Sleep Apnea Secondary to PTSD

Sleep Apnea Secondary to PTSD

Many Veterans who have been diagnosed with PTSD are also facing symptoms of sleep apnea. This has led to Veterans questioning the link between PTSD and sleep apnea. More specifically, what is the risk factor for a Veteran with PTSD to display symptoms associated with sleep apnea. Can your PTSD lead to sleep apnea? The short answer: yes. PTSD can lead to sleep apnea. From a VA disability standpoint, this means a Veteran could develop sleep apnea secondary to PTSD and would therefore be entitled to compensation

In this article, we will discuss both post-traumatic stress disorder and sleep apnea and how these conditions can be linked to military service and each other. In addition, we will walk you through the steps you can take to appeal a Department of Veterans Affairs decision if you have been denied VA disability benefits for either of these conditions.

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a psychological condition that affects thousands of Veterans each year. Any form of traumatic experience can cause the condition. Some of the most common causes for PTSD in Veterans are:

  • Military Sexual Trauma (MST): Many Veterans endured sexual assault or abuse while in service in the military. However, this type of trauma is tragically under-reported and under-treated. Fortunately, the VA has taken steps in the last few decades to ensure that Veterans suffering from MST have better access to important resources, including VA disability compensation. 
  • Combat Experiences: Being on the frontlines while serving in the military can traumatize many soldiers. Many men and women serving in or around combat zones witness numerous deaths, often including the deaths of their friends and fellow soldiers. Engaging with the enemy can be equally traumatizing.
  • Combat experiences are some of the most common causes of PTSD in Veterans. 
  • Injuries: Getting severely injured, whether in combat, in an accident, or under other circumstances, can be highly traumatic for a soldier. Even decades after sustaining an injury, a Veteran may still have flashbacks, nightmares, and other symptoms related to their traumatic experience.

Other factors can also lead to the development of PTSD in soldiers, but these are some of the most common. 

Is PTSD Common?

PTSD is a prevalent disorder amongst those who have served in the military, so there is no shame if you suffer from it.

  • About 11-20% of Veterans that served in Iraq have PTSD
  • About 12% of Veterans who served in Desert Storm suffer from PTSD
  • About 30% of Veterans who served in Vietnam develop PTSD in their lifetime

These numbers show that you are not alone if you have PTSD. Once you recognize some of the symptoms and get a proper diagnosis of PTSD, the next important step is to seek treatment in order to stop your condition from progressing into something worse.

The Symptoms Of PTSD

There are four primary categories of PTSD symptoms: reliving, avoidance, negative thoughts and feelings, and arousal. 


Many people living with PTSD struggle with flashbacks, nightmares, and even insomnia due to the condition. These symptoms are often brought on by anything that serves as a reminder of a Veteran’s traumatic experience. As a result of PTSD symptoms, many Veterans develop sleep problems, including sleep apnea.


Veterans with PTSD may find themselves staying away from people, places, and items that remind them of their trauma. This avoidance can lead to isolation, pushing a Veteran away from relationships, work, and other responsibilities. Many Veterans with PTSD may have trouble staying consistent with their careers due to the avoidance-related symptoms of PTSD.

Negative Thoughts and Feelings

PTSD is sometimes treated with a toxic “blame the victim” mentality. The disability is often handled poorly by a sufferer’s friends and family, making a Veteran with PTSD feel responsible for their trauma. However, PTSD is not a weakness, nor is it something that anyone should blame themselves for. Nevertheless, many Veterans with PTSD feel intense guilt and shame related to their condition. 


Many sufferers of PTSD report a sense of being constantly “switched on,” a feeling that can lead to lingering anxiety and tension. A traumatic experience can make a Veteran with PTSD constantly feel like something is wrong, leading to hyper-arousal. The anxiety and stress that many PTSD sufferers experience can lead to the development of other physical or mental health problems.

Is There a Way To Diagnose PTSD?

If you believe you have symptoms of PTSD, it is best to visit a VA medical center or your local doctor and ask for a referral to a mental health professional. From there, you will be able to get a PTSD assessment or screening.

