Mental Health Disorders and Psychotropic Drugs Raise Risk for Sleep Apnea, Insomnia

Mental health disorders, as well as the psychotropic drugs used to treat them, pose a risk for sleep disorders, including sleep apnea and insomnia, according to study findings published in the journal Annals of General Psychiatry.

Schizophrenia, bipolar disorder, and depression are mental health conditions known to be associated with sleep disorders, such as insomnia and sleep apnea. Moreover, having 1 mental health condition predisposes individuals to developing further conditions over time. Yet, it remains unknown whether this combined load of psychiatric conditions further raises the risk for insomnia and sleep apnea. Existing research on psychotropic medications also is inconclusive regarding their effect on sleep quality.

To examine both questions, researchers determined rates of both mental health and sleep disorders, based on insurance claims data between 2016 and 2020, among patients aged 18-64 years residing mainly in Utah and other Mountain and Pacific US states.

The studied mental health conditions included schizophrenia, bipolar disorder, anxiety, obsessive-compulsive disorder (OCD), stress-related disorder, and attention-deficit hyperactivity disorder (ADHD). Among psychotropic therapies, the researchers considered central nervous system (CNS) stimulants, antidepressants, amphetamine-based drugs, nonbarbiturate sedatives, tranquilizers, and anticonvulsants. They analyzed the relationships among index and comorbid conditions, sleep apnea and insomnia, and those drug classes, controlling for age, sex, marital status, dependent children (yes/no), salary, and year.

They confirmed that both sleep apnea and insomnia were comorbid with mental illness at high rates. These ranged from approximately 20% for stress to almost 34% for bipolar disorder. Odds of either sleep disorder were especially high in patients with either bipolar disorder (odds ratio [OR], 3.88; 95% CI, 2.81-5.36) or depression (OR, 3.32; 95% CI, 3.07-3.59). Sleep apnea in particular was associated with these 2 conditions; insomnia was most tightly associated with bipolar disorder and schizophrenia.

These odds rose still further when more than 1 mental health condition was present. Again, the odds of either sleep disorder were highest for bipolar disorder with comorbidity (OR, 6.27; 95% CI, 5.09-7.71) and depression with comorbidity (OR, 4.76; 95% CI, 4.41-5.13).

The studied medications likewise raised odds of a sleep disorder, particularly insomnia. Most notably, nonbarbiturate sedatives raised the risk for insomnia at an order of magnitude beyond those of the other drug classes (adjusted OR, 21.49; 95% CI, 19.53-23.64).

When the model was adjusted for medication, depression and bipolar disorder were no longer associated with insomnia, and anxiety was only weakly associated. This indicated that the drugs used to treat these conditions contribute to the associated insomnia. By contrast, stress, ADHD, OCD, and schizophrenia remained associated with insomnia, indicating that these disorders themselves, rather than medications, carry risk for insomnia.

The researchers cautioned that the rates reported for the studied conditions may be lower than true population values, as many people with those conditions do not seek care for them. Therefore, these risk estimates for sleep disorders may likewise be too low. Also, the direction of causality remained uncertain. “However,” the researchers wrote, “beyond stress, anxiety, and depression, it is likely that the mental disorders led to the sleep disorders.”