Sleep Apnoea and Co-morbid insomnia

Poor sleep is a major public health issue that is associated with impairment of sleep, daytime function, mental health and physical health outcomes, and mortality risk. Sleep is vital to our health and well-being, impacting both our physical and mental health. For some people, the path to a peaceful night's sleep encounters obstacles in the form of the complex interplay between sleep apnea and co-morbid insomnia 1-2. It is estimated that 30% - 50% of people with OSA may also have significant insomnia 3.

Sleep Apnea explained:

Sleep apnea is a common condition where a person can have breathing pauses in breath during sleep caused by intermittent narrowing or collapse of the upper airway. These breathing pauses can occur numerous times resulting in broken, disrupted, and unrefreshing sleep. Obstructive sleep apnea (OSA) is thought to affect 1 billion people globally which is a major health concern for those that have this diagnosis, and it represents a huge healthcare burden 4.

Co-morbid Insomnia:

Co-morbid insomnia occurs when insomnia coexists with another medical or psychiatric condition. In the context of sleep apnea, this concurrent insomnia often presents as challenges in initiating or maintaining sleep, frequent awakenings, or experiencing sleep that doesn't provide the expected restoration. The dynamic interaction between these two disorders can establish a cycle of sleep deprivation, amplifying the symptoms of both conditions1-3.

Co-morbid Insomnia is linked to mortality:

Three epidemiological studies using the Sleep Heart Health Study, 5, National Health and Nutrition Examination Survey, ,6 and Wisconsin Sleep Cohort 7, data (a total sample size of 13,248) have reported that people with COMISA experience a 47% to 71% increased risk of all-cause mortality over 10 to 20 years of follow-up, compared to people with neither condition. Insomnia alone and OSA alone were not linked with increased risk of mortality in controlled models.

The Vicious Cycle:

Sleep apnea and insomnia often create a vicious cycle, with each condition impacting and magnifying the effects of the other. The frequent disruptions in sleep due to apnea events can induce insomnia symptoms, while the increased stress and anxiety linked to insomnia can worsen the severity of sleep apnea. Breaking this cycle requires a thorough approach that recognises and tackles the distinct challenges presented by each disorder

Treatment Strategies:

Continuous Positive Airway Pressure (CPAP) Therapy: The most common and effective treatment for sleep apnea involves using a CPAP device during sleep which keeps the airway open and prevents breathing pauses from occurring.

Lifestyle Modifications:

Adopting healthy sleep routine practices, such as maintaining a consistent sleep schedule, creating a conducive sleep environment, and avoiding stimulants before bedtime, can be beneficial for co-morbid insomnia and sleep apnea.

Cognitive Behavioural Therapy for Insomnia (CBT-I):

CBT-I is a structured program that helps individuals identify and modify thoughts and behaviours that contribute to insomnia. It can be a valuable component in managing the co-morbid aspects of these sleep disorders 8.

The intricate challenges posed by sleep apnea and co-morbid insomnia create a nuanced set of obstacles impacting both sleep quality and overall well-being. To enhance sleep and promote a more energised life, it is crucial to seek expert guidance to reach a comprehensive treatment plan. By grasping the interconnected nature of these disorders, individuals can proactively work towards breaking the cycle and attaining refreshing sleep.

References:

1.Yu Y. Links between Sleep Apnoea and Insomnia in a British Cohort. Clocks Sleep. 2023 Sep 11;5(3):552-565. doi: 10.3390/clockssleep5030036. PMID: 37754354; PMCID: PMC10529849.References:

2.Sweetman A, Osman A, Lack L, Crawford M, Wallace D. Co-morbid insomnia and sleep apnea (COM CP.0000000000001007. Epub 2023 Aug 29. PMID: 37642477.

3.Cho YW, Kim KT, Moon HJ, Korostyshevskiy VR, Motamedi GK, Yang KI. Comorbid Insomnia With Obstructive Sleep Apnea: Clinical Characteristics and Risk Factors. J Clin Sleep Med. 2018 Mar 15;14(3):409-417. doi: 10.5664/jcsm.6988. PMID: 29458695; PMCID: PMC5837842.

4. Bjorvatn B, Pallesen S, Grønli J, et al. Prevalence and correlates of insomnia and excessive sleepiness in adults with obstructive sleep apnea symptoms. Percept Mot Skills. 2014 Apr;118(2):571-86.

5. Lechat B, Appleton S, Melaku Y, et al. Co-morbid insomnia and obstructive sleep apnoea is associated with all-cause mortality. Euro Resp J. 2021;in press.

6. Lechat B, Appleton S, Melaku YA, Hansen K, McEvoy RD, Adams R, Catcheside P, Lack L, Eckert DJ, Sweetman A. Comorbid insomnia and sleep apnoea is associated with all-cause mortality. Eur Respir J. 2022 Jul 13;60(1):2101958. doi: 10.1183/13993003.01958-2021. PMID: 34857613.

7.Slowik JM, Sankari A, Collen JF. Obstructive sleep apnea. InStatPearls [Internet] 2022 Jun 28. StatPearls Publishing.

8.Sweetman A, Lack L, Bastien C. Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials. Brain Sci. 2019 Dec 12;9(12):371. doi: 10.3390/brainsci9120371. PMID: 31842520; PMCID: PMC6956217.