Sleep and Persistent Teen Depression

The following is information from the 2017 31st Annual Meeting of the Associated Sleep Societies

Sleep-disordered breathing (SDB) may play a role in persistent depressive symptoms and poor response to standard pharmacologic treatments in adolescents. Screening adolescents with treatment resistant depression (TRD) for SDB “may be clinically valuable, since SDB is readily treatable.” Said Teena Chase, MD, PHD, Department of Psychiatry, University of Ottawa, Ontario, Canada, during her oral presentation. She also noted diagnosing and treating SDB may improve clinical outcomes early in the course of mood disorders in adolescents and lead to a better long-term prognosis.

The prevalence of SDB in adolescents is estimated to range from 1-7%, but the data are inconsistent. Major depressive disorders affect 5% to 8% of adolescents, and 40% may be treatment resistant.

Participants in a study (J Clin Sleep Med. 2013:9:1213-1220) were divided into 20 outpatient adolescents with TRD and 20 healthy controls matched for sex and age. The severity of depressive symptoms was rated on the Beck Depression Inventory.

They found that rates of SDB were significantly higher in the TRD group than the control group (50% vs 15%; P=.018), In the TRD group, the number of respiratory disturbances correlated with depressive symptoms.

While more studies are needed to determine the effect that treating SDB has on adolescent depression, in the treatment resistant group, it is recommended that adolescents with depression be screened for sleep disordered breathing early in their care. If you feel your adolescent may benefit from an evaluation, ask your pediatrician about screening for sleep disordered breathing.

You can access a free online screening tool at:

Sleep Apnea Headache Diagnosis and Treatment

By Colleen Doherty, MD | Reviewed by Timothy Morris, DDS

Updated February 04, 2018

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Do you suffer from a headache when you wake up in the morning? Do you also find yourself dozing off multiple times throughout the day? Does your partner report episodes of snoring at night? You may be suffering from a medical condition called Obstructive Sleep Apnea (OSA).

Let’s review the basics of what OSA is and the morning “sleep apnea headache” that may accompany it. 

What Is Obstructive Sleep Apnea (OSA)?

OSA is a medical condition characterized by frequent nighttime awakenings due to abnormal breathing during sleep. People with OSA have episodes throughout the night where they either stop breathing or breathe shallowly, causing low oxygen levels.

As a result of this disorder, people with OSA often report excessive daytime sleepiness, thinking problems, and morning headaches. The diagnosis of OSA is made by a sleep specialist after a patient undergoes an overnight sleep study.

What Is a Sleep Apnea Headache?

According to the classification criteria of the third edition of the International Classification of Headache Disorder (ICHD-III), a sleep apnea headache is a recurrent morning headache in a person who has been diagnosed with sleep apnea. A headache has one or more of the following features:

  • Occurs more than 15 times a month.
  • Occurs on both sides of the head, has a pressing quality, and is not associated with nausea, photophobia, or sensitivity to sound. 
  • A headache resolves within 4 hours

Before making the diagnosis, your doctor will take a thorough history and perform a careful physical examination to make sure there is not another cause for your headaches, especially since multiple medical conditions can cause morning headaches)

The precise “why” behind a sleep apnea headache is not fully understood. It may be due to the actual sleep disturbance. Or, the headache could be triggered by the low oxygen and high carbon dioxide levels that occur during the repetitive episodes of apnea.


Treatment of a sleep apnea headache entails treating the primary disorder, OSA. Sleep apnea is usually treated with a variety of interventions including weight loss, oral appliances, continuous positive airway pressure (CPAP), upper airway surgery, and treatment of nasal allergies.

What This Means for You

If you think you suffer from a sleep apnea headache, please speak with your doctor. The good news is that there are effective therapies out there for your sleep apnea and your morning headaches. Also, with treatment, you will likely find that you feel better and improve other health parameters, besides just your headaches.


Sleep Apnea and Pain

Florida Snoring and Sleep Apnea Center, as a team of dedicated practitioners and staff, is constantly working to identify, educate and provide treatment for people suffering from sleep disordered breathing.

The link between chronic pain and sleep disordered breathing is well established.


