Sleep Apnea in Veterans: Why PTSD, Mood Disorders, and Tinnitus Matter

Many veterans struggle with obstructive sleep apnea (OSA)—a serious condition where breathing repeatedly stops and starts during sleep. While sleep apnea is often linked to age and obesity in the general population, veterans face very different risk factors that are often overlooked.

A publication from the VA’s own National Center for PTSD warns that veterans with PTSD face a significantly higher risk for sleep apnea than the general public. According to the 2016 PTSD Research Quarterly:

“There is growing evidence that this population also suffers from obstructive sleep apnea (OSA)… more often than the general population.”
(Jaoude, Vermont, Porhomayon, & El-Solh, 2015)

Mental Health and Sleep Apnea Go Hand-in-Hand in Veterans

A major study by Sharafkhaneh et al. reviewed health records of over 4 million VA patients. They found that among veterans diagnosed with sleep apnea:

• 21.8% also had depression
• 16.7% had anxiety
• 11.9% had PTSD

The link was clear: veterans with sleep apnea were far more likely to also suffer from mood disorders, anxiety, and PTSD. Most importantly, the statistical certainty of this link was 99.999%—meaning it was almost impossible this connection was due to chance.

And these numbers may be an underestimate. That study looked only at veterans from 1998 to 2001, before large numbers of Iraq and Afghanistan veterans were diagnosed with PTSD, mood disorders, and tinnitus. More recent research shows that up to 70% of veterans with sleep apnea now have coexisting mood disorders.

Young, Fit Veterans Still Face High Risk

The Journal of Clinical Sleep Medicine, published by the American Academy of Sleep Medicine, recently reported:

“A new study of young U.S. veterans shows that the probability of having a high risk of obstructive sleep apnea (OSA) increased with increasing severity of PTSD symptoms.”
(Colvonen et al., 2015)

In that study, 69% of Iraq and Afghanistan veterans screened at high risk for sleep apnea. These veterans weren’t necessarily old or overweight—factors usually seen in sleep apnea. Instead, it was their PTSD symptoms that drove their risk higher.

Another study by Mysliwiec et al. found similar results among active-duty soldiers within 18 months of returning from deployment. Despite being young (average age 33.6) and not obese:

• 62.7% had sleep apnea
• 63.6% had insomnia
• 38.2% had both
• 70% had at least one of the following: depression, PTSD, traumatic brain injury (TBI), or chronic pain

The soldiers with both insomnia and sleep apnea had the highest rates of mental health issues.

These studies make one thing clear: the causes of sleep apnea in veterans are not the same as in the general public.

The VA’s Misguided Comparison

Unfortunately, VA decisions often rely on sleep apnea statistics from the general population, where PTSD, mood disorders, and tinnitus are rare. This leads to flawed conclusions.

For instance, a large national health survey found the rate of sleep apnea in the general public to be just 4.7%, and 12.1% in obese men. But that doesn’t reflect what’s happening among veterans.

Data from Caldwell et al. shows that between 2005 and 2014, the rate of sleep apnea among U.S. service members jumped from 4.4% to 27.3%—a 517% increase. Veterans now suffer from sleep apnea at rates 10 times higher than the general public, not because of age or weight alone, but due to service-related conditions like:

• PTSD
• Mood disorders
• Tinnitus
• TBI (Traumatic Brain Injury)

Conclusion

The evidence is overwhelming: veterans are at a uniquely high risk for sleep apnea—not just because of lifestyle or age, but because of what they’ve endured in service. Conditions like PTSD, mood disorders, and tinnitus aren’t just side effects—they are major contributors to the development of sleep apnea.

Any medical or disability decision that fails to consider these veteran-specific factors is incomplete. The VA must stop comparing veterans to the general population and start recognizing the true causes of sleep apnea in those who’ve served.