Insomnia and obstructive sleep apnea (OSA) are two of the most common sleep disorders, and they often occur together in a condition sometimes called “COMISA” (co-morbid insomnia and sleep apnea). When they co-occur, the symptoms, impacts, and treatments can be more complex than when either disorder occurs alone. Here’s a closer look at what each disorder involves and why managing them together can be so important.
What is Obstructive Sleep Apnea?
OSA affects about 10% to 20% of middle-aged to older adults and occurs when the upper airway is repeatedly blocked during sleep, causing breathing pauses (apneas) or shallow breaths (hypopneas). These interruptions lower blood oxygen levels and activate the sympathetic nervous system, which disrupts sleep and can lead to daytime sleepiness and increased cardiovascular risks. Severe OSA is associated with a higher risk of mortality and serious health issues, including hypertension and diabetes.
What is Insomnia?
Insomnia, experienced by 6% to 30% of adults, is marked by trouble falling asleep, staying asleep, or waking up too early, often for at least three months. It’s linked to issues like daytime fatigue, reduced productivity, and a higher risk of accidents. Insomnia can also increase the risk of mental health conditions, hypertension, and metabolic disorders. Research suggests that insomnia involves hyperarousal, both mentally (racing thoughts) and physically (elevated body temperature and muscle tension).
Why Do OSA and Insomnia Co-Occur?
Historically, insomnia was seen as a secondary symptom of conditions like OSA, but experts now recognize insomnia as a distinct disorder that can exist alongside OSA. This perspective allows for diagnosing “comorbid insomnia” with OSA, recognizing that the two conditions can exacerbate each other, making symptoms worse.
Treating COMISA
When OSA and insomnia occur together, treating both is key to improving sleep quality and overall health. Untreated, these disorders can amplify each other, making it harder to manage symptoms like daytime fatigue and cardiovascular health risks. Specialized treatment approaches, often combining therapies for sleep apnea (like CPAP) and insomnia (such as cognitive behavioral therapy), can be more effective than treating one disorder alone.
Understanding the interplay between insomnia and OSA helps professionals better tailor care for people dealing with both. For those experiencing disrupted sleep, addressing both issues together can lead to better health outcomes and a better quality of life.
Ong JC, Crawford MR. Insomnia and Obstructive Sleep Apnea. Sleep Med Clin. 2013 Sep 1;8(3):389-398. doi: 10.1016/j.jsmc.2013.04.004. PMID: 24015117; PMCID: PMC3763954.