Pain and sleep are integrally connected.  Chronic pain is very common and even more common in people who have poor sleep, and it becomes a vicious cycle.  Pain greatly affects your ability to sleep, and the lack of sleep makes the pain substantially worse.

Pain can be the main reason that someone wakes up multiple times at night, and this results in a decrease in sleep quantity and quality and, on the flip side, sleep deprivation can lower your pain threshold and pain tolerance and make existing pain feel worse.


The first step is to figure out if the lack of sleep is contributing to the pain cycle or if the pain is causing a lack of sleep, and then you treat which ever is prevalent.


Pain may not be the only problem interfering with your sleep.  Some people may also have an underlying sleep disorder, such as sleep apnea.  Treating an underlying sleep disorder may improve a person’s response to and tolerance of chronic pain. An evaluation to be sure there is no underling sleep disorder is recommended.


The first step in making this determination is to take the online sleep survey linked below.  Based on the results, you may need a follow-up home study to determine the severity of your sleep disorder.


We would appreciate if you would take a few minutes to complete this survey.



Thank you.


Sleep Disorders and Cardiovascular Health

At the Florida Snoring and Sleep Apnea Center, Dr. Morris and his dedicated staff members are constantly working to find better ways to provide the most comprehensive care and treatment for our patients. In order to do so it is necessary to examine every aspect of a patients daily living. 

Cardiovascular health and sleep are integrally related.  Cardiovascular disease is common in people who have sleep disorders, and visa versa.  Conditions like hypertension, heart failure, atrial fibrillation, stroke, even diabetes can be related to sleep disorders.

There are multiple physiologic events taking place when a patient has obstructed breathing in their sleep. During the obstruction, which can happen many times an hour, a person’s oxygen level will decrease. This decrease can be low enough, and long enough, to harm the muscles of the heart. It can also lead to plaque buildup in the arteries – the start of the cascade of events leading to a stroke. 

It has been shown time and time again that untreated sleep disorders increase the risk of cardiovascular disease.  More recently it has been shown that treatment of sleep disorders can clearly reduce the risk from cardiovascular disease.  In addition, sleep disorders can contribute to daytime sleepiness and the danger of falling asleep at the wheel. 

The first step is to find out if there are signs and symptoms that lead us to suspect the presence of a sleep disorder.  Our main concern is obstructive sleep apnea.  There are other conditions such as loud snoring and upper airway resistance syndrome that can also disturb sleep and lead to cardiovascular consequences. 

We begin by asking you to take and fill out the Sleep Assessment Survey linked below.  Based on the results we can determine if you should be further screened with a home sleep study, literally done in the privacy of your own home.  This will confirm the presence and the severity of a sleep disorder.

We appreciate you taking a few minutes to complete the attached survey, and thereby help us to potentially reduce your risk from cardiovascular disease.

Thank you,

Dr. Morris and Staff.



Sleep Hygiene

Sleep hygiene is defined as behaviors that one can do to help promote good sleep quality and quantity.

The importance of sleep:

Sleep is the time your brain uses to reset its own chemical balance. While the mix of chemicals in the brain is quite complex it is easiest to think of them all like liquids in a storage tank. During restful sleep you refill your storage tank. When the tank is full you awaken naturally. During the day you use up your storage tank and as it empties you feel tired and fall asleep.

In the ancient world this is how people lived – based on how they felt – tired or awake.

Today we have modified our daily activities so much that we no longer pay attention to what our bodies are telling us. We get up when we’re still tired, we go to bed when we’re not tired, we stay awake when our bodies tell us to sleep. The cost of this change is feeling poorly. People have an increase in headaches, feel worn out and tired, and lack concentration  As a result, people use stimulants like sugar, caffeine and nicotine to try to keep going when they really need better sleep.

What can we do?:

First – listen to your body. By setting a proper environment for sleep you can assure yourself of both better quantity and quality of sleep. The following are some ideas to help you get the rest you need to feel energetic and happy.

Sleep hygiene tips:

Maintain a regular sleep routine

  • Go to bed at the same time. Wake up at the same time. Ideally, your schedule will remain the same ( /- 20 minutes) every night of the week.

