The connection between sleep apnea and Hashimoto’s

Photo: Kinga Cichewicz/Unsplash. Design: BOOST Thyroid.

Photo: Kinga Cichewicz/Unsplash. Design: BOOST Thyroid.

Interrupted sleep can lead to an underactive thyroid

Sleep apnea is a sleep disorder, where breathing stops during sleep for a period of 10 seconds or longer for a few times a night. Some symptoms of sleep apnea are similar to Hashimoto’s symptoms.

Breathing is automatically regulated during sleep, maintaining the healthy balance between oxygen and CO2. If the breathing is interrupted, oxygen levels drop — causing a lot of problems with brain capacity, hormonal balances, and healthy blood pressure (1, 2).

Sleep apnea can be mild, moderate, or severe, depending on how many episodes of interrupted sleep a person experiences (2).

Symptoms of sleep apnea (3)

  • Fatigue
    When breathing stops during sleep, thebrain is left without oxygen, and starts sending an SOS wakeup signal. Waking up for a few seconds — even without recognizing or remembering — disturbs the sleep cycle and will likely cause next day exhaustion. This can make it easy to fall asleep anytime, anywhere.

  • Memory problems
    Sleep apnea can cause memory and concentration difficulties as it interrupts deep sleep. Deep sleep aids in memory function.

  • Loud snoring
    Although not everyone that snores has sleep apnea, and not everyone who has sleep apnea snores. Sleep apnea can make sleep quite light, which can make it easier to be woken up by a full bladder.

  • Waking up with a headache
    Lack of oxygen can cause morning headaches, they usually resolve within a few hours after waking up.

  • Waking up with a dry throat and mouth
    Snoring and breathing mainly through the mouth, can inhibit the production of saliva by the salivary glands.

Can Hashimoto’s cause sleep apnea?

People that have Hashimoto’s or an underactive thyroid are more likely to develop sleep apnea (4). About 4 in 10 people with an underactive thyroid also have sleep apnea (5–10).

Hashimoto’s can usually causes a type of sleep apnea called obstructive sleep apnea (OSA), occurring when the throat is swollen and inhibiting breathing. Other health conditions, such as obesity, polycystic ovary syndrome (PCOS), and pituitary gland problems may cause OSA.

Hashimoto’s causes the thyroid to become bigger (goiter) and this narrows the throat’s airway passage, making it harder for air to pass through. Even if no goiter is present, there is still an ongoing inflammation — which means a lot of molecules causing inflammation can also affect the throat causing swelling (11).

With good health management — including regularly taking prescribed therapy, balancing TSH levels, reducing TPO and TG antibodies, and lifestyle adjustments — sleep apnea can be reduced (12–14).

Can sleep apnea cause Hashimoto’s?

Severe OSA can be present even with normal TSH levels, if thyroid antibodies TPO and TG are high. Sleep apnea causes inflammation, which triggers other autoimmune conditions. It’s possible that sleep apnea is one of many environmental factors that can trigger Hashimoto’s (15, 16).

What increases the risk of developing OSA? (17–20)

  • Being overweight and obese

  • Polycystic ovary syndrome

  • Type 2 diabetes

How to diagnose sleep apnea?

Sleep apnea is usually diagnosed after being observed during one or more nights of sleep in a hospital’s sleep lab. The first steps in diagnosis can be analyzed at home: recording snoring with apps like SnoreLab, detecting any variations in sleep pattern through wearables like FitBit and Oura ring, and tracking fatigue and memory in the BOOST Thyroid app.

Your healthcare provider may ask you additional questions and perform a physical examination of your throat (21–23).


  1. Guilleminault C, et al. The sleep apnea syndromes, 1976

  2. Malhotra A, et al. Obstructive sleep apnoea, 2002

  3. Spicuzza L, et al. Obstructive sleep apnoea syndrome and its management, 2015

  4. Erden S, et al. Hashimoto thyroiditis and obstructive sleep apnea syndrome: is there any relation between them? 2004

  5. Grunstein RR, et al. Sleep apnea and hypothyroidism: mechanisms and management, 1988

  6. Hira HS, et al. Sleep apnea syndrome among patients with hypothyroidism, 1999

  7. Lin CC, et al. The relationship between sleep apnea syndrome and hypothyroidism, 1992

  8. Meslier N, et al. Prevalence of hypothyroidism in sleep apnoea syndrome, 1992

  9. Misiolek M, et al. Sleep apnea syndrome and snoring in patients with hypothyroidism with relation to overweight, 2007

  10. Rajagopal KR, et al. Obstructive sleep apnea in hypothyroidism, 1984

  11. Deegan PC, et al. Goitre: a cause of obstructive sleep apnoea in euthyroid patients, 1997

  12. Jha A, et al. Thyroxine replacement therapy reverses sleep-disordered breathing in patients with primary hypothyroidism, 2006

  13. Lin CC, et al. The relationship between sleep apnea syndrome and hypothyroidism, 1992

  14. Skjodt NM, et al. Screening for hypothyroidism in sleep apnea, 1999

  15. Bozkurt NC, et al. The association between severity of obstructive sleep apnea and prevalence of Hashimoto’s thyroiditis, 2012

  16. Mirrakhimov AE. Obstructive sleep apnea and autoimmune rheumatic disease: is there any link? 2013

  17. Frey WC, et al. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery, 2003

  18. O’Keeffe T, et al. Evidence supporting routine polysomnography before bariatric surgery, 2004

  19. Vgontzas AN, et al. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance, 2001

  20. Reichmuth KJ, et al. Association of sleep apnea and type II diabetes: a population-based study, 2005

  21. Hoffstein V, et al.Predictive value of clinical features in diagnosing obstructive sleep apnea, 1993

  22. Rowley JA, et al.The use of clinical prediction formulas in the evaluation of obstructive sleep apnea, 2000

  23. Collop NA, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients, 2007