Breathing Disorders Steal Sleep and Strain Mental Health: Why Older Adults Must Get Diagnosed and Treated

You or a loved one wakes up gasping for air. The days are blending together. You feel anxious or forgetful—and you wonder if it's just aging. You're not alone.

Breathing is automatic, but when it falters — especially at night — your body and mind pay the price. For many adults, especially as you age, undiagnosed breathing problems can be the hidden cause of anxiety, depression, memory issues, and even heart trouble.

Doctors have long known that sleep apnea and other breathing disorders disrupt rest. Now, research shows these interruptions also reshape brain chemistry, flooding your body with stress hormones and altering mood-regulating neurotransmitters like serotonin and dopamine.

Breathing problems are common—and often misunderstood—and many people ignore the problem or just make fun of it. It is a serious health issue that can become more serious as you age.

From traditional sleep apnea equipment like CPAP machines to innovative solutions like the Inspire therapy system, addressing breathing disorders has become a cornerstone of complete mental and physical health care.

Understanding them can help you reclaim rest, mood, and independence.

Breathing Problems Increase with Age

Let’s explore how aging affects breathing—and why older adults are at greater risk.

As you get older:

• Natural muscle tone decreases, making airway collapse during sleep more likely.
• Body changes—including weight gain or fat redistribution—increase pressure around the neck and throat.
• Chronic conditions (heart disease, diabetes, COPD) and certain medications (sedatives, pain meds) worsen breathing control during sleep.

By one estimate, up to 30 percent of older adults may have obstructive sleep apnea (OSA), though many go undiagnosed. Research indicates that as many as 70 percent of nursing home residents have OSA.

Around 1 billion people worldwide are estimated to have obstructive sleep apnea (OSA), but it often goes undiagnosed or untreated. There are many reasons someone can feel tired, overworked, stressed out, etc. And until someone complains about your snoring or points out the amount of caffeine you’re consuming, or you go over the rumble strip while driving, or something drastic happens, you tend to ignore it. — Gracia Nabhane, MD, MU Health Care sleep specialist.

Mental Health, Memory and More

Let’s look at how poor breathing affects your mind.

Interrupted breathing at night reduces oxygen, increases carbon dioxide, and triggers stress hormones like cortisol. That fight-or-flight response fragments sleep and disrupts your mood.

• One study of OSA patients found depression in 35 percent and anxiety in 43.8 percent.
• Reviews show depression prevalence in OSA patients ranges widely, from 5 percent to as high as 60 percent.
• OSA can mimic dementia. It fragments sleep needed for memory consolidation and clear thinking. Untreated, it worsens cognitive decline.

Sleep‑disordered breathing is a powerful, under‑recognized driver of mental health symptoms.

Physicians who see people with depression shouldn't stop at the first diagnosis, but instead look into the presence of a breathing-related sleep disorder. — Maurice Ohayon, M.D., PhD, associate professor of psychiatry and behavioral sciences, Stanford University School of Medicine.

Health Consequences Beyond the Mind

Let’s review the broader risks of untreated breathing problems.

They include:

• Higher chances of high blood pressure, heart disease, and stroke
• Worsened diabetes control
• Falls and injuries due to daytime sleepiness and poor concentration

Untreated OSA costs the U.S. health care system more than $1,300 extra per person annually. Addressing apnea can reduce these risks and preserve independence.

How Sleep Disorders Get Diagnosed

If you suspect a breathing problem, the first step is a proper sleep study. These tests, called polysomnography, measure your breathing, oxygen levels, heart rate, and brain activity while you sleep. A full study is often done overnight in a sleep lab, but increasingly, home sleep apnea tests (HSATs) provide a convenient, less expensive option.

Home sleep tests use portable monitors to track breathing patterns and oxygen drops while you sleep in your own bed. They can detect obstructive sleep apnea but may miss subtler conditions like central sleep apnea or upper airway resistance syndrome. That’s why doctors sometimes recommend a lab-based study for a clearer picture.

Diagnosis matters. Many older adults live with fatigue, mood changes, or memory issues without realizing that sleep-disordered breathing is to blame. Identifying the problem allows for treatment that can improve both mental and physical health.

In a Long-Term Care Facility or at Home: Why It Matters

This issue matters even more if you or a loved one lives in an extended care facility or receives help at home.

