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Vets with PTSD and sleep apnea less likely to use CPAP

Filed in
  • Sleep apnea
  • military
  • CPAP
  • PTSD

American Academy of Sleep Medicine  |  Dec 10, 2012
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Post–traumatic stress disorder (PTSD) in returning combat veterans with comorbid obstructive sleep apnea (OSA) is associated with significantly worse continuous positive airway pressure (CPAP) adherence compared to a similar population of patients without PTSD, according to a new study.  

“Current combat veterans are a particularly vulnerable population due to psychiatric diseases such as PTSD, depression and anxiety, substance use, traumatic brain injuries and multiple injuries often associated with disability and chronic pain," said lead author Jacob Collen, MD, Maj., MC, U.S. Army, Pulmonary, Critical Care and Sleep Medicine fellow at Walter Reed National Military Medical Center in Bethesda, Md. “Sleep disordered breathing is highly prevalent and has been demonstrated to worsen outcomes in patients with psychiatric disease, and prior, smaller studies have demonstrated that CPAP therapy may improve outcomes in patients with PTSD and obstructive sleep apnea.”

The study, which will appear in the December 15, 2012 edition of the Journal of Clinical Sleep Medicine, involved 90 patients with newly diagnosed OSA who initiated CPAP therapy (45 with combat-related PTSD and 45 controls). Results show that regular use of CPAP was significantly less common among patients with PTSD and was observed in 25.2 percent, compared with 58.3 percent among patients without PTSD. Greater adherence with CPAP was observed among patients with PTSD who were chronically using sedatives.

The authors were surprised to find that concurrent use of unspecified sedative agents was associated with improved CPAP compliance in patients with PTSD. Given the near universal use of multiple psychoactive medications in this population, it was not possible to discern which agents were responsible. However, in previous studies, they have demonstrated that use of nonbenzodiazepine sedative hypnotics, a group of drugs used to treat insomnia, improves short-term CPAP compliance. 

“Given the multiple health concerns these soldiers face, and the rise in suicides in returning veterans, it is critical that we look for viable strategies to improve their overall health," said Collen.  “Patients with PTSD tend to have worse adherence with a number of medical therapies, which creates a barrier to improving clinical outcomes. This study makes it clear that we need to do a better job at optimizing CPAP compliance in this population.”

The project mentor for this study was Christopher Lettieri, MD, Lt. Col., MC, U.S. Army, Chief of Sleep Medicine at Walter Reed National Military Medical Center in Bethesda, Md.


  1. 1 Crystal Poertner 23 Dec
    I'm not sure if this will ever be seen by anyone here but oral appliance therapy may be helpful to those of you who can't use your cpap machines. Nothing blocking your breathing just a mouth guard like device that you put in your mouth to help keep your airway open while you sleep. It might be worth checking out. 
  2. 2 Margaret 21 Jan
    i'm 75 yrs old and still have PTSD symptoms from early childhood trauma. One symptom is my inability to fall asleep, fearing that someone with bad intent will find me. I have not slept through the night for decades.
    I have recently been diagnosed with OSA and am trying to use CPAP. It is difficult to tolerate and I am developing an aversion.  I can't get myself to use it tonight.
  3. 3 GPB 17 Mar
    I have suffered from PTSD for 42 years. Many years it was masked beneath a cloud of alcoholism. Long buried things uncovered, and sleep habits worsened. Sleep Apnea created another layer of problems which in turn made sleep more difficult. One VA study called it the "Sleeping with One Eye Opened" syndrome (fearing the cause of the PTSD) I lay awake with the CPAP running trying to sleep, removing the mask and noise I fall asleep. Severe back pain and medications add another layer. I haven't slept longer than 3 hours at a time for over 15 years and it has taken its toll. God Bless those of you who know what I am talking about. Still waiting for answers on this side of the Pale.
  4. 4 AASM 26 Oct
    It depends on what you mean by "linked." Many veterans have both PTSD and sleep apnea - but any causal relationship between the two disorders is unclear. However, there is some research showing that sleep apnea (and its treatment) may impact PTSD symptoms. And the presence of PTSD may impact adherence to treatment for OSA. Both problems require careful management and effective treatment.
  5. 5 Arden Duhon 21 Oct
    I'm a Veteran I have PTSD and sleep apnea.the Veteran administration doesn't see these two linked. I recently seen the VA rep to reopen my case because they were saying .i had to have my sleep apnea linked to service connected disability. They don't link sleep apnea to PTSD . I live in Louisiana is there any National site to rectify this. Our howo
  6. 6 Randall E. Burley 30 Jun
    Had PTSD for decades. Recent operation revealed sleep apnea, that answered all the questions as to why I was always tired, even as a younger man. VietVet, 69-70. Did one year of sleep studies at Buffalo VA. BiPap system is a nightmare, way too restrictive as I need to sleep comfortably. First Comp attempt for this was denied, first Appeal was denied, I have one more try at this.
    All you do for Vets is greatly appreciated.
  7. 7 willie 08 Dec
    what is the connection with ptsd and cpap?
    what is a connection ?
    ptsd and insomnia ?
  8. 8 M. Amundson, SSG Ret. 27 Jun
    I have been having symtoms of PTSD for 20 plus years.  Have been treated with Doxepin 75 mg & Ativan 2 mg for sleep at night.  The combination of the two helped to give me 7-8 hours of sleep for the past 20 years. Recently I began seeing a new Primary Care Doctor and she asked that I be tested for sleep Apnia.  I quit breathing 120 times during that night.  For the past four weeks I have been using a CPAP Nasal Pillow.  I now can't sleep without it!  I don't take any sleeping medication any longer!  I sleep all night long.  No night mares. I have more energy, my thought process is sharper during the day. My memory is sharper!  All because of this CPAP machine.

    If this CPAP machine has helped me over come some of my PTSD problems,  I'm sure it can be of great help with other Veteran's!  Please continue your research for our Veterans!!  Thank you for all you do.
  9. 9 Terry McCullough 06 Jun
    Very Helpful...I'm having a tough time with my cpap, I can't use it. I'm a stroke waiting to happen.
  10. 10 Tod Merley 22 Dec
    Proper Treatment of Insomnia and PTSD: During a recent interview Dr. Barry Krakow related that his group has found that 90% of those presenting with insomnia had a sleep breathing disorder (half UARS half OSA) and in the rest the awakenings were over 90% attached to respiratory incidents[1].
    The pathology for PTSD also appears to be a sleep breathing physiological problem not a psychological one. This year I have found my symptoms of PTSD much helped by a simple solution which corrects the CO2 maintenance issues involved [2]. I believe it is so effective because the brain is so sensitive to changes in CO2 [3]. Please treat insomnia and PTSD as the breathing disorders that they are.
    [1] :MP3 of - Expert Interview: Dr. Barry Krakow on PTSD, Insomnia, and Sleep Apnea
    [2] : J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Treatment of positive airway pressure
    treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS). Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ. Source: Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Link:
    [3] : Philip N. Ainslie and James Duffin, Integration of cerebrovascular CO2 reactivity and chemoreflex control of breathing: mechanisms of regulation, measurement, and interpretation Published online before print February 11, 2009, doi: 10.​1152/​ajpregu.​91008.​2008 AJP - Regu Physiol May 2009 vol. 296 no. 5 R1473-R1495 Link: