Sleep Apnoea and Co-morbid Insomnia

Poor Sleep and Its Impact

Poor sleep is a major public health issue linked to impaired daytime function, mental health challenges, physical health conditions, and even increased mortality risk. Sleep is essential for overall well-being, and for some, the path to restorative rest is disrupted by the combined effects of sleep apnoea and co-morbid insomnia. It’s estimated that 30% to 50% of people with sleep apnoea may also experience significant insomnia symptoms.

Sleep Apnoea Explained

Sleep apnoea is a common condition where breathing pauses repeatedly during sleep due to the narrowing or collapse of the upper airway. These interruptions can happen many times per night, resulting in disrupted and unrefreshing sleep. Obstructive sleep apnoea (OSA) affects over 1 billion people worldwide and poses a serious risk to individual health and healthcare systems.

Learn more about sleep apnoea →

Co-morbid Insomnia

Co-morbid insomnia occurs when insomnia exists alongside another medical or psychiatric condition—in this case, sleep apnoea. It can involve:

  • Difficulty falling asleep

  • Difficulty staying asleep

  • Frequent night-time awakenings

  • Sleep that doesn’t feel restorative

When insomnia co-occurs with sleep apnoea, the interaction between both disorders can create a cycle of sleep deprivation that worsens the symptoms of each.

Co-morbid Insomnia and Mortality Risk

Multiple long-term studies have found that individuals with both sleep apnoea and insomnia are at significantly higher risk of death over time.

Three large-scale studies—the Sleep Heart Health Study, National Health and Nutrition Examination Survey, and the Wisconsin Sleep Cohort—with a combined sample size of over 13,000 people, found that those with both conditions had a 47% to 71% increased risk of all-cause mortality over a 10–20 year period.

Notably, having either condition alone was not linked to the same increased risk, underlining the importance of recognising and treating both together.

The Vicious Cycle

Sleep apnoea and insomnia often reinforce each other. Breathing disruptions from apnoea can lead to frequent arousals, making it harder to stay asleep. Meanwhile, the stress and anxiety linked to insomnia can increase arousal levels, exacerbating the severity of sleep apnoea.

This cycle can result in poor sleep quality, fatigue, irritability, and difficulty concentrating—impacting every aspect of daily life.

Treatment Strategies

Continuous Positive Airway Pressure (CPAP)
The gold standard for treating sleep apnoea, CPAP therapy uses gentle air pressure to keep the airway open throughout the night. It helps restore regular breathing and improves sleep quality.

Lifestyle Modifications
Good sleep hygiene can help address both conditions. Useful strategies include:

  • Maintaining a consistent sleep schedule

  • Creating a calm, dark sleep environment

  • Avoiding caffeine, alcohol, and screen time before bed

Cognitive Behavioural Therapy for Insomnia (CBT-I)
CBT-I is a structured, evidence-based approach that helps identify and change behaviours and thought patterns that interfere with sleep. It is particularly effective for treating insomnia and can be used alongside CPAP to improve outcomes.

The relationship between sleep apnoea and co-morbid insomnia is complex, but not insurmountable. By identifying and treating both conditions together, individuals can work toward improved sleep, better health outcomes, and a higher quality of life. Expert support and a tailored treatment plan are key to breaking the cycle and achieving restorative sleep.

References

  • Yu Y. Links between Sleep Apnoea and Insomnia in a British Cohort. Clocks Sleep. 2023;5(3):552-565.

  • Sweetman A et al. Co-morbid insomnia and sleep apnea. Curr Opin Pulm Med. 2023.

  • Cho YW et al. Comorbid Insomnia With Obstructive Sleep Apnea. J Clin Sleep Med. 2018;14(3):409-417.

  • Bjorvatn B et al. Prevalence of insomnia and sleepiness in OSA. Percept Mot Skills. 2014;118(2):571-86.

  • Lechat B et al. Co-morbid insomnia and OSA linked to all-cause mortality. Eur Respir J. 2021.

  • Lechat B et al. All-cause mortality and sleep disorders. Eur Respir J. 2022;60(1):2101958.

  • Slowik JM et al. Obstructive sleep apnea. StatPearls [Internet]. 2022.

  • Sweetman A et al. CBT-I and COMISA: Recent trials. Brain Sci. 2019;9(12):371.

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