In facilities, untreated obstructive sleep apnea can show up as daytime sleepiness, agitation, or confusion—symptoms that can be mistaken for cognitive decline. A proper diagnosis points staff to the real cause. When therapy such as CPAP is started and supported, teams often see better alertness and mood and fewer avoidable transfers. Effectiveness depends on consistent use; poor adherence undermines benefit.

At home, caregivers may struggle with a loved one who is constantly fatigued or irritable. Instead of chalking it up to “getting older,” ask about nighttime breathing. Home sleep apnea testing (HSAT) is widely used for appropriate, uncomplicated adults when ordered by a clinician, with in-lab polysomnography recommended when HSAT is negative, inconclusive, or the patient has significant comorbidities. Medicare covers several HSAT device types under defined criteria.

Why Caregivers and Facilities Must Support Device Use

Getting a diagnosis is the first step. The real work is adherence—especially for older adults who rely on caregivers or live in long-term care. CPAP (or, when CPAP cannot be used, alternatives such as hypoglossal nerve stimulation) only works when used as prescribed.

In long-term care facilities, staff should ensure residents use prescribed devices nightly. A mask on the nightstand does nothing. Facilities need protocols for proper mask fitting, cleaning, humidification, and quick troubleshooting of leaks, skin irritation, or discomfort. Consistent use is linked to fewer nighttime awakenings, better mood, and lower health risks—and can reduce readmissions and other utilization in older adults with cardiovascular disease.

Early evidence also suggests CPAP may reduce fall-risk markers in seniors, likely by improving daytime alertness. For those aging at home, families can support adherence by checking nightly use, encouraging follow-ups with the sleep team, coordinating with the equipment provider, and watching for warning signs that the device isn’t working well—persistent fatigue, snoring, mask pain, or dryness.

If CPAP truly can’t be tolerated, ask about alternative therapies and whether you’re a candidate for them. (The NEJM STAR trial established hypoglossal nerve stimulation as an option for selected CPAP-intolerant patients.)

Supporting device use isn’t just about better sleep. For older adults in care settings, better adherence is associated with safer days, fewer preventable transfers, and a higher quality of life.

If you are looking for professional in-home caregivers or a long-term care facility for a loved one, use the resources available with the LTC News Caregiver Directory.

• Guide to Home Care: Services, Costs, and Search Tools
• Guide to Assisted Living: Facility Services, Costs, and Search Tools
• Complete Guide To Nursing Homes

Long-Term Care Insurance can also make a difference. A loved one with LTC Insurance coverage often has access to higher-quality in-home caregivers and extended care facilities that can manage sleep and breathy disorders.

Treatments That Make a Real Difference

Here’s how proper treatment helps—and what your options are.

Today’s therapies include:

• CPAP therapy keeps your airway open at night. It improves sleep, mood, and blood pressure, though long-term use can be a challenge.
• Inspire therapy, an FDA-approved implant, stimulates the hypoglossal nerve to keep airways open. In the STAR trial, it reduced apnea-hypopnea events by 78 percent and improved quality of life measures.
• Oral appliances that reposition your jaw or tongue—especially for mild to moderate OSA.
• Lifestyle changes—like losing weight, avoiding alcohol before bed, managing medications, and sleeping on your side—can ease symptoms.
• CBT-I (cognitive behavioral therapy for insomnia) helps break anxious breathing patterns and restores sleep rhythms.

For cases of mild OSA, these lifestyle changes may be all you need to successfully treat the disorder. For more advanced cases, there are interventions other than CPAP that can be explored, including custom-designed mouth pieces worn at night that hold the lower jaw forward during sleep, as well as a variety of surgical procedures. — Eric Olson, M.D., Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota.

What You Can Do Next

Let’s end with practical steps you can take today.

Watch for these signs:

• Loud or chronic snoring
• Waking up gasping or choking
• Morning headaches
• Feeling exhausted even after “enough” sleep
• Mood swings or memory issues

Talk to your doctor about a sleep study—either at home or in a lab. This simple step may reveal a treatable condition that’s behind fatigue, irritability, or forgetfulness. 

Better breathing nights can lead to brighter mornings: clearer thinking, calmer moods, fewer falls—and more time doing what you love. It’s not just aging—it’s medicine working for you.