The assessment is highly specialized. It is designed so that the patient does not over-emphasize or de-emphasize their symptoms.

There is a blend of questionnaires and interviews done by medical and psychological professionals. Your spouse, if you have one, is also able to participate in this process.

The goal is to understand how frequently the symptoms occur and at what intensity. It may happen all in one session, or it may occur over multiple sessions.

Making a Claim for Your PTSD

Once your PTSD is diagnosed, it is time to make a claim through the VA. You can fill out VA Form 21-526 in order to apply for benefits.

It is best to give as much detail as possible in your application regarding your PTSD and how it connects to your time in the service. If you have any official reports that describe a certain event or situation that caused or aggravated your PTSD, make sure to include that in your application.

Buddy Statements

Buddy statements are a piece of evidence that many Veterans use to help describe the event that caused or aggravated their service-connected disability or the severity of their symptoms. Buddy statements can be written by fellow service members who witnessed the event or family members and friends who can describe your symptoms in detail. 

The writer of a buddy statement must give the most honest account they can. If they do not, they could be subject to fines or punishment.

C&P Exam

Once you apply for your benefits, the VA may require you to go to a compensation and pension examination (C&P exam). At this exam, you will go to your local VA medical center and undergo tests to see whether your PTSD is related to your time in the service and how severe your PTSD is. You must go to this exam. If you do not, the VA will likely deny your claim.

If they decide at your C&P exam that your PTSD is not service-related or the VA denies you a C&P exam, then you can do your own Independent Medical Examination (IME).

During the IME, a private doctor will give their opinion on whether your PTSD is service-related. Your doctor must read through any reports from your time in the military since it will give their opinion more weight when the VA finally examines it.

What Is Sleep Apnea?

One of the most common sleep disorders for Veterans is obstructive sleep apnea. Obstructive sleep apnea occurs when an individual stops breathing during sleep. This lack of breathing can last for either a few seconds or for several minutes. The symptoms associated with sleep apnea include fatigue, slow reflexes, and problems related to the heart. If you are a Veteran with PTSD and suffer from sleep apnea, you may be eligible for sleep apnea disability benefits as secondarily related to your service-connected PTSD.

Is Sleep Apnea Connected To PTSD?

An increasing number of scientific studies show that sleep apnea and PTSD are comorbid conditions. One study compared the records of 4 million Veterans with and without PTSD in order to find a connection between PTSD and sleep apnea. They found an incredible statistical difference. Approximately 11.85% of individuals who have PTSD also had sleep apnea. This is a relatively significant difference when you compare it to the 4.74% of individuals with sleep apnea who do not have PTSD. 

Thus, according to the study, individuals with PTSD are 2.7 times more likely to suffer from sleep apnea than those without PTSD. This means Veterans are at a higher risk of having sleep apnea secondary to PTSD. This statistic does not verify that a Veteran’s sleep apnea is secondary to PTSD, but it is still helpful. To get service connected, a Veteran will need to provide the VA with medical records and other information to verify that the two conditions are directly linked.

This study is not unique. In fact, other researchers have come to the same conclusion — that the development of PTSD can cause or aggravate sleep apnea. Researchers at Walter Reed Army medical center looked at sleep problems among 80 OIF/OEF Veterans returning from combat diagnosed with PTSD.  Almost all of them said they had problems sleeping, and almost two-thirds suffered from sleep apnea. This is substantial compared to the American frequency of 20% of men and 9% of women who have had sleep apnea at some time in their lives.

However, at the time of writing, there is no concrete or scientific basis for a 100% link between sleep apnea and PTSD. Some people develop sleep apnea (in both its minor and severe forms) naturally as they get older, partially due to developments in their bodies or weight gain.

Can I Still Connect My Sleep Apnea to PTSD?

The most common type of sleep apnea is obstructive sleep apnea (OSA). This causes your airways to become blocked or collapsed during sleep. That said, sleep apnea prevents you from getting plenty of rest and experiencing the restorative effect of sleep. Because of this, it may make your other PTSD symptoms worse.

