Sleep, Snoring, and Psychiatry

I'm writing from Orlando, where I'm attending a medical education conference on sleep apnea and snoring, sponsored by the University of Pennsylvania. Although sleep apnea (temporary cessation of breathing during sleep) is a common problem, some patients with psychiatric disorders are at greater risk than others for this serious sleep disturbance.
By far the most common form of sleep apnea is the obstructive type, where the airway becomes temporarily blocked. The other one is central sleep apnea, which happens when there is a decreased drive to breathe resulting from a cardiovascular or neurologic disorder. With obstructive sleep apnea, the person still attempts to breathe.
Obstructive sleep apnea is sometimes thought of as a complete stopping of breathing, but it really is a decrease in airflow to the lungs due to a partial or total collapse of the airway. The extent of this collapse is influenced by a person's airway anatomy and their body weight. Skinny and normal-weight people can have severe obstructive sleep apnea, but the risk is much greater among those who are obese.
Why are people with chronic mental illnesses at greater risk for obstructive sleep apnea? One reason is that they also tend to be overweight. Lifestyle and diet are very important influences on body weight, but the problem of excess weight can be worsened by some psychiatric medications, including certain antidepressants, antipsychotics, and mood stabilizers. I've seen some patients go from skinny to obese in just a few years. Under the best conditions, losing weight usually is a struggle, and weight loss usually requires a well-organized life and a lot of motivation.
Why worry about obstructive sleep apnea? Because it leads to both short- and long-term problems. Sleep apnea often causes disrupted sleep, which makes people sleepy during the day. And this excessive daytime drowsiness can be made even worse by the sedating effects of some psychiatric medications. Daytime sleepiness not only can be a nuisance that interferes with people achieving their goals, but it can also have catastrophic effects for people who are driving or doing activities that require concentration and attentiveness.
But wouldn't someone know it if they had sleep apnea? Not necessarily. Since the apnea events occur during sleep, those affected are unaware of them. The events disrupt sleep, but not enough to wake the person up. And if people do wake up, they usually don't know what caused the awakening. Occasionally, people with sleep apnea awaken with a gasping sensation. Most simply are aware that something is wrong with their sleep, since they still feel tired and unrefreshed upon awakening.
Even if people are unaware of their own sleep apnea, their bed partners may be very aware of the problem due to the sounds of loud snoring interrupted by extended pauses and followed by deep, sometimes gasping breaths.
If you think that you or the person you sleep with may have sleep apnea, a health care professional can help determine whether a sleep study is appropriate. The benefits of treatment can be dramatic, especially in promoting increased energy and alertness. These gains can be especially meaningful for psychiatric patients who may feel sleepy and sluggish, and believe that they are drifting backwards in their lives.