Sleep Apnea and Insomnia: Are They Related?

If you struggle with insomnia despite trying various medications without success, it’s possible you might have sleep apnea or another breathing disorder disrupting your sleep.

Some people endure years of failed treatments, feeling exhausted and hopeless. But there’s hope. Forward-thinking sleep experts have discovered that sleep apnea can be the root cause of certain insomnia cases.

In this article, we explore the connection between these sleep disorders, the risks associated with both, and the treatment options for comorbid insomnia and sleep apnea (COMISA).

What is Insomnia?

Sleep Apnea and Insomnia

Insomnia is a sleep disorder that makes it difficult to fall asleep or stay asleep. It can also cause you to wake up too early and struggle to go back to sleep, leaving you feeling tired the next morning. Insomnia can drain your energy, affect your mood, and impact your overall health, work performance, and quality of life.

Adults need 7 to 9 hours of sleep, but it varies from person to person.

The majority of adults experience short-term insomnia at some point, usually caused by stress or a distressing event. Some people, however, suffer from chronic insomnia, which lasts three months or longer. Sometimes insomnia is the issue, but it can also be a side effect of another medical condition.

There is no need for you to endure sleepless nights. You may find relief by making simple changes to your daily habits.

What is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder (SRBD) where the airway repeatedly closes partially or completely during sleep.

OSA is the most severe type of SRBD, but other types include hypopneas, respiratory-effort related arousal (RERA), and upper airway resistance (UAR).

During OSA, the airway is fully obstructed, while in hypopneas, RERAs, and UARs, the obstruction is partial. All of these SRBDs can lead to various medical issues.

How Are Sleep Apnea and Insomnia Related?

There is a strong link between insomnia and sleep apnea. According to a 2019 review, having one condition increases the likelihood of having the other by 30–50%. Another study from 2021 suggests that insomnia symptoms are 40–60% more common among those with sleep apnea compared to the general population.

This association isn’t fully understood, but there are a couple of possibilities:

  • Sleep deprivation caused by insomnia may weaken upper-airway muscles and reduce oxygen levels.
  • People with chronic insomnia may be more likely to experience obstructive sleep apnea.
  • Insomnia may lead to lighter sleep, so you wake up easier during apneas.
  • Sleep apnea itself can disrupt sleep patterns and contribute to insomnia.

There’s ongoing research to better understand how comorbid insomnia and sleep apnea (COMISA) interact.

Symptoms to Watch For

Sleep-related breathing disorders (SRBDs), such as obstructive sleep apnea (OSA), are linked to various health issues like heart disease, stroke, depression, metabolic problems, and even mortality. Lesser-known symptoms of OSA/SRBD include:

  1. Dry Mouth: Due to airway obstruction, OSA reduces oxygen intake, leading to mouth breathing and dry mouth in the morning. This dryness is a reliable indicator of OSA.

  2. Morning Headaches: A build-up of carbon dioxide in the brain causes vasodilation and pressure on cerebral arteries, resulting in morning headaches.

  3. Urinating at Night: Apnea causes frequent urination at night because of increased pressure in the obstructed airway. The pressure affects the veins, causing the right atrium to dilate. As a result of fluid overload, the heart releases a natural diuretic peptide and increases urine production, causing frequent nighttime bathroom trips.

Risks of COMISA

Insomnia and sleep apnea share common symptoms, which can be more severe in individuals with comorbid insomnia and sleep apnea (COMISA). These symptoms include:

  • Feeling unrefreshed by sleep
  • Fatigue or daytime sleepiness
  • Difficulty falling asleep, staying asleep, or waking up
  • Issues with attention, concentration, and memory
  • Mood or social dysfunctions

These symptoms can reduce quality of life and raise the risk of accidents. Moreover, poor sleep quality is increasingly linked to serious health issues such as stress, high blood pressure, high cholesterol, heart attack, and cancer, as indicated by a 2017 review. Given these potential consequences, it’s crucial for individuals with COMISA to seek diagnosis and treatment.

COMISA Diagnosis and Treatment

Diagnosing COMISA involves identifying both sleep apnea and insomnia in the same individual. There’s no standardized diagnostic procedure; doctors typically diagnose each condition separately.

For insomnia diagnosis, doctors may use:

  • Questionnaires
  • Reviewing sleep diaries
  • Actigraphy, which monitors sleep habits using a wristwatch-like device

Polysomnography tests, primarily used for sleep apnea diagnosis, may also be employed if other sleep disorders are suspected.

Treatment for COMISA involves addressing both insomnia and sleep apnea. However, treating both simultaneously presents unique challenges. Continuous positive airway pressure (CPAP) therapy is standard for moderate to severe sleep apnea but may be challenging for those with insomnia due to discomfort.

Some experts suggest starting insomnia treatment, particularly cognitive behavioral therapy for insomnia (CBT-I), before CPAP therapy. Evidence supports the effectiveness of initiating CBT-I before or alongside CPAP therapy, but the optimal combination remains uncertain.

For mild cases of sleep apnea, you may consider using some anti-snoring devices or anti-snoring mouthpieces.

How to Improve Sleep If You Have Sleep Apnea or Insomnia

Healthy sleep is important, especially if you have sleep apnea or insomnia. Here are four tips to help you sleep better:

1. Set a Consistent Bedtime Routine

You can regulate your body’s sleep-wake cycle by going to bed and waking up at the same time each day. Before bedtime, spend an hour reading or meditating to wind down. It is best to avoid stimulating activities and electronic devices that emit blue light, which can interfere with sleep.

2. Watch Your Diet and Drinks

You should avoid large meals, caffeine, and alcohol close to bedtime. When you eat a large meal, digestion takes priority over rest, while caffeine keeps you awake. You may feel sleepy after drinking alcohol, but it can disrupt your sleep pattern and worsen sleep apnea symptoms.

3. Get Tested for Both Disorders

If you are experiencing the symptoms of one sleep disorder, consider getting tested for the other as well. Insomnia and sleep apnea often coexist and share similar symptoms. Sleep studies can help diagnose sleep disorders accurately.

4. Follow Your Treatment Plan

Keep following the prescribed treatment for your sleep disorder. For insomnia, treatments may include sleep aids or cognitive behavioral therapy. Continuous positive airway pressure (CPAP) therapy is a common treatment for sleep apnea, but if it’s uncomfortable or ineffective, discuss alternatives with your doctor.

The Bottom Line

If you do not treat your sleep disorders, your overall health will suffer. You should consult a sleep specialist if you are uncertain about your sleep quality or suspect that you have a sleep disorder.

Need professional help to diagnose and address your sleep problems? Schedule an online consultation with sleep specialist Dr. John Williams.

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