How Sleep Apnea Intersects with Veterans’ Mental Health

Sleep apnea and mental health conditions frequently affect veterans after military service, and research continues to show the connection between mental illness and sleep apnea is stronger than many people realize. Veterans living with post-traumatic stress disorder (PTSD), depression, or anxiety are significantly more likely to develop obstructive sleep apnea (OSA), the most common form of sleep apnea.

How Often Do Sleep Apnea and Mental Health Illnesses Occur Together?

Veterans experience OSA at much higher rates than the general population, particularly those living with PTSD, depression, or anxiety. Large studies involving veterans, active-duty service members, and civilians consistently show that sleep apnea and mental health conditions frequently overlap.

Veterans Are More Than Twice as Likely to Have Sleep Apnea

Veterans are more than twice as likely as non-veterans to have OSA. A 2025 study published in the American Journal of Health Promotion compared 15,166 veterans with 4,654 non-veterans and discovered that 21% of veterans had OSA, compared with just 9% of non-veterans. The findings suggest that military service is associated with a substantially greater risk of developing sleep apnea.

Active Duty Sleep Apnea Diagnoses Rose Nearly 30-fold in 14 Years

Sleep apnea diagnoses increased nearly 30-fold among active-duty service members over 14 years. A study published in the journal Sleep found that the incidence of OSA increased from 11 cases per 10,000 service members in 2005 to 333 per 10,000 in 2019. This dramatic increase highlights the growing impact of sleep apnea across the military community.

Up to 75% of People with PTSD Have Sleep Apnea

People with PTSD are far more likely to have obstructive sleep apnea than the general population. A 2017 meta-analysis published in Sleep Medicine reviewed multiple studies and found that 75.7% of people with PTSD met the standard definition of OSA. Even when researchers applied stricter diagnostic criteria, 43.6% still had the condition. These rates are dramatically higher than those reported in the general population, reinforcing the strong relationship between PTSD and OSA.

Nearly 70% of Veterans Treated for PTSD Screen as High Risk for OSA

Veterans seeking treatment for PTSD have a much higher risk of sleep apnea than the general population. A 2015 study of veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn found that 69.2% screened as high risk for obstructive sleep apnea. By comparison, a study in the New England Journal of Medicine estimated that OSA affects only around 4% of men and 2% of women in the general population.

Depression, Anxiety and PTSD Are Common Among Veterans with Sleep Apnea

In a 2005 study published in the journal Sleep, researchers analyzed medical records from more than 4 million veterans and identified 118,105 with obstructive sleep apnea. Among those veterans with OSA, 21.8% also had depression, 16.7% had anxiety, and 11.9% had PTSD. Each mental health condition occurred significantly more often than in veterans without sleep apnea, confirming the close relationship between sleep disorders and mental health.

What Comes First, Sleep Apnea or Mental Health Illness?

Research shows the relationship works both ways. Mental health conditions can contribute to the development or worsening of obstructive sleep apnea, while untreated sleep apnea can worsen those same mental disorders.

How Do Mental Health Conditions Worsen Sleep Apnea?

Researchers have identified several biological changes that may explain why veterans with PTSD, depression, and anxiety are more likely to develop OSA.

• Sleep disruptions: Anxiety, depression, and PTSD may cause frequent awakenings and changes in REM (rapid eye movement, the stage of sleep when most dreaming occurs). These repeated sleep disruptions can interfere with normal breathing throughout the night.
• The body’s stress response: Long-term activation of the sympathetic nervous system (the body’s “fight-or-flight” response) and the hypothalamic-pituitary-adrenal (HPA) axis, which is the body’s primary stress hormone system, can adversely affect sleep quality and breathing, contributing to sleep apnea.
• Weight gain from medications: Side effects of medications that cause weight gain may make sleep apnea more likely. Certain medications (such as those used to treat mental health conditions) can contribute to weight gain. Excess fat tissue puts a heavy mechanical load on the airway, increasing the risk of airway collapse when muscles relax during sleep.

PTSD Severity Is Linked to a Greater Risk of Sleep Apnea

Veterans with more severe PTSD symptoms are also more likely to have obstructive sleep apnea. A study published in the Journal of Clinical Sleep Medicine found that every 10-point increase in PTSD symptom severity was associated with a 40% greater likelihood of screening as high risk for obstructive sleep apnea.

Researchers additionally identified a 20% higher risk of snoring and an 80% greater likelihood of fatigue with every 10-point increase in PTSD symptoms.

Combat Exposure Contributes to OSA

In addition to PTSD and other diagnosed mental health conditions, the physical and psychological demands of deployment and combat themselves are likely to increase the risk of obstructive sleep apnea.

A large-scale observational study in the journal Sleep found that deployment and combat exposure more than doubled the likelihood of developing OSA, even after researchers considered the influence of other factors (such as PTSD, depression, and traumatic brain injury).

While PTSD is often assumed to only affect service members who were physically in combat, recent forms of warfare produce similar trauma. Research indicates that drone operators experience as much PTSD as traditional combat pilots.

When Treating One Condition Changes the Other

Treating sleep apnea often improves mental health conditions and vice versa. There is evidence that PTSD can make OSA more difficult to treat, while successful treatment of sleep apnea can reduce PTSD symptoms and improve overall quality of life.