For example, if you suffer PTSD because of a traumatic event you experienced during your military service, your sleep apnea may cause those symptoms to exacerbate. Without enough sleep, you may have more difficulty regulating your mood, concentrating at work, and carrying out other day-to-day tasks.

In keeping with other PTSD symptoms, Veterans can begin to feel symptoms or connections to their sleep apnea at different times. For example, some Veterans have sleep apnea symptoms related to their PTSD right after experiencing a traumatic event. Others don’t experience symptoms until months or years after the event occurs.

What Is a Secondary Service Connection?

Secondary service connection can be established both where a service-connected condition contributes to the creation of a new disability and where a service-connected disability aggravates (worsens) a non-service-connected condition.

Most mental and physical conditions can lead to other disabilities that are compensable by the VA. For example, let’s say a Veteran has diabetes related to Agent Orange. The Veteran is entitled to disability compensation for diabetes. However, the Veteran may also suffer from neuropathy, which is pain and nerve damage typically caused by diabetes. Because the diabetes caused the neuropathy, the Veteran should be entitled to compensation for that as well.

Now, if a Veteran has been diagnosed with PTSD and is also displaying sleep apnea symptoms, they could receive disability compensation for both PTSD and sleep apnea. To receive compensation, the Veteran would need to prove service connection for sleep apnea secondary to PTSD.

To prove that there is a connection between sleep apnea and PTSD, a disabled Veteran will need to medically verify that their PTSD symptoms led to the development or exacerbation of sleep apnea and sleep deprivation. A Veteran may have had a sleep apnea diagnosis before being diagnosed with PTSD. However, sleep apnea can still be considered a secondary condition if the Veteran’s symptoms were made worse by PTSD.

Making a Claim for Your PTSD and Sleep Apnea

If you believe you have PTSD and your sleep apnea symptoms are worsening your condition, you can and should make a claim for disability benefits. You can either apply for disability benefits initially or appeal to have your disability rating increased, given the new severity of your symptoms.

Making a claim for your PTSD means filing VA Form 21-526. This is the starting point at which you can begin applying for benefits. On your application, remember to include as much detail as possible regarding your PTSD, your sleep apnea symptoms, and how both connect to your time in the military. Knowledgeable Veterans law attorneys can help you file a successful, detailed application on time.

You should consider adding buddy statements to your application for benefits as well. Buddy statements are statements written by fellow servicemembers who witnessed the traumatic event that caused or aggravated your PTSD, alongside friends and family members who may be able to describe your symptoms in detail. For example, your spouse should be able to detail how your snoring has gotten worse and prevented you from sleeping or dealing with your PTSD.

You’ll also need to go through a compensation and pension examination (C&P exam). The C&P exam will be carried out by a private medical professional. You’ll go to a doctor’s office, answer questions, and submit to examinations. The doctor will then analyze your condition and write a recommendation for the VA, including helping the organization determine if your PTSD is connected to your military service.

No matter the details of your case, Veterans law attorneys can help. Making a claim for your PTSD and sleep apnea doesn’t have to be complex or tricky. With the right legal assistance, you’ll know exactly what to do and make the best decisions for you and your family.


Applying for benefits through the VA can be a difficult task. With disorders such as PTSD, there are even more complicated steps.

Because applying for benefits and gathering evidence can take a long time and a lot of work, it is always best to have an attorney at your side that can help you along the way. At Berry Law, our experience has led to many Veterans receiving the compensation they deserve while also allowing some of the burden relieved from Veterans.

For any more information or questions that you may have concerning VA applications, visit our website.


[PDF] Association of psychiatric disorders and sleep apnea in a large cohort. | Semantic Scholar

What Is Sleep Apnea? | NHLBI, NIH

About VA Form 21-526EZ | Veterans Affairs

Berry Law

The attorneys at Berry Law are dedicated to helping injured Veterans. With extensive experience working with VA disability claims, Berry Law can help you with your disability appeals.

This material is for informational purposes only. It does not create an attorney-client relationship between the Firm and the reader, and does not constitute legal advice. Legal advice must be tailored to the specific circumstances of each case, and the contents of this blog are not a substitute for legal counsel.

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