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Sleep Apnoea and Co-morbid insomnia


Sleep Apnea and Co-morbid Insomnia explained. 


  • 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 wellbeing, impacting on 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 insomnia1-2. 

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 health care burden3. 

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 conditions1-2.

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:

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

Lifestyle Modifications:

  • 2: 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 with co-morbid insomnia and sleep apnea.


Cognitive Behavioural Therapy for Insomnia (CBT-I):

  • 3: 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 disorders4.

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.


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 (COMISA): recent research and future directions. Curr Opin Pulm Med. 2023 Nov 1;29(6):567-573. doi: 10.1097/MCP.0000000000001007. Epub 2023 Aug 29. PMID: 37642477.

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

4.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.


Patients with Complex OSA represent a treatment challenge and the optimal therapeutic approaches remain to be defined. They have more problems adapting to CPAP with large residual AHI/CAI events similar to the situation with CSA patients. In most Complex OSA cases, CSA events during initial CPAP titration are transient and they disappear after continued CPAP use. Because Complex OSA patients have a poor initial experience with CPAP, they may be nonadherent with continued therapy. Treatment options like Adapto servo ventilation (ASV are available that may rapidly resolve the disorder and relieve the symptoms of this disease with the potential of increasing early adherence to therapy. But not all Complex OSA patients need an expensive and complicated device. 

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