Treating Sleep Apnea Can Improve PTSD Symptoms

A study published in the Journal of Clinical Sleep Medicine discovered that veterans with PTSD who consistently used continuous positive airway pressure (CPAP) therapy reduced their PTSD-related nightmares by approximately 49% (from an average of 10.3 nightmares each week to 5.3 per week). Daytime sleepiness improved, and every 10% increase in CPAP use nearly doubled the likelihood of PTSD symptom improvement.

PTSD Can Make Sleep Apnea Harder to Treat

Even as CPAP therapy helps reduce PTSD symptoms, veterans with post-traumatic stress disorder are significantly less likely to use their CPAP machine consistently than those without PTSD. A study published in the journal Sleep found that only 41% of veterans with PTSD and OSA used positive airway pressure (PAP) therapy as recommended, compared with 70% of veterans who had OSA without PTSD.

These findings suggest that PTSD could make it more difficult for veterans to follow long-term sleep apnea treatment, creating a challenge that can affect both conditions. Other studies have reached the same conclusion. A meta-analysis published in Sleep Medicine found that people with PTSD were not only more likely to have OSA, but those with PTSD were also less likely to consistently use CPAP therapy than people who did not have PTSD.

The Toll of Combined Sleep Apnea and Mental Illness

When sleep apnea and mental illness go untreated, the effects often extend well beyond nighttime sleep. Veterans may experience severe daytime fatigue, difficulty concentrating, worsening mood, and additional strain on the cardiovascular system (the heart and blood vessels). These symptoms may make work, relationships, and everyday activities more difficult while affecting overall health and quality of life.

Sleep Disorders in PTSD Sufferers Are Linked to Suicidal Thoughts and Behaviors

A review published in Frontiers in Psychiatry discovered a disproportionate occurrence of sleep disorders, including obstructive sleep apnea, in people with PTSD. The review also found that ongoing sleep disturbance is associated with suicidal ideation (thoughts of suicide) and suicidal behavior (planning suicide) in those with sleep disorders and PTSD.

Sleep Apnea Is Linked to Higher Suicide and Self-Harm Risk

A nationwide Danish study published in the journal Sleep found that people with obstructive sleep apnea had a 29% higher risk of death by suicide and a 28% higher risk of self-harm than people without the condition.

An Analysis of Board of Veterans’ Appeals Decisions

The cases evaluated by the Board of Veterans’ Appeals tend to be among the most complex and disputed VA disability claims. Although each is decided individually based on its own evidence, these appellate decisions can reveal common claim patterns, outcomes, and recurring evidentiary issues.

Hill & Ponton analyzed BVA decisions issued between 2021 and 2025 where the veteran’s asserted or adjudicated secondary theory was PTSD, anxiety, depression, or another acquired psychiatric disorder. The results suggest that many claims reach the Board without sufficient evidence for a final decision.

PTSD Is the Leading Secondary Theory

PTSD appears far more often than any other mental health condition in sleep apnea appeals: Hill & Ponton found 6,733 instances involving PTSD as the secondary theory for sleep apnea, compared with 672 for anxiety and 267 for depression.

This makes PTSD the dominant mental health theory used to support secondary service connection for sleep apnea at the BVA level. Approval rates for secondary sleep apnea BVA appeals were otherwise relatively similar for PTSD, depression, and anxiety.

• 36.8% of BVA appeals for sleep apnea secondary to PTSD were granted
• 42.8% of BVA appeals for sleep apnea secondary to anxiety were granted
• 32.8% of BVA appeals for sleep apnea secondary to depression were granted

Remands Are the Most Common Outcome

The most frequent outcome in appeals involving sleep apnea secondary to a mental health condition was remand: when a claim is sent back rather than being denied or granted because more evidence is needed to make a determination. In the BVA decisions identified by Hill & Ponton, roughly 1 in 2 cases were sent back for additional development rather than granted or denied outright.

• 50.6% of BVA appeals for sleep apnea secondary to PTSD were remanded
• 47.3% of BVA appeals for sleep apnea secondary to anxiety were remanded
• 52.5% of BVA appeals for sleep apnea secondary to depression were remanded

Why Are So Many Claims Remanded?

High remand rates often reflect correctable problems. Common issues include:

• Inadequate VA medical opinions
• Failure to address aggravation separately from causation
• Opinions that do not engage with relevant medical literature
• Failure to consider obesity or another intermediate step when evaluating the relationship between mental health condition and sleep apnea

What These Findings Mean for VA Claims

Today’s growing body of research increasingly shows that sleep apnea and mental health conditions are medically linked, rather than coincidentally occurring at the same time. The 2021-2025 Board of Veterans’ Appeals decisions analyzed by Hill & Ponton also indicate that the VA recognizes these medical connections, but many claims are delayed because of inadequate medical evidence.

In this context, a thorough and well-reasoned medical opinion that explains the relationship between the two conditions (and is supported by current research) can make all the difference in a VA claim’s outcome.

References

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Content Reviewed by

Attorney Shelly M. Mark

Shelly is an attorney passionate about serving underserved communities, including veterans, homeless individuals, and those in need. With experience in VA disability claims and social security law, she has worked with non-profits and as an Equal Justice Works Fellow.