Can Hypothyroidism Cause Obstructive Sleep Apnea or Insomnia?

Problems Breathing in Sleep, Awakenings May Occur Due to Thyroid Problems

Thyroid problems like hypothyroidism may contribute to sleep disorders like obstructive sleep apnea and insomnia and treatment may help
Thyroid problems like hypothyroidism may contribute to sleep disorders like obstructive sleep apnea and insomnia and treatment may help. nicolesy/E+/Getty Images

For individuals with sleep-disordered breathing like snoring and witnessed pauses or gasping, the cause of their obstructive sleep apnea can occasionally be somewhat elusive. Although it may not be a common contributor, hypothyroidism may surprisingly play a role. Consider whether thyroid hormone problems may be contributing to difficulty sleeping like sleep apnea (or even insomnia), blood testing options, and how treatment with thyroid replacement may help.

What Is Hypothyroidism and How Does It Impact Breathing?

Hypothyroidism refers to the inadequate secretion of thyroid hormones by the thyroid gland in the neck. This is sometimes referred to as having an underactive thyroid. When hypothyroidism is present, there may be changes within the upper airway that lead to difficulties breathing during sleep.

How Are Hypothyroidism and Obstructive Sleep Apnea Related?

Like hypothyroidism, obstructive sleep apnea is a relatively common disorder in the general population. Patients with obstructive sleep apnea often experience symptoms including excessive daytime sleepiness, apathy, and feeling lethargic. These symptoms are also common in hypothyroidism, making the two disorders difficult to tease apart based on a patient's history and physical. 

In addition, patients with hypothyroidism may be at greater risk for developing obstructive sleep apnea, due to multiple factors involving respiration, such as a decreased ability to respond to chemical changes within the blood and even damage to the nerves or muscles involved in breathing.

In addition, hypothyroidism may contribute to obstructive sleep apnea through enlargement of the tongue (called macroglossia) or disruption of the muscles that control the upper airway. Finally, patients with hypothyroidism are at risk for obesity, another factor that contributes to obstructive sleep apnea.

 

The Link of Thyroid Problems to Insomnia

Some people with hypothyroidism and sleep apnea will experience insomnia. Sleep apnea may cause disrupted breathing that leads to sudden arousals from sleep. This may be characterized by frequent awakenings during the night, especially towards morning during REM sleep. Sleep may be light and unrefreshing.

Due to the poor quality of the sleep, the time in bed may be extended. Going to bed early, or staying in bed too late, may lead to problems falling asleep at the beginning of the night. If the time in bed exceeds the amount of sleep that is needed to feel rested, chronic insomnia may ensure.

As such, it may be important to look for sleep apnea if insomnia symptoms are experienced in the context of thyroid dysfunction.

Treating the Source of Obstructive Sleep Apnea

Hypothyroidism is relatively easy to diagnose and treat based on the results of blood tests measuring various indicators of thyroid function. For those already diagnosed with hypothyroidism and symptoms of sleep apnea, a sleep study can help determine whether sleep apnea is present. During a sleep study, healthcare providers will monitor your sleep either in a lab or at your home using portable home sleep apnea testing equipment.

 

Patients with symptoms of sleep apnea who are either referred for testing or have been officially diagnosed may wish to ask their physicians to order a blood test to analyze their thyroid levels, especially if their symptoms persist despite appropriate sleep apnea treatments. Sleep apnea is most commonly treated with continuous positive airway pressure (CPAP) therapy. Alternatives include oral appliances from dentists, surgery, positional therapy, and weight loss.

In addition to the symptoms that overlap with sleep apnea, there are some additional symptoms that can make a diagnosis of hypothyroidism more likely.

These include:

  • Sensitivity to cold
  • Constipation
  • Dry skin
  • Brittle nails
  • Hair loss
  • Unexplained weight gain
  • High cholesterol
  • Irritability
  • Sexual dysfunction
  • Slow heart rate
  • Irregular uterine bleeding

If you have some of these symptoms, it may be time to speak with your doctor about getting a blood test to evaluate the function of your thyroid. Generally, it can be helpful to evaluate the thyroid-stimulating hormone (TSH). If this is abnormally elevated, suggesting that the thyroid is not working properly, the levels of T3 and T4 may also be tested.

Fortunately, if hypothyroidism is causing sleep apnea or breathing difficulties, it will improve with thyroid hormone replacement. This is typically taken as a pill called Synthroid (levothyroxine). There are also natural alternatives, derived from animal sources, such as Armour thyroid.

A Word from Verywell

It is very common to have hypothyroidism. It is also very common to have sleep apnea. There may be a relationship between the two conditions. If you have persisting symptoms, despite a normalization of your blood testing, consider the role of sleep apnea. It may be helpful to have a sleep study after an evaluation by a board-certified sleep specialist. If sleep apnea is discovered, and effectively treated, you may enjoy both improvements in your health and well-being.

Source:

Skatrud J et al. "Disordered breathing during sleep in hypothyroidism." Am Rev Respir Dis 1981;124:325.

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