the walls of the throat coming together, blocking off the upper airway and supply of oxygen to the brain. Breathing reduces or stops for a period of time (generally between ten seconds and up to one minute) until the brain registers the lack of breath or a drop in oxygen levels and sends a small wake-up call - a gasp for air. Symptoms – rubbing eyes, droopy eyelids, snoring, consistent fatigue or excessive daytime sleepiness, waking throughout night for toilet breaks or water, irritability, inability to focus or manage stress, and microsleeping when driving. Affects – mental and physical health through oxygen and sleep deprivation.

Hospital Anxiety and Depression Score (HADS) A = Anxiety D = Depression Add up the scores for A and D separately. Scores in the 8 to 11 range indicate "at risk" or mild impairment. Before treatment I scored 9 for anxiety and 10 for depression. Yesterday, I scored 4 for both anxiety and depression.

Mood Assessment Susanne Anderson November 2017

Sleep – Perception vs Reality Invited to join study for sleep app, but declined as personal perception of my sleep was a consistent 8 hours a night. I believed I was doing well on this indicator for mental and physical health. The reality was vastly different. A test for Obstructive Sleep Apnoea revealed I stopped breathing on average 6 times an hour, and experienced partial breathing obstruction an additional 28 times per hour (a total of 34 disturbances per hour). As such, I very rarely progressed into deep sleep, the phase in which daily mental and physical restoration occurs. As such, my mental and physical health was severely compromised.

About sleep A healthy deep sleep range is approximately 20% of the night for a person their early 50s. I achieved only 1.6%. My perception of the quantity of sleep I got nightly was incorrect. Additionally, I realised the quality of sleep I received, or required, had never before been assessed or addressed. Susanne Anderson, Unattended Polysomnography 6.12.17

Sleep Statistics and Respiratory Analysis

Sleep Apnea and Bipolar Research A 2016 Taiwanese study looked at 5415 people with sleep apnea and 27,075 people who did not have the condition. The study found that people with sleep apnea were two to three times more likely to receive a bipolar disorder diagnosis as compared to people without sleep apnea. (https://link.springer.com/article/10.1007/s11325-016-1389-x) Researchers hypothesized some people evidencing ill-health, both mental and physical, caused by sleep apnea and sleep deprivation, were incorrectly diagnosed with bipolar disorder.

Obstructive Sleep Apnea and Depression Journal of Clinical Sleep Medicine

A Personal Story of Change The treatment for Sleep Apnea is to ensure the airways are unobstructed at night. Since sleeping with a Continuous Positive Airway Pressure (CPAP) machine, I’ve observed multiple changes. They include – Increased mental acuity when undertaking very intense study and exams A change in skin tonality from ‘grey to pink’ Vast improvement in mood, from consistently irritable, stressed and grumpy to increasingly ‘balanced’ Improved interpersonal skills Waking refreshed and no longer feeling the daily need for a nana-nap

In Conclusion The perception of sleep quantity can be erroneous in mental health studies Sleep quality is not assessed in the majority of mental health studies Sleep deprivation due to Obstructive Sleep Apnea may be a main contributor, if not the underlying cause, of mental health symptoms in some people As such, an awareness and consideration of Obstructive Sleep Apnea should be incorporated into mental health studies.