April 28, 2023 3 min read

Sleep apnea is a serious condition in which breathing repeatedly stops during sleep. These pauses in breathing result in low blood oxygen levels and fragmented sleep — with both having a devastating impact on health.


Just some of the health problems associated with untreated sleep apnea include high blood pressure, heart disease, type 2 diabetes, and even fatty liver [1]. And because sleep apnea results in nonrestorative sleep, sufferers see their mood, memory, and focus take a hit as well. But these problems are not just due to fragmented sleep but also structural brain changes.


While studies show that sleep apnea can cause unfavorable changes in brain matter, there is also evidence that this damage is completely reversible. Below is more on the impact of sleep apnea on brain health.

How Sleep Apnea Affects the Brain

Based on what we know from research and according to several theories, sleep is off the brain, by the brain, and for the brain [2]. Your brain activity slows down and changes during sleep, and this helps the brain rest, recover, and grow. For example, we now know the brain consolidates memories during the REM phase of sleep [3].


But sleep apnea can disrupt this. The pauses in breathing from sleep apnea can last for up to a minute and repeat hundreds of times in a single night. These episodes lead to dips in blood oxygen levels as the body struggles to get enough oxygen in and subsequent arousal from sleep. While sufferers are not aware this is happening, their sleep becomes seriously fragmented nonetheless. 


The low blood oxygen levels paired with the disrupted sleep architecture are believed to be behind the low mood, trouble focusing, and poor memory. But studies carried out over the past two decades also found structural brain changes in sufferers [4]. More specifically, they found that regions of the brain responsible for learning and memory shrink when you have sleep apnea.  

Does Treating Sleep Apnea Reverse Brain Damage?

The good news is that there is evidence that the damage done by sleep apnea is reversible.


A neuroimaging study published in 2014 is the first of its kind to show that the consequences of sleep apnea can be near-completely reversed with treatment [5]. The study involved 17 men with untreated sleep apnea, and brain scans carried out at the beginning of the study found evidence of white matter atrophy. But after 6 and especially 12 months of treatment, there was a near-complete reversal of white matter damage and improvement in mood and cognition. A later study also found that long-term treatment leads to an increase in volume in brain regions affected by sleep apnea [6].


However, according to sleep apnea expert Paul M. Macey, it may be too early to jump to such conclusions [7]. Some of the damage done to white matter from sleep apnea may be permanent, especially if we look at older studies. Commenting on a 2012 study [8], he notes that white matter changes in sleep apnea patients reflect injury that is not reversible and that the reversible changes are due to the resolution of inflammation rather than tissue repair.


So, while you have reason to be optimistic, it’s also important to keep in mind that some forms of brain damage (i.e. atrophy and neuronal cell death) may be permanent. This can be a good motivating factor to seek treatment in the form of continuous positive airway pressure (CPAP) therapy, lifestyle changes, or mouthpieces like the  Good Morning Snore Solution.


References: 


  1. Cumpston E, Chen P. Sleep Apnea Syndrome. [Updated 2022 Nov 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK564431/

  1. Hobson JA. Sleep is of the brain, by the brain and for the brain.Nature. 2005;437(7063):1254-1256.doi:10.1038/nature04283

  1. Li W, Ma L, Yang G, Gan WB. REM sleep selectively prunes and maintains new synapses in development and learning.Nat Neurosci. 2017;20(3):427-437.doi:10.1038/nn.4479

  1. Morrell MJ, McRobbie DW, Quest RA, Cummin AR, Ghiassi R, Corfield DR. Changes in brain morphology associated with obstructive sleep apnea.Sleep Med. 2003;4(5):451-454.doi:10.1016/s1389-9457(03)00159-x

  1. Castronovo V, Scifo P, Castellano A, et al. White matter integrity in obstructive sleep apnea before and after treatment.Sleep. 2014;37(9):1465-1475. Published 2014 Sep 1. doi:10.5665/sleep.3994

  1. Kim H, Joo E, Suh S, Kim JH, Kim ST, Hong SB. Effects of long-term treatment on brain volume in patients with obstructive sleep apnea syndrome.Hum Brain Mapp. 2016;37(1):395-409.doi:10.1002/hbm.23038

  1. Macey PM. Is brain injury in obstructive sleep apnea reversible?.Sleep. 2012;35(1):9-10. Published 2012 Jan 1.doi:10.5665/sleep.1572

  1. O'Donoghue FJ, Wellard RM, Rochford PD, et al. Magnetic resonance spectroscopy and neurocognitive dysfunction in obstructive sleep apnea before and after CPAP treatment.Sleep. 2012;35(1):41-48. Published 2012 Jan 1.doi:10.5665/sleep.1582



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