Avoid naps if possible

  • Naps decrease the ‘Sleep Debt’ that is so necessary for easy sleep onset.
  • Each of us needs a certain amount of sleep per 24-hour period. We need that amount, and we don’t need more than that.
  • When we take naps, it decreases the amount of sleep that we need the next night – which may cause sleep fragmentation and difficulty initiating sleep, and may lead to insomnia and sleep deprivation.

Don’t stay in bed awake for more than 5-10 minutes.

  • If you find your mind racing, or worrying about not being able to sleep during the middle of the night, get out of bed, and sit in a chair in the dark. Do your mind racing in the chair until you are sleepy, then return to bed. No TV or internet during these periods! That will just stimulate you more than desired.
  • If this happens several times during the night, that is OK. Just maintain your regular wake time, and try to avoid naps.

Don’t watch TV or read in bed.

  • When you watch TV or read in bed, you associate the bed with wakefulness.
  • The bed is reserved for two things – sleep and sex.

Drink caffeinated drinks with caution

  • The effects of caffeine may last for several hours after ingestion. Caffeine can fragment sleep, and cause difficulty initiating sleep. If you drink caffeine, use it only before noon.
  • Remember that soda and tea contain caffeine as well.

Avoid inappropriate substances that interfere with sleep

  • Cigarettes, alcohol, and over-the-counter medications may cause fragmented sleep.

Exercise regularly

  • Exercise before 2 pm every day. Exercise promotes continuous sleep.
  • Avoid rigorous exercise before bedtime. Rigorous exercise circulates endorphins into the body which may cause difficulty initiating sleep.

Have a quiet, comfortable bedroom

  • Set your bedroom thermostat at a comfortable temperature. Generally, a little cooler is better than a little warmer.
  • Turn off the TV and other extraneous noise that may disrupt sleep. Background ‘white noise’ like a fan is OK.
  • If your pets awaken you, keep them outside the bedroom.
  • Your bedroom should be dark. Turn off bright lights.
  • Have a comfortable mattress.

If you are a ‘clock watcher’ at night, hide the clock.

Have a comfortable pre-bedtime routine

  • A warm bath, shower
  • Meditation, or quiet time

Some who are struggling with sleep regularly find it helpful to print out these recommendations and read them regularly. If you accidentally miss some recommendations, or have a bad night, do not fret. By following these sleep hygiene recommendations regularly, you will help yourself develop a routine that promotes better sleep.

How is Sleep Apnea Treated?

There have been a multitude of theories about what causes sleep apnea. Because of this there have been many treatments proposed as well. The solutions range from surgery on the various tissues in the nose, mouth and throat; to CPAP (continuous positive air pressure) and a very large selection of oral and nasal appliances. Because people vary in their response to treatment, many of these therapies have worked for at least some people. The best treatment is that which keeps the airway open with the fewest negative side effects and risk. Additionally, the treatment must be one which people will use.


CPAP meets many of the criteria for success. It opens the airway, has few side effects, has a low risk profile and is readily available. However, many people find the mask, tubes and associated maintenance to be too cumbersome and uncomfortable to use on a daily basis.


Surgery, likewise, has its proponents and for some conditions surgery is necessary. For instance, to remove overgrown tissue from the airway or correct malformed jaw bones. Surgery, however,  does not have a low risk profile, can have significant side effects, requires highly specialized skills and must be done in an operating room environment.


Oral appliances are suggested as a first line treatment for mild and moderate sleep apnea. Oral appliances can also be effective for severe sleep apnea and are used frequently is patients who don’t tolerate CPAP. Oral appliances require at least a few teeth to hold them in and do put a strain on the teeth and supporting structures. This is usually not significant. We will help with determining if your teeth are strong enough.


The key takeaway is that we seek to limit the bad effects of sleep apnea on your health with the fewest treatment side effects. The only way to know how you will respond to treatment is to measure your sleep apnea both before and after treatment. This is done with a home sleep test which records many parameters of sleep during the night. Both the experience in working with different devises and the ability to monitor the results of therapy are the reasons to choose professional help in treating your own sleep disorders.


The consequences of poor sleep are serious and substantial. We have a quick, easy and well thought out process to help you. Please contact us.