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Have you ever encountered a not-so-happy person and thought to yourself, they must have woken up on the wrong side of the bed? Just about everyone is a little grumpier and more irritable after a poor night’s sleep. That’s no surprise. But could disturbances in sleep be associated with more-severe and longer-lasting consequences in mood and behavior?

Let’s explore what researchers have found. This article will address the association between sleep quality, behavior, and everyday disruptors inhibiting good sleep. We will then dive into obstructive sleep apnea, a prevalent sleep disorder associated with behavior problems, and address ways to treat it.

Sleep and Behavior

There is a strong association between sleep quality and behavior, especially in children.

“Inadequate sleep – whether too short or poor quality – causes specific changes in mood and thinking,” said Dr. Dean Beebe, director of the neuropsychology program at Cincinnati Children’s Hospital Medical Center.

When children don’t get enough sleep, he explains, they tend to have a more negative outlook on everything, experience extreme reactions, act without thinking, and have difficulty regulating their mood, paying attention, and solving problems. “Children who don’t get sufficient sleep at night, are more likely to be overactive and noncompliant, as well as being more withdrawn and anxious,” Dr. Beebe added.

The same is true for adults. Since sleep helps your brain function properly, insufficient sleep and sleep disorders have been associated with changes in mood, irritability, difficulty focusing, impaired ability to make decisions, depression, anxiety, and cognitive disorders. One explanation is that lack of sleep activates the amygdala, the brain’s emotional center, and  triggers the “fight-or-flight” response.5 With their brains in this state, people tend to have more emotional reactions, including increased anger and aggression.5 Prolonged sleep deprivation can alter the functional communication between brain regions.5

Common Sleep Disruptors

So, what prevents people from getting a good night’s rest? According to the Sleep Foundation, there are a few reasons for interrupted sleep:

  • Sleep fragmentation in older adults
  • Sleep disorders, such as obstructive sleep apnea (OSA) and restless legs syndrome (RLS)
  • Stress and anxiety
  • Lifestyle choices such as schedules, alcohol and coffee consumption, electronic use, or amounts of light and noise

While many factors contribute to sleep quality, let’s dive into a significant sleep disruptor affecting more than 1 billion people worldwide: obstructive sleep apnea.

Obstructive Sleep Apnea and Behavior Problems

Many children face challenges with attention, behavior, communication, sociability, hyperactivity, and more. Recent studies have shown that sleep apnea might be connected to these common problems.4

In one study, researchers found children usually experience behavioral problems as the first symptoms of a sleep breathing disorder. Behavior issues documented by parents typically include the following:

  • Short attention span
  • Disruptive behaviors
  • Hyperactivity
  • Rebelliousness
  • Impulsiveness

Another study tracked over 11,000 children for six years. Of the children, 5,000 generally breathed during sleep, while 6,000 had breathing problems. Their parents completed questionnaires reporting their children’s sleeping patterns over the course of the study. When their children reached age seven, they noted five aspects of behavior: hyperactivity, emotional symptoms (e.g., anxiety and depression), peer relationship problems, conduct problems, and social behavior.3 The results showed that children with breathing problems were 40 percent more likely to develop behavior problems, especially hyperactivity.

Obstructive sleep apnea (OSA) is present in one to five percent of children, often due to risk factors like obesity, genetic or health disorders, family history of sleep apnea, facial anomalies, and sickle cell disease. If a child or adult struggles with behavior problems, it may be worth considering whether OSA contributes.

Here are the main symptoms of OSA to look out for:

  • Loud snoring
  • Gasping for air during sleep
  • Awakening with a dry mouth
  • Morning headache
  • Difficulty staying asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Difficulty paying attention while awake

Treatment Options

Mild cases of OSA can often be cured with lifestyle adjustments, such as exercising more, losing weight, and quitting smoking or drinking.6 If lifestyle changes do not improve OSA symptoms, there are other kinds of treatment:

  • Continuous positive airway pressure (CPAP) machines deliver constant air through a mask while you sleep. The air delivered is at a slightly higher pressure than average, which helps keep the airway open, preventing snoring and interrupted breathing. Other airway pressure devices, such as auto-CPAP machines, are also available, automatically adjusting the air pressure.
  • Oral appliances are more manageable for patients to use compared to CPAP machines. Most oral appliances are designed to bring your jaw forward and open your throat, relieving obstructive sleep apnea.
  • Surgery is a last-resort option used if other treatment options have failed. Surgical options can include tissue removal, tissue shrinkage, jaw repositioning, implants, nerve stimulation, and tracheostomy (creating a new air passageway).

Since OSA is linked to behavior problems and other long-term effects, screening and testing patients early is crucial. To learn how to screen and treat OSA, visit thevivosinstitute.com.

References
1. Delgado Rodrigues RN, Alvim de Abreu E Silva Rodrigues AA, Pratesi R, Krieger J. “Outcome of restless legs severity after continuous positive air pressure (CPAP) treatment in patients affected by the association of RLS and obstructive sleep apneas.” Sleep Med. 2006;7(3):235-239. doi:10.1016/j.sleep.2005.06.009
2. Dunietz GL, Lisabeth LD, Shedden K, et al. “Restless Legs Syndrome and Sleep-Wake Disturbances in Pregnancy.” J Clin Sleep Med. 2017;13(7):863-870. doi:10.5664/jcsm.6654.
3. Lakshminarayanan S, Paramasivan KD, Walters AS, Wagner ML, Patel S, Passi V. “Clinically significant but unsuspected restless legs syndrome in patients with sleep apnea.” Mov Disord. 2005;20(4):501-503. doi:10.1002/mds.20366.
4. Memon J, Manganaro SN. “Obstructive Sleep-Disordered Breathing.” StatPearls Publishing; 2021. Accessed July 6, 2022. https://www.ncbi.nlm.nih.gov/books/NBK441909/
5. Myc LA, Churnin IT, Jameson MJ, Davis EM. “Treatment of Comorbid Obstructive Sleep Apnea y Upper Airway Stimulation Results in Resolution of Debilitating Symptoms of Restless Legs Syndrome.” J Clin Sleep Med. 2018;14(10):1797-1800. doi:10.5664/jcsm.7400.
6. Pistorius F, Geisler P, Wetter TC, Crönlein T. “Sleep apnea syndrome comorbid with and without restless legs syndrome: differences in insomnia specific symptoms.” Sleep Breath. 2020;24(3):1167-1172. doi:10.1007/s11325-020-02063-8.
7. Seeman MV. “Why Are Women Prone to Restless Legs Syndrome?” Int J Environ Res Public Health. 2020;17(1). doi:10.3390/ijerph17010368.
8. Silber MH, Buchfuhrer MJ, Earley CJ, et al. “The Management of Restless Legs Syndrome: An Updated Algorithm.” Mayo Clin Proc. 2021;96(7):1921-1937. doi:10.1016/j.mayocp.2020.12.026.
9. Silva C, Peralta AR, Bentes C. “The urge to move and breathe – the impact of obstructive sleep apnea syndrome treatment in patients with previously diagnosed, clinically significant restless legs syndrome.” Sleep Med. 2017;38:17-20. doi:10.1016/j.sleep.2017.06.023.