COMISA: When Insomnia and Sleep Apnea Collide
Do you struggle to fall asleep at night, only to be woken up choking or gasping for air? You might be dealing with more than just one sleep disorder. The two most common sleep disorders, insomnia and sleep apnea, often exist together in a condition known as Co-Morbid Insomnia and Sleep Apnea, or COMISA. Understanding this overlap is the first step toward getting a truly restful night's sleep.
What is Insomnia?
Insomnia is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or both, leading to significant daytime impairment. People with insomnia often experience:
Difficulty initiating sleep
Waking up frequently during the night
Waking up too early and being unable to return to sleep
Feeling anxious or developing negative associations with bedtime
Non-restorative sleep, leaving them tired upon waking
It's a persistent problem for 6-10% of adults, impacting their mood, concentration, and overall quality of life.
What is Sleep Apnea?
Obstructive sleep apnea (OSA) is a serious condition where the airway repeatedly narrows or closes during sleep, interrupting breathing. These pauses in breathing, called apneas, can happen hundreds of times a night. This leads to tell-tale symptoms like:
Loud snoring, often with pauses
Gasping or choking sounds during sleep
Morning headaches and dry mouth
Severe daytime sleepiness
Frequent awakenings
About 10% of adults have moderate-to-severe sleep apnea, which also causes significant daytime impairment.
Understanding COMISA: The Overlap of Insomnia and Sleep Apnea
For many people, the line between insomnia and sleep apnea is blurred. This overlap is COMISA, a diagnosis for those who suffer from both conditions simultaneously. The connection isn't a coincidence; each disorder can worsen the other. For instance, the anxiety from insomnia can make it harder to tolerate sleep apnea treatment, while the frequent awakenings from apnea can create the sleep habits and anxiety that fuel insomnia.
The statistics highlight this strong connection:
30-40% of people with chronic insomnia also have sleep apnea.
30-50% of people with sleep apnea also report significant insomnia symptoms.
This means that a huge number of people seeking help for one condition are unknowingly struggling with both.
Why COMISA is a Serious Health Concern
Having COMISA is more than just a bad night's sleep multiplied by two. The combination of insomnia and sleep apnea creates a unique and more severe set of challenges. People with COMISA often report worse outcomes than those with either condition alone, including:
Higher rates of depression, anxiety, and stress
More severe daytime fatigue and poor concentration
Worse overall physical health and quality of life
An increased risk of mortality
The constant struggle to fall asleep, coupled with frequent respiratory events throughout the night, creates a cycle of exhaustion and frustration that can feel impossible to escape.
How is COMISA Treated?
Because COMISA involves two distinct disorders, treatment must address both insomnia and sleep apnea.
Treating Sleep Apnea
The first-line treatment for moderate-to-severe sleep apnea is Continuous Positive Airway Pressure (CPAP) therapy. A CPAP machine keeps the airway open with a steady stream of air. However, people with COMISA often have lower CPAP compliance. The discomfort of the mask can worsen the anxiety and hyperarousal associated with their insomnia, making it harder to fall asleep and stick with the treatment.
Treating Insomnia
For insomnia, the gold-standard treatment is Cognitive Behavioral Therapy for Insomnia (CBT-I). This therapy helps patients reframe negative thoughts about sleep and build healthier sleep habits. Encouragingly, studies show that treating insomnia with CBT-I can have positive effects on sleep apnea. Patients not only sleep better but may also experience a reduction in the severity of their breathing events (AHI).
For anyone with COMISA, a combined treatment approach is essential for success. If you suspect your struggles with insomnia and sleep apnea are connected, it's crucial to speak with a sleep specialist to get a comprehensive diagnosis and a treatment plan that addresses both conditions.
If you are dealing with COMISA, we can start CBT-I even if the sleep apnea hasn’t been addressed yet! Go here to contact me about a free 15-minute phone consultation.